Sclerotherapy Critiqued in Amputation Case

Cody Porcoro

Written by
on October 31, 2017

This is a medical malpractice case involving a young boy who required amputation after sclerotherapy. The two year old was diagnosed with venous malformation when he was admitted to pediatric care with large venous bumps on his left knee and lower leg. He was treated with multiple rounds of sclerotherapy, having salt solutions injected into his veins depending on the increase and decrease in severity of his symptoms. Despite the periodic treatment, MRI scanning checkups showed that the boy’s malformation was worsening and spreading to new areas on his leg. After a year of treatment his leg pain improved, but he was readmitted to treatment the following year when he began to have new complaints of foot pain. New areas of swelling were noted by doctors, with multiple venous bumps forming on the top and sole of his left foot. Undergoing more sclerotherapy, the boy’s foot began to turn a bluish hue from the middle of his foot down to his toes, and despite the doctor’s efforts his left foot needed to be amputated entirely.

Question(s) For Expert Witness

  • 1. How frequently do you treat vascular malformations with sclerotherapy?
  • 2. What are standard precautionary standards to take before initiating sclerotherapy in a patient with a large venous malformation?

Expert Witness Response E-030015

I treat up to five patients every week with vascular malformations, using sclerotherapy and embolization. I’ve been doing this for over three decades. Typically, required workup standards would be an evaluation of the patient in the clinic and review of previous imaging studies. If the symptoms are not explained by a previous MRI scan, obtain a new one. Otherwise, repeating the MRI is not necessary. Loss of blood circulation and tissue are usually caused by unintentional injection of sclerosant into an artery, and is not avoided by obtaining an MRI scan. I have not seen this complication in my practice, but have reviewed numerous cases of tissue loss due to sclerotherapy.

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