High-flow and low-flow vascular malformation sclerotherapy agents: embolotherapy’s “Tower of Babel”

Endovascular treatment techniques have emerged as the primary form of treatment for high-flow vascular malformations (arteriovenous malformations, arteriovenous fistulas) and low-flow vascular malformations (venous malformations, lymphatic malformations, capillary venous malformations and mixed lesions). To the forefront of endovascular treatment strategies for these problematic vascular malformations is the use of sclerotherapy agents for embolotherapy as a primary form of management. Many publications document the efficacy and complications of their clinical endovascular use. Not infrequently, authors use multiple sclerotherapy agents in each of their publications which then confuses the reader as to which embolic agent is superior to another, responsible for the best outcomes and which one may be more preferable in the hodgepodge of sclerotherapy agents employed by these various authors and by their vascular malformation teams. Thus, these interventional radiologists, angiologists, interventional neuroradiologists and endovascular trained vascular surgeons publishing their numerous patient series from their august institutions, have created their own endovascular sclerotherapy “Tower of Babel” for the rest of us to communicate and sort out. The “goal” of this review article is an attempt to clear the air and help sort things out to better treat afflicted patients with these terrible maladies and to proffer an important question based on the scientific data published in the world’s medical literature.