Novel scoring system shows sclerotherapy improves pain of venous malformation

Sep 3 2012

By Sarah Guy, medwireNews Reporter

Ethanol sclerotherapy reduces the signs and symptoms of venous malformation (VM) in the majority of patients after approximately two sessions, report Japanese researchers who used a novel scoring system to evaluate treatment outcomes.

The VM score compares patients' pre- and postinterventional signs and symptoms, taking into account the degree of swelling and pain, the frequency of swelling and pain attacks, stiffness, abnormal gait, administration of pain medication, and periods of discomfort or irritation, the team explains.

"VMs are congenital lesions that are present at birth, whether or not they are evident clinically, and grow commensurately with the patient," say Hiroshi Furukawa and co-investigators from the University of Hokkaido in Sapporo.

While percutaneous sclerotherapy has previously been associated with VM improvement, there is "no established method to evaluate overall outcome" in regard to specific signs and symptoms, adds the team in the European Journal of Plastic Surgery.

After an average of 2.6 sclerotherapy sessions and 19.4 months of follow up, Furukawa and colleagues reported that 19 of the 21 VM patients treated at their institution between 1996 and 2008 had reduced VM scores.

The participants (or their parents), aged a mean 18 years at VM diagnosis, gave an overall impression score for their pre-intervention pain and swelling (out of 10), and a comparison score for the severity of their current pain versus their most severe pre-intervention pain. A score of 0 indicated no pain, a score of 10 indicated no change, while a score between 0 and 10 indicated some improvement and a score over 10 indicated worsening of symptoms.

The average pre-intervention VM score was 10.0, report the researchers, which dropped to 4.1 after treatment, with no inverse correlation found between the amount of ethanol used (average 41.3 mL per patient) and the VM score.

However, in seven patients treated more than three times, there was a significant inverse relationship between VM score and the number of sclerotherapy sessions.

A total of 11 patients experienced complications arising from treatment; however, "most of them were minor skin trouble and sensory loss, both of which were healed conservatively," say Furukawa et al, who suggest a longer-term follow-up series is needed to assess the durability of pain relief after sclerotherapy.

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