Advances in Sclerosants for Low-Flow Vascular Malformations

Authors:

• Sun, Bingbing
• Sun, Xiye
• Gao, Qinghong
• Wang, Qizhang

Details:

Annals of Vascular Surgery, Volume 122, 2026-01-31

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Background
Low-flow vascular malformations (LFVMs), encompassing venous, lymphatic, and capillary malformations, are congenital vascular anomalies marked by abnormal vascular or lymphatic development and low-flow hemodynamics. Sclerotherapy has become the primary treatment due to its minimally invasive nature and high efficacy. This review aims to outline the clinical applications, mechanisms, and outcomes of commonly used sclerosants for LFVMs.

Methods
We conducted a narrative review related to the sclerotherapy of LFVMs. The search was performed on PubMed using combinations of MeSH terms and relevant keywords. This review encapsulates advances in sclerosants for LFVMs, including chemotherapeutic sclerosants (bleomycin, pingyangmycin), detergent sclerosants (polidocanol, sodium tetradecyl sulfate [STS], and sodium morrhuate), and other sclerosants (ethanol, OK-432, doxycycline, and ethanolamine oleate).

Results
Bleomycin and its derivatives show significant effectiveness with low complication rates. Polidocanol and STS foam have advantageous safety profiles, especially for sensitive anatomical areas. Ethanol is powerful despite its serious complications, and the combination of ethylcellulose and ethanol can enhance its safety. OK-432 and doxycycline offer different benefits in the treatment of lymphatic malformations. This review also emphasizes the significance of individualized treatment approaches and evolving sclerotherapy techniques for optimizing outcomes for patients with LFVMs.

Conclusion
This review summarizes the sclerosants presently employed for LFVMs and suggests that the sclerotherapy approach must be personalized, taking into comprehensive account the specific type of LFVM, anatomical location, patient factors, and so on. Future high-quality clinical studies are needed to compare the efficacy and safety of these agents and to identify the most suitable sclerosants for specific vascular abnormalities.