Multimodal therapy with percutaneous sclerotherapy, partial excision, and pulsed dye laser for lip arteriovenous malformations: a case series.

Lip arteriovenous malformations (AVMs) are rare vascular anomalies that cause significant functional and aesthetic problems. The aim of this study was to evaluate the effectiveness and safety of multimodal therapy combining percutaneous sclerotherapy, partial excision, and pulsed dye laser. A retrospective review was conducted of 20 patients (11 female, nine male; median age 37 years) with lip AVMs treated between 2008 and 2019. All patients underwent ultrasound-guided percutaneous sclerotherapy using 3% foamed polidocanol, with additional use of absolute ethanol in four patients. Near-infrared fluorescence imaging and mechanical compression techniques were employed to optimize sclerosant delivery. Patients with residual swelling after nidus reduction underwent partial excision, and pulsed dye laser was used for persistent superficial erythema. The median number of sclerotherapy sessions was three, and the median follow-up period was 58 months. Partial excision was performed in 16 patients, and laser therapy in six patients. The clinical outcome was classified as 'controlled' in nine patients and 'improved' in 11 patients. Complications occurred in two patients: mucosal ulceration in one patient and wound dehiscence in the other. These results suggest that this stepwise multimodal approach provides favourable outcomes with a low complication rate in the management of lip AVMs.