Cryoablation for Fibro-Adipose Vascular Anomaly

Cryoablation, sometimes called cryotherapy, is a minimally invasive procedure that uses extreme cold to destroy tissue that is painful, diseased, or both. It is a fairly novel but promising option for treatment of fibro-adipose vascular anomaly (FAVA) and other painful vascular malformations. FAVA is a complex vascular anomaly, frequently misdiagnosed as a venous malformation or arteriovenous malformation. A specially trained doctor called an interventional radiologist performs cryoablation.

Cryotherapy has been used since the 1960s and is mainly used to treat cardiovascular conditions and cancer. In 2012, a team at Boston Children’s Hospital discovered that this technique can also control the pain of FAVA and improve patients’ quality of life significantly. Since this can be done in a minimally invasive fashion, there are fewer risks and complications and faster recovery.

We see patients with FAVA in our Vascular Anomalies Center. Your child’s care team includes a team of experts from three specialties (interventional radiology, orthopedic surgery, and hematology) who analyze each patient’s medical history and symptoms and recommend the best treatment.

Our team is studying cryoablation as a treatment option for patients with other vascular anomalies who do not respond to conventional treatments. Cryoablation may be an option for patients with:

• Venous malformations
• Hemangiomas
• Kaposiform hemangioendotheioma (KHE)

Read more about what to expect before, during, and after the procedure.

Children with vascular anomalies who undergo cryoablation benefit from:

• Same-day procedure or a one-night hospital stay (surgical stays can be up to one month)
• Minimal recovery periods
• Fewer post-operative infections and complications than open surgery
• No open incisions or visible scars
• Reduced chance of recurrence
• Ability to repeat treatment and do it in conjunction with other treatments (such as medical treatment with sirolimus, a common medication for vascular anomalies)

Your child’s care team will provide tips for preparing your child. In addition, you may want to:

• Tell your child in simple terms why cryoablation is necessary and what will happen.
• Assure your child you will be close by during the procedure and present as soon as it’s over.
• Bring your child’s favorite toy or blanket to the hospital.
• Prepare your child for a small bandage over the needle site.

Read more tips for talking to your children in our age-related guidelines.

Before undergoing cryoablation, you may need an appointment in our pre-op clinic. During this visit, you and your child will:

• Review important details and questions with a pre-op nurse
• Meet with an anesthesiologist, who will explain how we will help your child relax and sleep during the procedure and review the consent process
• Undergo any necessary laboratory testing, such as blood work

Your child may have a nerve-block catheter put in place during the procedure to make the post-procedure recovery pain free.

We recommend you arrive at least one to two hours before the procedure.

You will meet with an interventional radiologist to review the procedure and sign a consent form, so the procedure may begin.

• You must be your child’s legal guardian to sign the consent form.
• If you are a legal guardian and not a parent, you must bring legal paperwork with you showing proof of legal guardianship.
• Get answers to frequently asked questions about consenting to tests, treatments, and procedures at Boston Children’s Hospital.

Once the consent process is done, there are a few extra steps.

• Your child will change into a hospital gown.
• Our team will bring you and your child to the room where the procedure takes place.
• The anesthesiologist will deliver medicine, called anesthesia, through an IV to help your child relax. (Young children may receive the medicine through a mask.) You may be able stay in the room until your child is asleep.
• You will wait in the third-floor, family waiting area during the procedure.

For many patients, cryoablation requires a short overnight stay. Read more about preparing for an overnight stay.

Our Interventional Radiology team performs cryoablation. An interventional radiologist is a board-certified specialist who performs minimally invasive, targeted treatments throughout the body that do not require open surgery.

Your child is asleep under general anesthesia during the procedure. During cryoablation, the interventional radiologist will:

• Insert a tiny, hollow needle in or next to the malformation
• Use advanced imaging technology to precisely guide the insertion
• Target the malformation with cooled gases that pass through the needle, causing the abnormal tissues to freeze and destroy abnormal tissue
• Remove the needle when the treatment is done and cover the insertion site with a small bandage

Your child will be admitted overnight for observation and pain control. We will remove the nerve catheter the following morning. The interventional radiology team will assess your child before discharge. We will discuss further follow-up with you before you go home.