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Aihole JS. A case of arteriovenous malformation of the hand and its outcome. Int J Surg Case Rep 2024; 120:109806. [PMID: 38796937 PMCID: PMC11152754 DOI: 10.1016/j.ijscr.2024.109806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/18/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE AVMs are rarest congenital anomalies constituting around 1% of pediatric population. Arteriovenous malformations originate at 4th to 10th weeks of intra uterine life due to persistence of primitive arteriovenous shunts. Though the exact prevalence is unknown, upper limb constitute around 10 % of all AVMs. Hand being the most common region affected after head and neck. CASE PRESENTATION Author is presenting here a rare case of palmar arteriovenous malformation in child since birth, hindering her routine daily activities, and its unique way of surgical management. CLINICAL DISCUSSION Hand arteriovenous malformations (AVMs) are challenging to treat due the necessity to maintain function and aesthetic appearance. CONCLUSION The risk of fatal bleeding makes resection of AVMs a challenging and stressful procedure, but however in the presence of available efficient equipments to control the bleeding and expertise of the available treating surgeons, primary surgical resection can be considered a feasible option in a tertiary care pediatric center.
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Hu S, Muss TE, Toyoda Y, Kim MS, Chang AE, Banala M, Graham EM, Gunturi D, Lin IC. Surgical Management of Vascular Malformations of the Upper Extremity: A 12-Year Retrospective Cohort Study. Ann Plast Surg 2024; 92:S132-S135. [PMID: 38556661 DOI: 10.1097/sap.0000000000003852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Vascular malformations (VMs) typically appear at birth and grow commensurately with patients. They can vary broadly in vessel type and tissue involvement, and upper extremity (UE) VMs can pose unique functional and aesthetic challenges in children. Given the advent of operative and nonoperative technologies like sclerotherapy and medications, a contemporary review of the surgical management of UE VMs is warranted. METHODS We performed a retrospective review of all patients who had surgical management of VMs from 2010 to 2021 at The Children's Hospital of Philadelphia. Demographics, lesion characteristics, treatment (including preceding nonsurgical therapies), complications, and final outcomes were recorded. Operative notes were reviewed for date of operation, depth of excision, type of closure, and current procedural terminology code. RESULTS Sixty-seven patients with 88 procedures were studied. Average patient age was 5.8 years, with 64% White and 67% male. Venous (34%) and lymphatic (19%) malformations were most common, and anatomic locations were most frequently on the hand (33%) and forearm (25%). The average lesion diameter was 4.2 cm, although this varied by location (eg, 2.9 cm, hand; 11.1 cm, chest wall). Fifty-eight patients (87%) underwent surgical excision as their index procedure, and 9 had sclerotherapy before surgery. Thirty-nine patients (60%) had subcutaneous excisions, and the remainder required subfascial or intramuscular excisions. Nearly all excisions were closed primarily (97%). Of the 53 patients with documented follow-up, 32 patients (60%) had complete resolution of their lesion as of their final visit. Thirty of these 32 patients with no clinical evidence of residual VM had only 1 surgery for excision. CONCLUSION Upper extremity VMs were composed of diverse conditions with varying vessel types, size, depth, and anatomic sites. Surgical excision of VMs of the UE was safe and effective. A majority of VMs were fully excised after 1 procedure and frequently closed primarily with relatively low complication rates. Future work should investigate decision-making and outcomes of all treatment options of VMs of the UE for optimal functionality and aesthetics.
