{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:43:20Z","timestamp":1777916600235,"version":"3.51.4"},"reference-count":23,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T00:00:00Z","timestamp":1620864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Phlebology"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Puig types 2 through 4 venous malformations (VMs) are challenging to treat with sclerotherapy given their robust systemic outflow. Endovenous balloon occlusion offers a means of temporarily occluding systemic venous outflow to allow for more complete sclerotherapy. This study reviews our experience of implementing this technique in patients with Puig advanced (types 2 through 4) VMs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An IRB approved review of treated venous malformations from 2013\u20132016 revealed 10 patients fitting inclusion criteria. Patient demographics, pre-procedural imaging, intra-procedural technical parameters, and post-procedural follow-up outcomes were recorded. All patients underwent temporary balloon occlusion of a systemic or major draining vein during sclerotherapy. Embolic agents included n-butyl cyanoacrylate glue, sodium tetradecyl sulfate foam, and coils. Standard 5 French angioplasty balloons ranged from 4 to 8\u2009mm diameter and 2 to 8\u2009cm length depending on vessel requiring occlusion. All patients underwent minimum 3-year follow-up questionnaire administration re-assessing resolution of lesion symptomology and post-procedural quality of life (QoL) measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 10 VMs treated, 2 were Type 2, 6 were Type 3, and 2 were Type 4. More than one sclerotherapy session was required in 7\/10 patients (mean: 2, range: 1\u20134). Most common sites of VM systemic drainage included subclavian, popliteal, internal\/external jugular, and basilic veins. All patients had no indication for further sclerotherapy following adjunctive balloon occlusion. No non-target embolization or immediate post-procedural complications occurred. Follow-up questionnaires (mean interval: 3\u2009years 6\u2009months, range: 3\u2009years\u20133\u2009years 11\u2009months) confirmed the persistence of embolization effects, improved QoL, and no additional sclerotherapy sessions for all patients in the cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Endovenous balloon occlusion as an adjunct to sclerotherapy can be considered when treating patients with types 2\u20134 venous malformations. This technique lowers the risk of non-target systemic venous embolization, allowing for operator-driven deeper intralesional sclerosant penetration and subsequently maintained treatment efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02683555211015565","type":"journal-article","created":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T11:48:18Z","timestamp":1620906498000},"page":"731-740","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Balloon occlusion as an adjunctive technique during sclerotherapy of Puig's classified advanced venous malformations"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6017-3603","authenticated-orcid":false,"given":"Sri Hari","family":"Sundararajan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, New York Presbyterian Hospital Weill Cornell Medicine, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9124-6150","authenticated-orcid":false,"given":"Srirajkumar","family":"Ranganathan","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine, Chicago, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sphoorti","family":"Shellikeri","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children\u2019s Hospital of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0180-4719","authenticated-orcid":false,"given":"Abhay","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children\u2019s Hospital of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W","family":"Low","sequence":"additional","affiliation":[{"name":"Department of Surgery, Children\u2019s Hospital of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan","family":"Pukenas","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Hurst","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne Marie","family":"Cahill","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children\u2019s Hospital of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,5,13]]},"reference":[{"key":"bibr1-02683555211015565","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198207000-00041"},{"key":"bibr2-02683555211015565","unstructured":"Anomalies ISftSoV. 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