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Dual-agent percutaneous sclerotherapy technique for macrocystic lymphatic malformations
  1. M Travis Caton1,
  2. Amanda Baker1,
  3. Eric R Smith1,
  4. Edgar Perez2,
  5. Kafi Hemphill3,
  6. Daniel L Cooke1,
  7. Christopher F Dowd1
  1. 1Neurointerventional Radiology, University of California San Francisco, San Francisco, California, USA
  2. 2Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
  3. 3Neurology, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr M Travis Caton, Neurointerventional Radiology, University of California San Francisco, San Francisco, CA 94143, USA; travis.caton{at}


Percutaneous sclerotherapy is an effective technique for treating lymphatic malformations of the head and neck, with clinical success rates exceeding 84%.1 Sodium tetradecyl, which damages lipid membranes and stimulates free radical-induced local damage, and doxycycline, which inhibits angiogenesis, have emerged as the safest and most effective of several available sclerosants.2–4 Although severe periprocedural morbidity is rare, temporary local complications are reported in 14% and skin necrosis or scarring in up to 0.8–5.8% of sclerotherapy procedures.5 As these lesions are frequently located in the face and/or neck, even minor complications can be disfiguring and must be avoided. This technical video describes a ‘dual-agent’ approach for percutaneous sclerotherapy of macrocystic lymphatic malformations using sodium tetradecyl as a ‘primer’ followed by doxycycline as a definitive sclerosant (video 1). This technique emphasizes meticulous backtable preparation and effective use of ultrasound and fluoroscopy to minimize complications.

Video 1

  • Vascular Malformation
  • Congenital
  • Inflammation
  • Neck
  • Technique

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  • Twitter @traviscaton, @amandaebaker, @EricRSmithMD

  • Contributors MTC: writing - original draft, conceptualization, methodology, formal analysis, visualization. AB: investigation, conceptualization, data curation. ERS: writing - review and editing, data curation. EP, KH: writing - review and editing. DLC: investigation, methodology, data curation, supervision. CFD: writing - review and editing, resources, project administration, investigation, methodology, data curation, supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.