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Affiliation(s)
- Sophia Hu
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Tessa E Muss
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Yoshiko Toyoda
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Mimi S Kim
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Ashley E Chang
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Manisha Banala
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Emily M Graham
- Department of Plastic Surgery, University of Michigan, Ann Arbor, MI
| | - Deepthi Gunturi
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ines C Lin
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
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3
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Sun N, Liu R, Cheng G, Wu P, Yu F, Qing L, Zeng L, Pang X, Pan D, Xiao Y, Khan UZ, Tang J. The rare complication of vascular malformations of the limb after sclerotherapy: a report of 3 cases and brief literature review. BMC Pediatr 2023; 23:202. [PMID: 37106458 PMCID: PMC10142400 DOI: 10.1186/s12887-023-04018-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Vascular malformations are common but complicated types of disease in infants, with unclear causes and lack of effective prevention. The symptoms usually do not disappear and tend to progress without medical intervention. It is extremely necessary to choose correct treatment options for different types of vascular malformations. A large number of studies have confirmed that sclerotherapy has a tendency to become the first-line treatment in near future, but it is also associated with mild or severe complications. Furthermore, to our knowledge, the serious adverse event of progressive limb necrosis has not been systematically analyzed and reported in the literature. CASE PRESENTATION Three cases (two females and one male) were presented who were all diagnosed as vascular malformations and were treated by several sessions of interventional sclerotherapy. Their previous medical records showed the use of several sclerosants in different sessions including Polidocanol and Bleomycin. The sign of limb necrosis did not occur during the first sclerotherapy, but after the second and third sessions. Furthermore, the short-term symptomatic treatment could improve the necrosis syndrome, but could not change the outcome of amputation. CONCLUSION Sclerotherapy undoubtedly tends to be the first-line treatment in near future, but the adverse reactions still remain major challenges. Awareness of progressive limb necrosis after sclerotherapy and timely management by experts in centers of experience of this complication can avoid amputation.
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Affiliation(s)
- Nianzhe Sun
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Rui Liu
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Gechang Cheng
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Panfeng Wu
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Fang Yu
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Liming Qing
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Lei Zeng
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Xiaoyang Pang
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Ding Pan
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Yongbin Xiao
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Umar Zeb Khan
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Juyu Tang
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China.
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China.
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Laurian C, Bisdorff A, Masonni C, Cerceau P, Paraskevas N. Surgical resection of venous malformations of the forearm. J Hand Surg Eur Vol 2022; 47:716-721. [PMID: 35296182 DOI: 10.1177/17531934221086889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We retrospectively reviewed 35 patients with venous malformations located in the forearm and treated by surgery in a single institution during the period 2010-19. The common complaints were pain and swelling (34 patients) and impaired function with contractures of fingers (15 patients). Twenty-four had complete resection and 11 had an incomplete resection. Associated procedures were reconstruction or lengthening of tendons in 17 patients. At the last follow-up (mean 61 months), 32 of the 35 had no residual pain and 27 had no functional sequelae. On MRI follow-up exams, 27 had no residual venous malformations. Venous malformations in the anterior compartment of the forearm can impair the function of the hand. They are developed almost exclusively in the connective tissue around tendons and muscles, deforming the musculotendinous structures and involving nerves. Surgery seems an appropriate option for the condition in this area.Level of evidence: IV.
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Affiliation(s)
- Claude Laurian
- Interdisciplinary Study Group for Vascular Malformations, Saint-Joseph Hospitals, Paris, France
| | - Annouk Bisdorff
- Interdisciplinary Study Group for Vascular Malformations, Saint-Joseph Hospitals, Paris, France
| | - Claudine Masonni
- Interdisciplinary Study Group for Vascular Malformations, Saint-Joseph Hospitals, Paris, France
| | - Pierre Cerceau
- Interdisciplinary Study Group for Vascular Malformations, Saint-Joseph Hospitals, Paris, France
| | - Nikos Paraskevas
- Interdisciplinary Study Group for Vascular Malformations, Saint-Joseph Hospitals, Paris, France
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Palmar Venous Malformation: A Case Report of a Rare Occurrence and a Treatment Algorithm. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4270. [PMID: 35441065 PMCID: PMC9010119 DOI: 10.1097/gox.0000000000004270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
Palmar venous malformations are not well described in the surgical literature and are a therapeutic challenge due to the intricate anatomy of the hand. We present the case of a 19-year-old right-handed female patient from Mexico who was referred to us with a right palmar lesion present since birth, previously diagnosed as a venous malformation. The patient reported that she had undergone sclerotherapy 10 years before in addition to a prior aborted attempt at excision. Venous palmar malformations are rare occurrences. Although an individualized approach is important, the development of an algorithm may assist in the standardization of the treatment of this pathology to preserve the hand’s functional status.
