37 - Utility of the Hybrid CT/Angiography IR Suit for Percutaneous Sclerotherapy of an Infiltrative Venous Malformation
A. Khalil, C. R. Bailey, C. R. Weiss
Purpose: To describe our experience on using the Siemens Nexaris (Edge/AXIOM-Artis) hybrid CT/Angiography suite for treating a trans-spatial head and neck venous malformation.
Material and Methods: A 37-year-old female presented with a large, infiltrative face and neck venous malformation presented causing her pain, swelling, difficulty swallowing, and facial pressure. On MRI, the malformation involved the right masticator, parotid, and parapharyngeal spaces with significant laryngeal narrowing.
Results: Due to the need to treat both superficial and deep pharyngeal lesions, a hybrid CT/Angiography IR suite was used. Pre-embolization non-contrast CT of the head and neck was performed to plan needle placement. Under general anaesthesia with nasotracheal intubation, the masticator, posterior mandibular, and parapharyngeal components were accessed percutaneously using five 21-gauge needles under CT guidance. Ultrasound was used to access additional four superficial sites. Pre-embolization Digital Subtraction Venography (DSV) was performed at each site to confirm intravascular location of needle tip, and to assess venous malformation distribution and draining veins. Foamed bleomycin foam was injected using negative DSV. Bleomycin was selected to minimize post-sclerotherapy airway oedema. Post-treatment, non-contrast CT (Nexaris) was performed to evaluate bleomycin distribution showing expected coverage.
The patient tolerated the procedure well with no complications. She remained intubated for airway protection and admitted overnight to the ICU. She was extubated in < 24 hours and was able to tolerate oral diet with no respiratory or pain-control issues. At 3-month follow-up, her pain and morning soreness had resolved.
Conclusions: This case underscores the utility of combined fluoroscopic/CT systems for treating infiltrative/deep venous malformations without the need for endoscopic/laryngoscopic assistance.