Sclerotherapy for vascular malformations
What is a vascular malformation?
A vascular malformation is a group of abnormal blood vessels. These can form in the skin, soft tissues or inside organs. They are present at birth but may only become noticeable as your child grows. They can affect veins, lymphatic vessels, or both. Some stay small and don’t cause problems, but others can grow and cause pain, swelling, bleeding or other issues.
What is sclerotherapy?
Sclerotherapy is a simple procedure used to treat some vascular malformations. A special medicine is injected into the abnormal vessels, causing them to shrink and close off. This helps reduce symptoms but does not make the malformation go away completely. Sometimes, more sessions of sclerotherapy are needed. Sclerotherapy works best for venous and lymphatic malformations.
Why is sclerotherapy recommended?
The goal of sclerotherapy is to improve symptoms, prevent complications and in some cases shrink the malformation. Your child’s doctor may recommend sclerotherapy if the malformation is:
- Causing pain or discomfort
- Swollen or getting bigger
- Bleeding or likely to bleed
- Affecting how an area looks or works, like a limb or face
What to expect before the procedure
| Pre-procedure consultation |
| Your child will meet with the specialist who will do the procedure. They will review your child’s medical history, do any needed imaging (like ultrasound or MRI), and discuss the procedure and its risks. This usually happens at CHEO’s Vascular Anomalies Clinic. |
| Fasting instructions |
| Your child may need to stop eating or drinking several hours before the procedure, especially if anesthesia is needed. The doctor will give specific instructions. |
| Medication |
| Tell the doctor about any medications your child is taking, especially blood thinners or medications that affect clotting. The doctor may advise stopping certain medications before the procedure. |
| Blood work |
| Your child may need blood tests before the procedure. |
What to expect during the procedure
| Informed consent |
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Just like other procedures at CHEO, a parent or legal guardian will need to give consent after the doctor reviews the procedure and its risks again. Any questions will be answered. If the child is already at the age of medical consent (12 years or older), they will be asked to sign the consent form themselves. |
| Sedation or anesthesia |
| Depending on the malformation’s size and location, your child may get sedation or general anesthesia to stay comfortable during the procedure. |
| Injection |
| The doctor will use imaging (ultrasound or fluoroscopy) to guide the injection of the medicine into the abnormal vessels. The procedure usually takes about 1-2 hours. |
| Monitoring |
| After the procedure, your child will be monitored in the recovery area for a short time to ensure there are no immediate problems. Most children can go home the same day. |
After the procedure: Recovery and care
| Pain and swelling |
| Your child may have pain, swelling, or bruising at the treatment site. This is normal and should get better in a few days. Over-the-counter pain medicine (like acetaminophen) may help, but avoid aspirin which can affect blood clotting. |
| Wearing compression garments |
| The doctor may recommend wearing a compression garment (like an elastic bandage or stocking) over the treated area to reduce swelling and help with healing. |
| Activity restrictions |
| Your child can usually return to normal activities within a day or two. Avoid strenuous activities, heavy lifting, or vigorous sports for a week or two. |
| Follow-up and monitoring |
| Your child will need follow-up appointments to check the healing process and see how the malformation is responding. Sometimes, more sclerotherapy sessions are needed. |
| Imaging studies |
| Repeat imaging (like ultrasound) may be done to check how well the treatment worked. |
| Potential side effects |
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Sclerotherapy is generally safe, but like any medical procedure, there are some risks, including:
|
| Additional treatments |
| If the malformation doesn’t improve after the first session, the doctor may recommend more sclerotherapy treatments or other options. |
When to call the doctor
Call your child’s doctor if you notice any of the following after the procedure:
• Fever or signs of infection (redness, warmth, pus at the site)
• Severe pain or swelling that doesn’t improve
• Difficulty breathing or chest pain (this is very rare but serious)
Frequently asked questions
| Will my child’s vascular malformation come back? |
| Sometimes the malformation may regrow or become symptomatic again, needing more treatments. Regular follow-up appointments will help monitor this. |
| How many treatments will my child need? |
| The number of sessions needed depends on the malformation’s size and type. Some children need just one session, while others may need multiple treatments. |
| Will there be any scars? |
| Sclerotherapy usually doesn’t leave significant scars, though some patients may have temporary skin discoloration or slight scarring at the injection site. |
Questions?
For more general information about vascular anomalies, visit the Vascular Access Canada website.
If you are a CHEO patient and have any questions or concerns, please don’t hesitate to contact your care team/reach out to our office: CHEO Vascular Anomalies Clinic 613-737-7600 ext. 2326