Scott M. Thompson BA, Presenter: Nothing to Disclose

Matthew Raymond Callstrom MD, PhD, Abstract Co-Author: Research Grant, Thermedical, Inc Research Grant, General Electric Company Research Grant, Siemens AG Research Grant, Galil Medical Ltd

Michael A. McKusick MD, Abstract Co-Author: Nothing to Disclose

David Arthur Woodrum MD, PhD, Abstract Co-Author: Nothing to Disclose

To determine the feasibility and safety of image-guided percutaneous ablation for treatment of symptomatic vascular malformations

An IRB-approved retrospective review was undertaken of all patients who underwent image-guided percutaneous ablation of symptomatic vascular malformations (VMs) that failed percutaneous Sotradecol or ethanol sclerotherapy. Ablations were performed under general anesthesia with US/CT or MRI-guided cryoablation or MRI-guided laser ablation. Cryoprobes or laser fibers were placed under intermittent CT or MR imaging. Intraprocedural monitoring was performed with intermittent CT or MRI during cryoablation to monitor ice-ball formation or with proton-resonance frequency MR thermometry every seven seconds during laser ablation to monitor thermal changes. Post-ablation monitoring varied between observation or hospital admission. Clinical follow-up began at one month post-ablation.

Seven patients (ages 10 to 48; 4 female) with eight VMs (N=7 intramuscular; N=1 subcutaneous) were treated with US/CT (N=3) or MRI-guided (N=2) cryoablation or MRI-guided laser ablation (N=3) for pain (N=6) or diffuse bleeding secondary to hemangioma-thrombocytopenia syndrome (N=1). The median (range) of the maximal diameter was 9 cm (6.5 to 11.1 cm) for VMs undergoing cryoablation and 2.5cm (2.3 to 5.3 cm) for laser ablation. Seven VMs were ablated in one session and one in a planned two-stage session. Two laser fibers and 3 to 10 cryoprobes were used per ablation session. The number of hospital days ranged from 1 to 3 for cryoablation and 0 to 1 for laser ablation. Minor complications included a small hematoma, which did not require further intervention (laser) and numbness of the dorsal aspect of first toe (cryoablation). There were no major complications. There was no recurrence of bleeding at four years post ablation in the patient with hemangioma-thrombocytopenia syndrome and 5 of 6 patients with painful VMs reported symptomatic pain relief beginning as early as one month post ablation.

Image-guided percutaneous ablation of symptomatic vascular malformations is feasible and safe in patients who have failed percutaneous sclerotherapy and provides symptomatic relief for the majority of patients at short-term follow-up.

Image-guided percutaneous ablation warrants further investigation as a therapeutic modality for treatment of symptomatic vascular malformations.

Thompson, S, Callstrom, M, McKusick, M, Woodrum, D, Feasibility and Safety of Image-guided Percutaneous Ablation for Treatment of Symptomatic Vascular Malformations Following Failed Percutaneous Sclerotherapy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14006288.html