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Son J, Hong CM, Lee J, Chung HY, Ahn BC. Clinical Values of Whole-Body Blood Pool Scans and SPECT for Evaluation of Congenital Vascular Malformation. Nucl Med Mol Imaging 2024; 58:69-80. [PMID: 38510824 PMCID: PMC10948652 DOI: 10.1007/s13139-023-00835-0] [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: 09/11/2023] [Revised: 11/25/2023] [Accepted: 12/19/2023] [Indexed: 03/22/2024] Open
Abstract
Purpose This study examines the diagnostic potential of whole-body blood pool scintigraphy (WBBPS) using technetium-99 m-labeled red blood cells to detect congenital vascular malformations (CVMs). It aims to compare its efficacy with traditional imaging techniques such as magnetic resonance imaging (MRI) and ultrasonography (USG), emphasizing its potential advantages in terms of characterization of lesions and capacity for whole-body assessment. Methods The efficacy of WBBPS and single-photon emission computed tomography (SPECT)/computed tomography (CT) imaging in diagnosing CVMs, comparing them with USG and MRI results, was evaluated in this retrospective study. Of the 38 patients, 21 were evaluated using these diagnostic methods, with CVMs classified according to the International Society for the Study of Vascular Anomalies guidelines. Also, this study aimed to elucidate the characteristics between WBBPS, SPECT/CT, USG, or MRI findings and their consistency with the final diagnosis. Results A total of 21 participants were included in this study, with an average age of 17.7 years old, with female predominance (57.1%). The most common diagnosis was vascular malformations (VMs) (71.4%), followed by combined vascular malformations (14.3%) and lymphatic malformations (9.5%). WBBPS demonstrated positive results in 95.2% of cases. Distinct imaging patterns for each condition were observed, with WBBPS being crucial in locating lesions. Conclusion The study findings suggested that WBBPS with SPECT/CT could be helpful in detecting occult VM lesions and ruling out a lymphatic malformation diagnosis. Thus, it can be employed in the evaluation of CVMs.
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Affiliation(s)
- Junik Son
- Departments of Nuclear Medicine, Kyungpook National University Hospital, 130 Dongdeok-Ro, Jung Gu, Daegu, Republic of Korea 41944
| | - Chae Moon Hong
- Departments of Nuclear Medicine, Kyungpook National University Hospital, 130 Dongdeok-Ro, Jung Gu, Daegu, Republic of Korea 41944
- Departments of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jaetae Lee
- Departments of Nuclear Medicine, Kyungpook National University Hospital, 130 Dongdeok-Ro, Jung Gu, Daegu, Republic of Korea 41944
- Departments of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ho Yun Chung
- Departments of Plastic and Reconstructive Surgery, Kyungpook National University Hospital, Vascular Anomalies Center, Daegu, Republic of Korea
- Departments of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Byeong-Cheol Ahn
- Departments of Nuclear Medicine, Kyungpook National University Hospital, 130 Dongdeok-Ro, Jung Gu, Daegu, Republic of Korea 41944
- Departments of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Liu JW, Ni B, Gao XX, He B, Nie QQ, Fan XQ, Ye ZD, Wen JY, Liu P. Comparison of bleomycin polidocanol foam vs electrochemotherapy combined with polidocanol foam for treatment of venous malformations. J Vasc Surg Venous Lymphat Disord 2024; 12:101697. [PMID: 37890588 DOI: 10.1016/j.jvsv.2023.101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/08/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE This study aims to investigate the difference in safety and efficacy between two treatments for venous malformations (VMs), electrochemotherapy combined with polidocanol foam (ECP) and bleomycin polidocanol foam (BPF), providing alternative therapies for VMs. METHODS We conducted a retrospective review of 152 patients with VMs treated with ECP and BPF. Pre- and post-treatment magnetic resonance images (MRIs) were collected, and clinical follow-up assessments were performed. Imaging results were used to calculate lesion volume changes. Clinical outcomes included changes in pain and improvements in perceived swelling. Patients were followed up at 1 week and 6 months after surgery. All emerging complications were documented in detail. RESULTS Of the 152 patients, 87 (57.2%) received BPF treatment, and 65 (42.8%) received ECP treatment. The most common location of VMs was the lower extremities (92/152; 60.2%), and the most common symptom was pain (108/152; 71.1%). Forty-three patients had previously undergone therapy in the BPF group (43/87; 49.4%), whereas 30 patients had received prior treatment in the ECP group (30/65; 46.2%). The study found that the percentage of lesion volume reduction in the BPF group was not significantly different from that in the ECP group (75.00% ± 17.85% vs 74.69% ± 8.48%; P = .899). ECP was more effective when the initial lesion volume was greater than 30 mL (67.66% ± 12.34% vs 73.47% ± 8.00%; P = .048). Patients treated with BPF had significantly less posttreatment pain than those treated with ECP, in different baseline lesion size. In the overall sample, pain relief was significantly higher in the BPF group than in the ECP group (4.21 ± 1.19 vs 3.57 ± 0.76; P = .002). However, there was no difference in pain relief between the two groups for the treatment of initially large VMs (4.20 ± 0.94 vs 3.70 ± 0.87; P = .113). The ECP group was significantly more likely to develop hyperpigmentation (5/87; 5.75% vs 11/65; 16.92%; P = .026) and swelling (9/87; 10.34% vs 16/65; 24.62%; P = .019) 1 week after surgery than the BPF group. CONCLUSIONS Our study demonstrates that both BPF and ECP are effective treatments for VMs, with BPF being a safer option. ECP is a better choice for patients with the initial lesion volume greater than 30 mL, but it is more likely to lead to early swelling and hyperpigmentation.
