Ultrasound-guided Endovenous Diode Laser in the Treatment of Congenital Venous Malformations: Preliminary Experience Manrita K. Sidhu, MD, Jonathan A. Perkins, DO, Dennis W.W. Shaw, MD, Mark A. Bittles, MD, and R. Torrance Andrews, MD The authors present their experience in treating congenital venous malformations with ultrasound (US)-guided endovenous diode laser. Six patients underwent treatment of eight venous malformations for complaints including pain, activity limitation, or cosmetic defect. At a mean follow-up interval of 14.5 months, all had either resolution of (fivepatients)ormarkeddecreasein(onepatient)pain,allowingthemtoresumepreviouslylimitedactivities.There werenoinstancesofnervedamageorskinnecrosis.Onepatienthadaself-limitedmucosaltonguebaseulcer.Inthis small series of patients, endovenous laser treatment of venous malformations was effective during short-term follow-up. J Vasc Interv Radiol 2005; 16:879–884 Abbreviation: VM = venous malformations CONGENITAL venous malformations (VM) are histologically benign lesions that typically grow with the patient and may undergo accelerated growth during adolescence, pregnancy, sur- gery, or trauma (1,2). They consist of clusters of abnormal veins with defi- cient smooth muscle and endothelial layers, which undergo passive disten- sion with dependent positioning or exercise (3). This results in swelling, pain, and thrombosis (2,3). Current treatments can be effective but have limitations (4). Surgical excision may result in scarring, deformity, or hem- orrhage. Percutaneous sclerotherapy can result in skin necrosis, nerve dam- age and, rarely, cardiopulmonary ar- rest (2,5,6). Because VM can recur after an apparently effective treatment, and can be quite extensive and infiltrative, the emphasis of treatment is on palli- ation of symptoms rather than eradi- cation of the lesion (2). A recently developed energy source, the diode laser, has been found to be safe and effective for endovenous ab- lation of the incompetent saphenous vein in adults (7–9). Endoluminal laser therapy is a minimally invasive ther- apy that may offer less systemic and local morbidity than chemical sclero- therapy. We wish to report our expe- rience with diode laser ablation in percutaneous ultrasound (US)-guided treatment of congenital VM, including technique, outcome and complications. MATERIALS AND METHODS After obtaining institutional review board approval, we retrospectively re- viewed the records of all patients who began ultrasound guided endovenous laser treatment of VM at our institu- tion between August 2002 and August 2003. Patient Group Six patients, ranging in age from 14 to 16 years, underwent US-guided di- ode laser treatment for a total of eight VM. There were two boys and four girls. The lesions were located on the shoulder (n = 3), cheek, tongue, back, forearm, or foot (n = 1 each). Diag- nosis was made with typical clinical parameters and imaging findings (1,4,10).Allpatientswiththediagnosis of VM who were candidates for con- ventional sclerotherapy were also offered the choice of laser treatment. All chose to try laser treatment. All patients were experiencing pain at presentation, including one who re- quired significant pain medications, presumably because of brachial plexus involvement seen by magnetic reso- nance (MR) imaging. Additional com- plaints included limitation of activity (three patients) and cosmetic deficit (three patients). Three patients had had previous unsuccessful attempts at surgical resection. One of these had also been treated by percutaneous sclerotherapy with sotradecol, with transient improvement. The last pa- tient had been previously treated with both ethanol and sotradecol sclero- From the Departments of Radiology (M.K.S., D.W.W.S.) and Otolaryngology (J.A.P.), Children’s Hospital and Regional Medical Center; and the De- partment of Radiology (M.A.B., R.T.A.), University of Washington School of Medicine, Seattle, Washington. Presented at the 2004 SIR Annual Meeting. Received September 9, 2004; revision re- quested October 25; final revision received January 25, 2005; accepted January 26. Address correspon- dence to M.K.S.; Department of Radiology, Chil- dren’s Hospital and Regional Medical Center, 4800 Sand Point Way NE, R5438-1, Seattle, WA 98105; E-mail: manrita.sidhu@seattlechildrens.org None of the authors has identified a potential con- flict of interest. © SIR, 2005 DOI: 10.1097/01.RVI.0000163005.50283.62 879