Intramuscular low flow vascular malformations: treatment by means of direct percutaneous embolization

Abstract

Purpose: Intramuscular hemodynamically inactive Vascular malformations are infrequent entities whose surgical treatment is often impossible, crippling, or inefficient. We describe a nonsurgical therapeutic approach consisting on embolization by direct puncture with sclerosant substances. Methods: Four patients have been treated from April to November 1994, three female and one male, ranging in age from 13 to 31 years. Three vascular malformations were located in the quadriceps and one in the deltoid muscle. The point of access was determined with information provided by MR. The skin was cleaned with an antiseptic solution and puncture was performed with a 22 gauge Chiva needle. Blood flow inside the malformation was slow in all cases and no afference to the normal venous system was detected. We embolized with 5-15 cc (mean 7.5 cc) of a mixture of ethibloc and ethanol. Results: The mean follow-up period was 17 months (range 14-21). All patients remain asymptomatic and have resumed normal daily life activities. There were no complications. Conclusion: Percutaneous embolization by direct puncture of intramuscular vascular malformations is a feasible and simple procedure. Our preliminary results are promising, although more extensive studies need to be to performed in order to reach definite conclusions.