Sclerotherapy is an injection of a sclerosing (e.g., alcohol) substance directly through the skin into a lesion and is used primarily for slow-flow vascular anomalies (particularly for VM and LM). Various needles are used under ultrasound guidance to obtain access and then the sclerosant agent is injected into the lesion very carefully. If there are draining veins, the veins should be temporarily (using manual compression or blood pressure tourniquet) or permanently closed off (venous embolization) before the injection of the sclerosant agent so that the substance will be maintained within the lesion.

Absolute alcohol (ethanol) is the most commonly used sclerosant agent because of its superior ability to cause endothelial damage and induce thrombosis and sclerosis. Major potential risks of alcohol injection include nerve damage, cardiovascular toxicity and skin necrosis. Therefore, the procedure should be planned carefully and be performed only by an experienced interventional radiologist.

Weaker sclerosant agents such as sodium tetradecyl sulfate (Sotrecol) or ethanolamine oleate (Ethamolin) are considered safer sclerosant agents in terms of skin necrosis, neurotoxicity and cardiovascular effects. After sclerotherapy, particularly when using alcohol, the lesion feels firm to palpation and the injected area shows significant swelling and pain.

Maximum swelling occurs within the first 24 hours after the procedure and decreases gradually. It is important to monitor patients for compartment syndrome and neurological deficits after the procedure. Airway protection is also mandatory when a lesion involving the airway is treated with sclerotherapy. Skin blistering is a common occurrence and may result in scarring.

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