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Percutaneous Sclerotherapy of Venous Malformations of the Hand: A Multicenter Analysis. Cardiovasc Intervent Radiol 2021; 44:1543-1550. [PMID: 34286368 PMCID: PMC8478723 DOI: 10.1007/s00270-021-02926-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/11/2021] [Indexed: 11/06/2022]
Abstract
Purpose To evaluate the safety and outcome of percutaneous sclerotherapy for treating venous malformations (VMs) of the hand. Materials and Methods A retrospective multicenter trial of 29 patients with VMs primarily affecting the hand, including wrist, carpus, and/or fingers, treated by 81 percutaneous image-guided sclerotherapies using ethanol gel and/or polidocanol was performed. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Substratification analysis was performed with respect to the Puig’s classification, the sclerosing agent, the injected volume of the sclerosant, and to previously performed treatments. Results The mean number of procedures per patient was 2.8 (± 2.2). Last follow-up (mean = 9.2 months) revealed a partial relief of symptoms in 78.9% (15/19), while three patients (15.8%) presented symptom-free and one patient (5.3%) with no improvement. Post-treatment imaging revealed an overall objective response rate of 88.9%. Early post-procedural complications occurred after 5/81 sclerotherapies (6.2%) and were entirely resolved by conservative means. Type of VM (Puig’s classification) as well as sclerosing agent had no impact on clinical response (p = 0.85, p = 0.11) or complication rates (p = 0.66, p = 0.69). The complication rates were not associated with the sclerosant volume injected (p = 0.76). In addition, no significant differences in clinical success (p = 0.11) or complication rates (p = 0.89) were detected when comparing patients with history of previous treatments compared to therapy-naive patients. Conclusion Percutaneous sclerotherapy is both safe and effective for treating VMs of the hand. Even patients with history of previous treatments benefit from further sclerotherapy showing similar low complication rates to therapy-naive patients. Level of Evidence Level 4, Retrospective study.
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Oliver CL, Brown J, Watkins M, McCafferty I, Oliver RJ. The Addition of Lipid-Based Contrast Medium does not Inactivate the Detergent Sclerosant Sodium Tetradecyl Sulfate in-vitro. Cardiovasc Intervent Radiol 2021; 44:1103-1108. [PMID: 33709269 DOI: 10.1007/s00270-021-02797-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/03/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate if the detergent sclerosant sodium tetradecyl sulfate (STS) is deactivated by the lipid-based contrast agent ethiodised oil. METHOD 3% STS was mixed with ethiodised oil and room air in a 2:1:4 ratio in two luer lock syringes and a three way connector and agitated to make foam (the Tessari technique) to replicate the clinical use of the products. The assay of STS in the mixture was assessed using the British Pharmacopoeia method. Briefly this is a manual titration method where the solution of STS is mixed with an indicator solution and titrated with hyamine solution of known concentration; the concentration of the STS can then be calculated with the titration results. To further mimic the clinical environment with the presence of blood, the effect of adding increasing amounts of albumin to the STS-ethiodised oil mixture was assessed. RESULTS The assay of STS in the solution after mixing with ethiodised oil was 3% indicating that the ethiodised oil did not deactivate the STS. The addition of albumin to the STS-contrast mixture resulted in near linear neutralisation of the STS with increasing concentrations in the same quantities as with STS alone. CONCLUSIONS The mixture of the lipid-based contrast agent ethiodised oil with the detergent sclerosant STS did not affect the availability of the sclerosant. The continued use of STS-ethiodised oil in the management of vascular malformations can be supported.
