Introduction/Purpose Venous malformations are low-flow congenital lesions that frequently occur in the head and neck and often require treatment to address airway compromise, infection risk, bleeding, or cosmesis. Multiple treatment approaches have been employed, including resection, percutaneous sclerotherapy, laser photocoagulation, or a combination of these approaches. Numerous agents have been utilised for percutaneous sclerotherapy. Ethanolamine oleate has approval from the Food and Drug Administration (FDA) for sclerosis of varices, yet little has been published on use of this agent for facial venous malformations. This study reports single centre results of percutaneous sclerotherapy with ethanolamine to treat venous malformations of the head and neck.

Materials and Methods Prospectively maintained procedural records were retrospectively reviewed to identify all patients with venous malformations who underwent percutaneous sclerotherapy. The Mulliken and Glowacki classification was used to diagnose venous malformations. Medical records and images were reviewed to record demographic information, lesion characteristics, treatment sessions, and clinical and imaging response. Lesions were categorised as not visible, small, medium, or large, and clinical response was categorised as excellent, good, fair, or poor in keeping with previously reported classification schemes. Lack of residual visible lesion was considered an excellent response. Good response was assigned when visible post-treatment size was subjectively less than half the pre-treatment size. Fair was assigned when residual size was great than half that prior to treatment. Poor response was assigned for no reduction or lesion enlargement. Locations were classified as neck, oral, periorbital, or elsewhere in the face. Quantitative volumetric analysis was conducted according to methods we have presented elsewhere. Response was assessed after each session and after all sessions in those patients undergoing more than one intervention. Chi-square analysis was performed to evaluate effects of above-described characteristics on outcomes.

Results 52 interventions were performed for lesions in 26 patients. No complications occurred following any procedures. Response to individual sessions was categorised as excellent following 2 (3.8%) sessions, good following 45 (86.5%), and fair following 4 (7.7%). No sessions resulted in poor responses. Final results were excellent in 2 patients (7.7%), good in 22 (84.6%), and fair in 2 (7.7%). Average lesion volume reduction was 39% following each session and 61% after treatment completion. Periorbital lesions were less likely than lesions located elsewhere to have good or excellent outcomes, χ2, (3, n=47) = 9.730, p=0.021.

Conclusion Many approaches have been utilised to treat venous malformations of the head and neck. Practitioners performing percutaneous sclerotherapy have many options when choosing an agent. This study demonstrates the safety and efficacy of ethanolamine oleate for this use. Percutaneous sclerotherapy with ethanolamine should be considered when treating these complex lesions, and further investigation of such treatments should evaluate this compound alongside the many others currently utilised.

Disclosures M. Alexander: None. R. McTaggart: None. O. Choudhri: None. M. Marcellus: None. H. Do: None