Sclerotherapy

Sclerotherapy is a minimally invasive procedure used to treat vascular malformations in children. In these conditions, blood vessels or lymphatic channels don’t develop in the typical way. This can happen anywhere in the body and may lead to swelling, pain, or other symptoms.

During the procedure, an interventional radiologist (a specialist in minimally invasive, image-guided procedures) injects a medication directly into the malformation. This medication, called a sclerosing agent (or sclerosant), causes the abnormal vessel or channel to shrink and gradually close over time. This treatment can help reduce symptoms and make your child feel more comfortable.

Sclerotherapy is most commonly used to treat certain types of vascular malformations, particularly venous and lymphatic malformations.

The sclerosing agent may cause the malformation to swell briefly, then slowly shrink and close. Over time, your child’s body safely absorbs the sclerosant. Sclerotherapy can help reduce swelling, discomfort, and visible or felt fullness caused by the malformation.

Some children may need more than one treatment session. The number of sessions varies based on the size, type, and location of the malformation.

Before the procedure

Your child’s care team may order imaging tests, such as ultrasound or MRI, to help plan treatment. In some cases, your child may also need lab tests or a pre-operative evaluation to make sure it is safe to proceed with anesthesia.

A member of the care team will call you a few days before the procedure to review instructions and answer any questions you may have. They will also tell you when your child should stop eating, drinking, and taking medications before the procedure, and explain how anesthesia works and what to expect.

Important: If your child becomes ill within three days before the procedure, please inform their health care provider. Your care team may need to reschedule.

On the day of the procedure

When you arrive at the hospital, you and your child will meet the anesthesia team, who will review the sedation plan and help your family feel comfortable before the procedure begins. You will also meet with your child’s interventional radiologist, who will explain the procedure, answer any questions you may have, and ask you to sign a consent form.

After the form is signed, your child will:

• Change into their hospital gown
• Have an IV line placed
• Receive anesthesia so they are asleep and comfortable during the procedure

Please note: You must be the patient's legal guardian to sign this form. If you are their legal guardian and not their parent, you must bring the paperwork showing proof of legal guardianship.

During the procedure

Your child’s interventional radiologist uses ultrasound and X-ray imaging to guide a small needle or catheter into the area being treated. They may also use a contrast solution, so the malformation and nearby vessels show up more clearly.

X-rays may be used to determine which channels need sclerotherapy. Once everything is in place, the doctor carefully injects the sclerosant into the malformation. When the injection is complete, the physician removes the needle or catheter and may place a small bandage over the site.

After the procedure

Your child will be taken to the recovery room, where you can stay with them until they are ready to go home. The interventional radiologist will meet with you to discuss how the procedure went and what to expect next.

Many children experience some swelling, tenderness, or bruising in the treated area afterward. The area may feel firm or “full” for a few weeks as the malformation shrinks. These symptoms are expected and usually improve gradually. Your care team will explain how to keep your child comfortable at home and when to call if anything concerns you.

Contacting your care team

After your child’s procedure is over, you may have questions or concerns about their recovery. Your care team is here to help.

During regular business hours, please call the Interventional Radiology clinic. A nurse practitioner can answer your questions, or you may leave a non-urgent message.

If urgent concerns arise after regular business hours, please go to the nearest emergency department. If you wish to contact the Interventional Radiology team, you may call Boston Children’s Hospital and ask to page the interventional radiology fellow on call.

Sclerotherapy is generally very safe, but like all medical procedures, it does carry some risks. Your child’s care team will talk with you about these before the procedure and answer any questions you may have. Some of these risks are specific to a sclerosing agent and your doctor will discuss this with you.

Your child may be exposed to a small amount of X-ray radiation as part of the imaging used to guide the treatment. Our team uses the lowest dose possible and takes special steps to limit radiation exposure, especially because children are more sensitive to it.

The Interventional Radiology team at Boston Children’s has extensive experience performing sclerotherapy in infants, children, and adolescents. Our specialists understand how these conditions can change as children grow and tailor treatment plans with their long-term health and comfort in mind. We work closely with the Vascular Anomalies Center to provide coordinated, family-centered care from specialists who understand vascular malformations and how they affect growing children.

Each child’s care team is tailored to meet their specific medical needs. Most often, the team includes:

• Interventional radiologists
• Neurointerventional radiologists
• Anesthesiologists
• Nurse practitioners
• Nurses
• Technologists