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Affiliation(s)
- Charlotte L Oliver
- Limbco Ltd, Plough Lane, Hereford, HR4 0EL, UK
- University of Oxford, Oxford, UK
| | - Judy Brown
- Limbco Ltd, Plough Lane, Hereford, HR4 0EL, UK
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8
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Chang S, Weisse C, Berent AC, Rosen RJ. Use of percutaneous foam sclerotherapy with 1.5% sodium tetradecyl sulfate for treatment of a pelvic limb venous malformation in a dog. J Am Vet Med Assoc 2020; 256:1368-1374. [PMID: 32459582 DOI: 10.2460/javma.256.12.1368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 6-year-old 17-kg (37.4-lb) spayed female mixed-breed dog was evaluated because of swelling and intermittent lameness of the right pelvic limb and perianal and vulvar bleeding caused by a suspected arteriovenous malformation. CLINICAL FINDINGS The right pelvic limb had a diffuse, raised, cobblestone-like appearance with lameness, edema, and multifocal ulcerations. The abdominal skin had multifocal circular erythematous lesions, the perianal region was erythematous, and the vestibule had superficial distended vessels. Ultrasonography and CT did not reveal the presence of an arteriovenous malformation; however, digital subtraction venography confirmed the presence of a venous malformation (VM) throughout the limb. TREATMENT AND OUTCOME A mixture of foam sclerosant (1.5% sodium tetradecyl sulfate) and contrast medium was agitated with air and injected percutaneously into the VM. The dog received an injection of corticosteroid solution, and a soft-padded bandage was applied to the limb for 3 days. Six weeks later, the dog would intermittently hop when running, and the limb was mildly edematous with ecchymotic lesions; the swelling and lameness had improved considerably. Perianal and vulvar bleeding and dilation of the vestibular vessels had resolved. At 21 months after the procedure, examination revealed no right pelvic limb lameness related to the VM; only small cyst-like lesions and edema around the tarsus remained. CLINICAL RELEVANCE The favorable clinical outcome for this dog for a 21-month period after treatment of a pelvic limb VM with foam sclerotherapy has suggested that foam sclerotherapy may be used to successfully treat limb VMs in some dogs.
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Fresa M, El Ezzi O, DE Buys Roessingh A, Qanadli SD, Ney B, Mazzolai L. Ultrasound-guided percutaneous endovenous laser treatment combined with sclerotherapy for the treatment of large intramuscular venous malformations. INT ANGIOL 2020; 40:1-8. [PMID: 33236869 DOI: 10.23736/s0392-9590.20.04549-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Among vascular anomalies, congenital venous malformations (VMs) are the most common lesions. Treatment of VMs is sometimes difficult or cumbersome, depending on their size and tissue involvement. Surgery may lead to invasive and mutilating excisions, often allowing only partial removal, with an increased risk of recurrence. Sclerotherapy is a mainstream technique, resulting in endothelium destruction, fibrosis and subsequent shrinkage of the vascular lesion, also with a risk of recurrence. However, this technique may not be efficient in cases of large and infiltrating VMs. Endovenous thermal ablation has been found to be more effective than sclerotherapy for transmural vascular destruction and has therefore been employed in the treatment of VMs. METHODS In this study we described a combined technique for the treatment of large intramuscular VMs in seven consecutive patients, associating endovenous laser ablation with sclerotherapy. The aim was to assess feasibility and safety of the procedure. RESULTS We reported a high immediate technical success, clinical and radiological improvement, with no complications. CONCLUSIONS The preliminary results presented herein show, that combining EVLA and sclerotherapy for the treatment of voluminous persistent intramuscular VM is safe and technically feasible. The combination of a wide direct intimal thermal damage with chemical sclerotherapy is the force of this approach. The small number of cases and the medium term follow up represent though a limitation.
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Affiliation(s)
- Marco Fresa
- Department of Angiology, Center for Malformation and Rare Vascular Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland -
| | - Oumama El Ezzi
- Department of Pediatric Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | - Salah D Qanadli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Barbara Ney
- Department of Angiology, Center for Malformation and Rare Vascular Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Lucia Mazzolai
- Department of Angiology, Center for Malformation and Rare Vascular Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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The Efficacy of Absolute Ethanol and Polidocanol in the Treatment of Venous Malformations. J Craniofac Surg 2020; 31:e272-e275. [PMID: 32068725 DOI: 10.1097/scs.0000000000006268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Using meta-analysis to evaluate the efficacy of absolute ethanol and polidocanol in the treatment of venous malformations. MATERIALS AND METHODS A systematic search of the English literature was conducted in April 2019 including PubMed, Embase and Web of Science. Article selection was based on preset criteria. The included literature was scored on the MINORS scale, and the meta-analysis and the forest plot were made using the R 3.5.1 software for efficiency. RESULTS Ten articles were included in the meta-analysis. Absolute ethanol response rate ranged between 79% and 92% with a pooled rate of 85%, and polidocanol response rate ranged between 63% and 94% with a pooled rate of 77%. DISCUSSION Although sclerotherapy is effective in most studies, a large number of randomized controlled trials are still needed to confirm the best treatment options at different sites.
