About us
What is sclerosis?
In this procedure, a sclerosing agent is injected directly into the malformation, "burning" its inner lining and inducing resorption of the cavity through an inflammatory reaction and thrombosis, leading to gradual retraction.
What's the point?
The aim of sclerosis is to limit painful symptoms and reduce its volume. However, it is very rare for the malformation to disappear completely. The aim of treatment is clinical improvement, not complete disappearance of the image.
How does the procedure work?
This is a relatively simple procedure from a technical point of view, which consists in identifying the lesion clinically and, if necessary, by ultrasound pre-operatively, puncturing the defect through the skin with a small-gauge needle, opacifying it under fluoroscopy, and then sclerosing it.
The use of certain sclerosing products such as alcohol ... local anesthesia or hypnoanalgesia
How do you prepare for this type of operation?
Given the need for a general anaesthetic, it is essential to have an anaesthetic consultation within 3 months of the procedure (no less than 48 hours before the procedure). A blood sample will be taken for a coagulation study and a pre-operative check-up.
In most cases, you will be hospitalized the evening before or in a day hospital. You must not eat, drink or smoke after midnight. The morning of the procedure :
In the case of treatment and general anesthesia for children, parental authorization signed by both parents is required.
What products are used for sclerosis?
There are several, each with its own advantages and disadvantages. The most commonly used products are Ethanol (pure alcohol) and Aetoxisclérol, but other products can also be used.
Depending on your habits, several sclerosing products can be used, e.g. Ethanol pure 96% replace Aetoxisclerol by Polidecanol / Lauromacrogol 400 / Bleomycin/ or others.
The sclerosis doctor will select the product best suited to your case.
What happens after sclerosis?
You will be taken to the recovery room for close monitoring by the anesthesia team for 2-3 hours, before being taken back up to the inpatient area.
Hospitalization is generally required for 24 to 48 hours after the sclerosis procedure, to ensure that pain is controlled by analgesic treatment. In fact, the after-effects are often marked by an increase in symptomatology, with an increase in the volume of the malformation, which appears much firmer and discreetly inflammatory, with small areas of reddish or bluish discoloration, and a slightly "sleepy" sensation in certain areas of the skin or muscles, which disappear after several days/weeks.
The intensity of these pains varies from case to case. Local application of ice bladders to the sclerosis site is sometimes necessary. If this is insufficient, painkillers and/or anti-inflammatories may be prescribed for a few days.
This symptomatology will gradually disappear, and evaluation of efficacy on volume or pain will take place after three months.
What are the risks of sclerosis?
It's a treatment that's proven to be effective, but it needs to be carried out in a specialized environment with a team accustomed to dealing with these lesions and any complications.
In most cases, these are minor, transitory complications such as skin discoloration or "blisters". Occasionally, they can be more serious, such as :
Major complications are exceptional. They only occur in cases of venous malformation (this does not apply to lymphatic malformations):
- cardiac rhythm disorders, reversible or not (leading to death),
- transient pulmonary hypertension,
- hemolysis, with red coloration of the urine, but of no consequence in cases of normal renal function.
In addition, neuroradiology examinations use X-ray equipment which emits X-rays. These treatments are not indicated for pregnant women unless absolutely necessary. X-ray doses vary according to the duration of the procedure, its complexity and your build. For particularly long examinations, skin lesions may appear. These lesions are essentially redness similar to sunburn, or transient hair loss. In such cases, we recommend that you contact the neuroradiology department, which will take the appropriate follow-up measures.
What precautions should be taken after surgery?
It is advisable to rest for 2 to 3 days after leaving hospital. This often means taking time off work. Resumption of school or professional activities is essentially guided by the intensity of residual pain.
The same applies to resuming sport, although any direct impact should be avoided for the first 15 days, as this could exacerbate the pain.
An analgesic and/or anti-inflammatory treatment will be systematically prescribed and adapted according to the intensity of the pain. This treatment should not usually exceed 5 to 7 days. There are no medical contraindications.
You will be seen again in consultation 2 to 3 months after the procedure, to assess its effectiveness.
What happens if sclerosis fails?
If the improvement in symptoms is present but insufficient, it is quite possible to repeat the sclerosis procedure under the same conditions to obtain a satisfactory result.
In the event of repeated failure, the indication for surgical treatment should be discussed with the care team during a multidisciplinary consultation.
