Utility of the Hybrid Computed Tomography/Angiography Interventional Radiology Suite for Percutaneous Sclerotherapy of an Infiltrative Venous Malformation

Purpose: To describe our experience on using the Siemens Nexaris (Edge/AXIOM-Artis) hybrid computed tomography (CT) and angiography suite for treating a trans-spatial head and neck venous malformation.

Materials and Methods: A 37-year-old woman presented with a large, infiltrative face and neck venous malformation causing her pain, swelling, difficulty swallowing, and facial pressure. On magnetic resonance imaging, the malformation involved the right masticator, parotid, and parapharyngeal spaces with significant laryngeal narrowing.

Results: Because of the need to treat both superficial and deep pharyngeal lesions, a hybrid CT and angiography IR suite was used. Pre-embolization noncontrast 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 the needle tip and to assess venous malformation distribution and draining veins. Foamed bleomycin foam was injected using negative DSV. Bleomycin was selected to minimize postsclerotherapy airway oedema. After treatment, noncontrast 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 intensive care unit. She was extubated in less than 24 hours and was able to tolerate an 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 and CT systems for treating infiltrative or deep venous malformations without the need for endoscopic or laryngoscopic assistance.