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Karimi E, Jafari M, Aghazadeh K, Sohrabpour S, Tavakolnejad F. Treatment of Head and Neck Venous Malformations with Sodium Tetradecyl Sulfate. OTO Open 2018; 2:2473974X18797067. [PMID: 31535070 PMCID: PMC6737864 DOI: 10.1177/2473974x18797067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 01/22/2018] [Accepted: 08/07/2018] [Indexed: 11/21/2022] Open
Abstract
Objective The purpose of this study was to discuss the clinical outcomes and complications of treating venous malformations with sclerotherapy, with sodium tetradecyl sulfate as the sclerosing agent. Study Design Case series with planned data collection. Setting Amiralam Hospital—a referral otolaryngology–head and neck surgery hospital affiliated with Tehran University of Medical Sciences. Subjects and Methods A total of 345 patients with venous malformations were treated with sclerotherapy with sodium tetradecyl sulfate 3% (1 mL for every 1 cm3 of the lesion). The venous malformation location, treatments before the current sclerotherapy with sodium tetradecyl sulfate, the number of sclerotherapy sessions, and complications resulting from sclerotherapy were recorded. Follow-up assessments were done for a minimum of 1 year following the procedure. A favorable outcome was defined as a 50% decrease in the lesion size based on clinical and radiologic assessments. Results A total of 759 injection sessions were documented, ranging from 1 to 6 injections per patient (mean = 3.1). The follow-up duration ranged from 12 to 84 months (mean = 55 months). Based on clinical assessment, a 50% reduction of size was reported for 95.6% of the patients. According to the imaging before and after the procedures, a 50% reduction of size was seen among 67.3% of the patients. Conclusion The results of the study showed that the use of sodium tetradecyl sulfate as a sclerosing substance can effectively reduce the size of venous malformation lesions.
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Affiliation(s)
- Ebrahim Karimi
- Otolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Jafari
- Otorhinolaryngology Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Keyvan Aghazadeh
- Otolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Sohrabpour
- Otolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Intramuscular Venous Malformations of the Upper and Lower Limbs: Indications and Outcomes of Sclerotherapy. Cardiovasc Intervent Radiol 2018; 41:1505-1512. [PMID: 29850938 DOI: 10.1007/s00270-018-1997-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/21/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Multiple treatment options have been described for intramuscular venous malformations (VMs) of the limbs. At the current time, there are no clear management guidelines. The aim was to evaluate efficacy and safety of sclerotherapy in this type of VMs. MATERIALS AND METHODS This is a single-center, retrospective review of patients treated for extremity intramuscular VMs between January 2013 and June 2017. The primary outcomes were the improvement of symptoms self-assessed by questionnaires, and the reduction in VM size measured by magnetic resonance (MRI). RESULTS Sclerotherapy was performed in 81 patients with extremity intramuscular VMs. The sclerosing agent was ethanol in 46 cases (56.8%), polidocanol in 27 cases (33.3%), a combination of both in 8 cases (9.9%). The mean follow-up was 26 months (range 3-52). Overall quality of life was improved in 62 patients (76.5%). The postoperative MRI showed a minimum change of VM size in 68 patients (83.9%). A major complication (peripheral nerve injury) was observed in 1 case (1.2% of patients, 0.5% of procedures). Minor complications occurred in 9 cases (11.1% of patients, 4.1% of procedures). CONCLUSIONS Sclerotherapy is a low-invasive, effective and safe treatment for intramuscular VMs of the extremities. It induces a significant improvement in symptoms, also when the VM size is unchanged. LEVEL OF EVIDENCE Level 4, Case Series.
