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Pedro Redondo, MD, PhD; Gorka Bastarrika, MD, PhD; Alejandro Sierra, MD, PhD; Antonio Martínez-Cuesta, MD, MSc, FRCR; Juan Cabrera, MD, PhD

Arch Dermatol. 2009;145(10):1147-1151.

Background  Sclerotherapy with polidocanol microfoam injection under duplex guidance is a new treatment for venous malformations associated with Klippel-Trenaunay syndrome. Multidetector-row computed tomography (MDCT) venography is extremely helpful in the assessment of disease extension and the planning of therapy.

Observation  In this particular case, MDCT venography demonstrated the origin, course, and relationship to adjacent anatomical structures of aberrant vessels that configure the superficial venous system with an anatomically normal and patent deep venous system. At the end of the treatment, which consisted of 8 sessions of microfoam sclerotherapy within 12 months, a considerable reduction in the number and size of the percutaneously treated aberrant veins was observed. The obvious clinical improvement was objectively demonstrated with MDCT venography, which showed clear reduction in the number and size of treated veins. Further clinical investigation performed because of isolated migraine episodes related to the sclerotherapy session revealed that the patient had a patent foramen ovale. A transcranial Doppler examination during the procedure showed middle cerebral artery bubbles, which indicated right-to-left shunt. No cerebral damage was observed in a subsequent diffusion-weighted magnetic resonance examination.

Conclusions  Microfoam sclerotherapy is an effective treatment option in patients with Klippel-Trenaunay syndrome. MDCT venography allows diagnosis of the disease, planning of therapy, and assessment of response to treatment. Although foam-induced microembolism is a common phenomenon during sclerotherapy, in this report we demonstrate that polidocanol microfoam prepared with a low-nitrogen gas mixture is safe in a patient with a patent foramen ovale.

Author Affiliations: Unit of Vascular Malformations, Department of Dermatology (Drs Redondo, Sierra, and Cabrera), and Department of Radiology (Drs Bastarrika and Martínez-Cuesta), University Clinic of Navarra, School of Medicine, University of Navarra, Pamplona, Spain.

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