Predictors of short-term pain relief after polidocanol foam sclerotherapy for painful venous malformations.

objectivesTo evaluate short-term pain relief and safety provided by polidocanol foam sclerotherapy for painful venous malformations (VMs) and determine imaging and procedural predictors of clinical efficacy. MATERIALS AND

methodsFrom April 2015 to September 2025, this single-center retrospective study included 240 consecutive patients who underwent polidocanol foam sclerotherapy for predominantly peripheral VMs. Among these, 181 patients treated for pain were enrolled. Polidocanol at a 1% or 2% concentration was used according to the treatment period and recorded as a candidate predictor. Pain was evaluated using the visual analog scale (VAS). The primary endpoint was a ≥ 50% VAS reduction 2 months after the initial session. Secondary endpoints included technical success and complications, with predictors analyzed using univariable analysis and multivariable logistic regression.

resultsThe cohort comprised 181 patients (116 females and 65 males; mean age, 31.4 ± 16.0 years). Two months after initial treatment, 84% patients demonstrated pain reduction, and 47% achieved a favorable response, with complete pain resolution in 28%. In univariate analysis, a smaller lesion size (≤ 5 cm), lobulated morphology, well-defined margins, good sclerosant stasis, and lower VM types were associated with a favorable response. Multivariate analysis demonstrated that good sclerosant stasis was an independent predictor of a favorable response (odds ratio, 2.44; 95% confidence interval, 1.18-5.18, p = 0.016); polidocanol concentration was not significantly associated with outcomes.

conclusionPolidocanol foam sclerotherapy provides substantial short-term pain relief with favorable safety in patients with painful VMs, with efficacy driven primarily by lesion hemodynamics and technical stasis. KEY POINTS: Question Identifying specific lesion- and technique-related predictors of short-term pain relief after polidocanol foam sclerotherapy for painful VMs remains an important unmet clinical need. Findings Multivariable analysis identified good sclerosant stasis as the sole independent predictor of a favorable clinical response, overriding baseline characteristics. Clinical relevance Polidocanol foam sclerotherapy safely relieves pain in VMs. To maximize efficacy, clinicians should support a stasis-first treatment strategy, prioritizing optimal intralesional stasis and management of outflow patterns.