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13
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Tahir M, Mumtaz MA, Sultan A, Iqbal J, Sayani R. Role of Interventional Radiology in the Management of Peripheral Vascular Malformations: A Tertiary Care Center Experience. Cureus 2018; 10:e2335. [PMID: 29774173 PMCID: PMC5955714 DOI: 10.7759/cureus.2335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Peripheral vascular malformations (PVMs) represent a wide spectrum of vascular abnormalities occurring due to anomalous connections between arteries, veins, capillaries, and lymphatic channels at the microscopic level, in different combinations. They are rare and challenging to treat. Different operators may have different approaches based on their experience and expertise. Sclerotherapy either alone or in combination with embolization has been used as an independent method for the treatment of PVMs. Purpose The aim of this study is to assess the safety and efficacy of sclerotherapy and embolization, with or without surgery, for the treatment of peripheral vascular malformations, based on our approach. Materials and methods A retrospective review of all patients with PVMs treated in our interventional radiology department from 2011 to 2017 was carried out. Medical records, imaging, and follow-up notes were reviewed to evaluate the response to treatment and post-procedure complications. Results Thirty-four sessions were performed in 15 patients (eight male, seven female) with PVMs. Low-flow lesions were identified in 10, intermediate flow in one, and high flow in four patients. Sodium tetradecyl sulfate (STS) was used as the sclerotherapeutic agent in 10 (66.67%), glue with lipoidal in three (20.0%), and bleomycin in one patient (6.67%). Coils with PVA and a covered stent were used in one and a combination of coil, PVA, and gel foam was used in one patient. A marked response was seen in 11 and a partial response in four patients. One patient developed foot gangrene. Stent thrombosis was noted in one patient with no clinical consequences. Recurrence was seen in two patients, who were lost to follow up. Conclusion PVMs are complex lesions. Sclerotherapy with or without embolization is a safe and effective treatment modality, with clinical response approaching 100%.
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Affiliation(s)
- Misbah Tahir
- Radiology, Liaquat National Hospital and Medical College
| | | | - Anum Sultan
- Radiology, Liaquat National Hospital and Medical College
| | - Jawaid Iqbal
- Radiology, Liaquat National Hospital and Medical College
| | - Raza Sayani
- Department of Radiology, The Aga Khan University, Karachi
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14
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Outcome Measures After Sclerotherapy of Venous Malformations: A Systematic Review. Cardiovasc Intervent Radiol 2018; 41:1141-1151. [DOI: 10.1007/s00270-018-1919-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/21/2018] [Indexed: 01/26/2023]
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15
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Andelman SM, Walsh AL, Rubin TA, Hausman MR. Acute Hand Ischemia Following Elective Venous Sclerotherapy for Dorsal Hand Varicose Veins. J Hand Surg Am 2017; 42:666.e1-666.e5. [PMID: 28410939 DOI: 10.1016/j.jhsa.2017.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/07/2017] [Accepted: 03/16/2017] [Indexed: 02/02/2023]
Abstract
Venous sclerotherapy is an emerging cosmetic treatment option for dorsal hand varicose veins. Although venous sclerotherapy is considered a safe and effective procedure for treatment of venous malformations and varicosities in both the upper and lower extremities, inadvertent injection of the sclerosing agent into the arterial system has led to reported instances of acute ischemic events and distal limb necrosis. This is a rare but well-documented complication of lower-extremity venous sclerotherapy. Only 2 cases have been reported in upper-extremity venous sclerotherapy, both of which occurred during treatment of complex vascular malformations. We report an instance of acute, distal digit ischemia after elective venous sclerotherapy for a dorsal hand varicosity. As this procedure grows in popularity, it is essential for hand surgeons to be aware of this rare but potentially devastating complication.
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Affiliation(s)
- Steven M Andelman
- Department of Orthopaedic Surgery, Icahn School of Medicine Mount Sinai, New York, NY.
| | - Amanda L Walsh
- Department of Orthopaedic Surgery, Icahn School of Medicine Mount Sinai, New York, NY
| | - Todd A Rubin
- Department of Orthopaedic Surgery, Icahn School of Medicine Mount Sinai, New York, NY
| | - Michael R Hausman
- Department of Orthopaedic Surgery, Icahn School of Medicine Mount Sinai, New York, NY
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