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Chapter-27 C Sclerotherapy for Vascular Malformations

BOOK TITLE: ACS(I) Textbook on Cutaneous and Aesthetic Surgery

Author
1. Khandpur Sujay
ISBN
9789350258903
DOI
10.5005/jp/books/11651_42
Edition
1/e
Publishing Year
2012
Pages
9
Author Affiliations
1. All India Institute of Medical Sciences, New Delhi, India, All India Institute Medical Science, New Delhi
Chapter keywords

Abstract

Sclerotherapy is a technique which induces local endothelial cell damage by selective intraluminal delivery of endothelial-cidal agent/sclerosant into chosen abnormal intravascular space that exerts its injurious effect on endothelial cell by direct contact in dose-dependent manner. It is an important therapeutic modality for treating venous malformations (VM) that occur with an incidence of 1-2 per 10,000 births and a prevalence of 1%. VM not only produce a devastating cosmetic impact but may be associated with pain, bleeding, ulceration, secondary infection and even compress vital structures. Management of VM may be conservative or interventional. It requires a multidisciplinary approach with participation of a general surgeon, plastic surgeon, orthopedician, head and neck surgeon, dermatologist, pediatrician, interventional radiologist, physiotherapist, nurse and a patient care coordinator. Conservative management is indicated when patient does either not want intervention or the symptoms are not meeting “intervention threshold”. Conservative therapy includes elevation of involved area during sleep, avoidance of activities producing symptoms, cessation of oral contraceptives, alleviation of paroxysmal pain due to localized intravascular coagulopathy with NSAIDs such as aspirin therapy, prophylactic administration of low molecular weight heparin for large VM in high-risk states and use of pressure garments/stockings. Interventional management includes sclerotherapy, lasers and other technologies and surgery. Of these, sclerotherapy is simple, cheap and relatively noninvasive.

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