Image-Guided Sclerotherapy with Sodium Tetradecyl Sulfate: Transforming the Management of Venous Malforma¬tions – A Tertiary Care Centre Experience

Background: Venous malformations (VMs) are congenital low-flow vascular anomalies resulting from developmental errors in vascular morphogenesis. They often present with pain, swelling, cosmetic deformity, and functional impairment. Image-guided percutaneous sclerotherapy has emerged as a first-line, minimally invasive treatment option for symptomatic VMs. Objective: To evaluate the therapeutic efficacy, safety, and outcomes of image-guided percutaneous sclerotherapy using Sodium Tetradecyl Sulfate (STS; SETROL) in patients with slow-flow venous malformations. Materials and Methods: This prospective study was conducted over two years (2018–2020) at a tertiary care center and included 50 consecutive patients (mean age: 20.3 years; range: 2–70 years) with clinically and radiologically confirmed VMs. Under ultrasound and/or DSA guidance, foam sclerotherapy was performed using 1.5–3% STS prepared via the Tessari technique. Patients underwent multiple sessions at 4–6-week intervals depending on lesion response. Clinical improvement was assessed based on reduction in pain, lesion size, consistency, and vascularity on Doppler imaging, and graded as excellent, good, minimal, or poor. Results: The most common lesion sites were head, neck, and face (38%), followed by lower (30%) and upper extremities (24%). Lesions were medium-sized (3–5 cm) in 48%, small (5 cm) in 20% of patients. Following treatment, 68% showed excellent improvement, 26% good improvement, and 6% minimal improvement. Minor complications, including pain and skin discoloration, were observed in 22% of cases, with no major adverse events. A significant reduction in lesion size and vascularity was noted after multiple sessions (p < 0.001). Conclusion: Image-guided sclerotherapy with Sodium Tetradecyl Sulfate is a safe, effective, and minimally invasive technique for managing venous malformations. It offers excellent symptom relief and cosmetic outcomes with low complication rates, making it a valuable primary therapeutic modality for low-flow vascular malformations.