Predictors of response to percutaneous ethanol sclerotherapy (PES) in patients with venous malformations: Analysis of patient self-assessment and imaging
Predictors of response to percutaneous ethanol sclerotherapy (PES) in patients with venous malformations: Analysis of patient self-assessment and imaging
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DOI：
10.1016/j.jvs.2009.03.058
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发表时间：
2009-09-01
影响因子：
4.3
通讯作者：
Lee, Byung-Boong
中科院分区：
文献类型：
--
作者：
Yun, Woo-Sung;Kim, Young-Wook;Lee, Byung-Boong
背景：经皮无水乙醇硬化治疗(PES)是治疗静脉畸形的主要手段。然而，PES已经知道了严重的并发症。本研究旨在确定VM患者PES反应良好的预测因素，以改善患者的选择。方法：我们对158例在专门的血管畸形中心接受乙醇硬化治疗的VM患者(平均年龄14.3岁，男性42%)进行了回顾性横断面研究。对于临床结果评估，儿科患者的患者或父母回答了PES后症状、功能和美容改善的问题。在每个类别中，与治疗前相比，可能的选择有显著改善、中等改善、无变化、中等、较差或明显较差。“良好反应”被定义为自我评估显著改善的一个或多个领域，并伴随着治疗后图像的显著改善(与治疗前图像相比，~gt；=VM油磁共振成像最大直径[MRI]下降30%或~gt；=全身血池闪烁[WBBPS]异常血池比率下降50%)。为了确定PES疗效的预测因素，对患者的人口学特征(年龄、性别)、临床特征(位置、大小、受累组织深度、伴发淋巴管畸形、MRI表现、边界清楚与否、PES期间静脉引流特点)和治疗变量(PES次数、PES中乙醇的最大浓度和剂量、辅助治疗)进行了单因素和多因素分析。结果：以石油患者问卷为基础，症状、功能和美容改善分别为28%、27%和34%。根据油成像检查，42例(27%)患者有明显改善。结合问卷调查结果和影像研究的综合结果显示，16%的患者反应良好。多因素分析显示，女性(优势比：4.49，95%可信区间：1.24~16.28)、引流静脉未显影或延迟显影(OR：9.22，95%CI：1.79~47.51)、边缘油MRI(OR：13.38，95%CI：2.84~63.12)是PES“良好反应”的独立预测因素。为了获得最好的结果和最大限度地减少并发症，应在选定的患者中实施PES。在初始直接穿刺法静脉造影中没有或延迟显示引流静脉、清晰的边缘油MRI和女性性别是PES“良好反应”的有统计学意义的预测因素，在选择患者时可能有用。(《花瓶外科杂志》2009；50：581-9)
Background: Percutaneous ethanol sclerotherapy (PES) is the primary tool in the treatment of venous malformations (VM). However, PES has known serious complications. This study is aimed at identifying predictors of good response to PES in patients with VM to improve patient selection.Methods: We performed a retrospective, cross-sectional study of 158 VM patients (mean age, 14.3 years, male 42%) who underwent ethanol sclerotherapy at a specialized vascular malformation center. For clinical result assessment, patients or parents in pediatric patients answered questions on symptomatic, functional, and cosmetic improvement after PES. In each category, the possible choices were markedly improved, moderately improved, no change, moderately, worse, or markedly worse compared with pretreatment status. A "good response" was defined as one or more areas of marked improvement on the self-assessment in conjunction with marked improvement in post-treatment images (>= 30% decrease in maximal diameter of VM oil magnetic resonance imaging [MRI] or >= 50% decrease in abnormal blood pool ratio on whole body blood pool scintigraphy [WBBPS] compared with pretreatment images). To determine predictors of a good response to PES, uni- and multivariate analysis were conducted on demographics (age, gender), clinical features of VM (location, size, depth of involved tissue, presence of associated lymphatic malformation, MRI findings; well-defined vs ill-defined margin, characteristics of venous drainage during PES) and treatment variables (number of PES sessions, maximal concentration and dosage of ethanol used in PES, adjuvant therapy).Results: Symptomatic, functional, and cosmetic improvement was 28%, 27%, and 34%, respectively, based oil patient questionnaires. Based oil imaging studies, 42 patients (27%) had markedly improvement. Composite outcome combining questionnaire results and imaging study showed that 16% of patients had a "good response". On multivariate analysis, female gender (odds ratio [OR]: 4.49, 95% confidence interval [CI]: 1.24-16.28), no or delayed visualization of drainage vein (OR: 9.22, 95% CI: 1.79-47.51), and a well-defined margin oil MRI (OR: 13.38, 95% CI: 2.84-63.12) were independent predictors of "good response" to PES.Conclusions. PES should be performed in selected patients in order to obtain the best outcomes and minimize complications. No or delayed visualization of drainage vein on initial direct puncture venogram, a well-defined margin oil MRI, and female gender were statistically significant predictors of a "good response" to PES and may be useful in selecting patients. (J Vase Surg 2009;50:581-9.)