Indications, Outcomes, and Complications of Percutaneous Sclerotherapy in the Management of Hemangiomas and Cystic Lesions at Kenyatta National Hospital

Abstract

Background The effective management of hemangiomas and cystic lesions using percutaneous sclerotherapy optimizes desired clinical outcomes and minimizes the associated complications in affected patients. Intra-lesional sclerotherapy involves injecting a sclerosing agent (such as bleomycin and sodium tetradecyl sulfate) into a lesion or the interstitial space around the lesion, causing endothelial injury, thrombosis, inflammation, scarring and shrinkage of the lesion. Extensive literature suggests that sclerotherapy has a role in the management of various lesions, including hemangiomas and cystic lesions, as demonstrated by better health outcomes and improved quality of life among affected patients. Objectives To evaluate the indications, outcomes and complications of percutaneous intra-lesional sclerotherapy in the management of hemangiomas and cystic lesions. Study Setting The study was conducted at the Kenyatta National Hospital, interventional radiology unit. Design The study was a prospective cross-sectional study. Study population Patients with hemangiomas and cystic lesions referred for intralesional sclerotherapy at Kenyatta National Hospital, Interventional Radiology unit. Materials and methods Data including the indications of intra-lesional sclerotherapy, short-term outcomes, and complications associated with intra-lesional sclerotherapy were recorded, and analyzed using SPSS version 28. They were presented using percentages, graphs, tables and pie charts. Technical and clinical success rates were calculated. The efficacy of intralesional sclerotherapy was analyzed using chi-square test. Approval to conduct this study was sought from the Ethics Review Committee (ERC) of the Kenyatta National Hospital-University of Nairobi. Results A total of 47 patients were treated with hemangiomas accounting for 42.6%(20) and cystic lesions 57.4%(27). Majority were females at 68.1% and male to female ratio of 1:2.1. The commonest indication for referral was pain for both the hemangiomas (21.6%) and cystic lesions (26.1%), followed by pressure symptoms for the cystic lesions (22.7%) and abnormal swelling for the hemangiomas (18.9%). Most lesions were located in the liver comprising 25% for the hemangiomas and 25.9% for the cystic lesions. Majority had significant clinical response with improvement in the symptoms, with p-value <0.05. Similarly, there was a statistically significant reduction in sizes of the lesions treated with p-value <0.05. The technical success rate was 100% and overall clinical success rate was 90% for the hemangiomas and 96.3% for the cystic lesions respectively. Mild pain (10%), mild edema (10%) and skin discoloration (5%) were the commonest minor complications encountered in hemangiomas treatment. Mild pain (7.4%) was the commonest minor complication encountered with cystic lesions percutaneous sclerotherapy. No major complications were encountered. Conclusion Percutaneous intralesional sclerotherapy is a safe and efficacious treatment of hemangiomas and cystic lesions with a high technical and clinical success rate. It should be considered as a first line of treatment for the hemangiomas and cystic lesions