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Affiliation(s)
- Jing-Wen Liu
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China; Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Bin Ni
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China; Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xi-Xi Gao
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Bin He
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Qiang-Qiang Nie
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xue-Qiang Fan
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhi-Dong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jian-Yan Wen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
| | - Peng Liu
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China; Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
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Fuad M, Goh BS, Lokman FL, Mohamad Yunus MR. Blue Parotid Unveiled: A Rare Case of Traumatic Hemorrhagic Parotid Lymphangioma in an Eight-Year-Old Boy. Cureus 2023; 15:e46415. [PMID: 37927667 PMCID: PMC10621628 DOI: 10.7759/cureus.46415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Parotid lymphangioma is a benign lymphatic malformation commonly observed in infancy or early childhood. It often grows insidiously and presents as a painless, soft fluctuant mass. We report a case of an eight-year-old boy who was diagnosed from another center with right parotid lymphangioma of one-year duration. He presented with right painful preauricular swelling and trismus for nine days after a recent history of blunt trauma to the preauricular caused an acute expansion of the swelling and subsequently, the patient developed ipsilateral facial nerve palsy. Examination showed right preauricular swelling measuring about 6 x 6 cm that extended posteriorly until the mastoid region, superiorly until the zygoma, and inferiorly until the angle of the mandible, pushing the ear lobule anteromedially. There was bluish discoloration of the overlying skin. The swelling was warm and tender on palpation. Multiple shotty lymph nodes were palpable at the posterior triangle. Aspiration of the swelling revealed blood content, but it reaccumulated after a few hours. A magnetic resonance imaging (MRI) of the neck showed a lesion confined within the parotid gland. There was a presence of air-fluid level with dependent layers of hyperintense on the T1-weighted image (T1WI) and T2-weighted image (T2WI) with clumps of isointensity on T1WI, which are hypointense on T2WI, which is suggestive of acute-late subacute blood product. A diagnosis of lymphatic malformation complicated with hemorrhage was made. Hence, the patient underwent surgery for the evacuation of blood clot and right superficial parotidectomy. Histopathological examination of the intraoperative tissue biopsy revealed evidence of venolymphatic malformation of the parotid gland. Postoperatively, he was discharged home after three days. The facial nerve function recovered from House and Brackmann grade II to grade I three weeks after the surgery.
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Affiliation(s)
- Muizzuddin Fuad
- Otolaryngology - Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Bee See Goh
- Otorhinolaryngology/Pediatrics Otorhinolaryngology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Farah Liana Lokman
- Otolaryngology - Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Mohd Razif Mohamad Yunus
- Otorhinolaryngology - Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
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Gowthame K, Mohanty S, Somu L. Management of Arteriovenous Malformation in Otolaryngology Practice: A Retrospective Study & Review of Literature. Indian J Otolaryngol Head Neck Surg 2023; 75:1323-1328. [PMID: 37275019 PMCID: PMC10235014 DOI: 10.1007/s12070-023-03514-w] [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: 07/26/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
Vascular malformations in the head and neck encompass a wide range of lesions and present an interesting challenge for the surgeon with their varied presentations. Early diagnosis and timely and adequate intervention help treat patients effectively. We reported our experience in the management of four patients diagnosed with low-flow venous malformation. Every patient was managed differently based on the site and size of the lesion, and all of them had the best outcome. 1 patient who had a smaller lesion was managed with oral propranolol, and 1 patient was managed with oral propranolol with local hot water injection. Two patients had larger lesions involving the airways and hence required an elective tracheostomy because of anticipated airway compromise, following which they were managed with intralesional sclerotherapeutic injection. As the lesion size shrank but remained, both underwent coblator-assisted tumor debulking at the end of two months. All four patients had a better outcome. Each patient received a different modality of treatment. No recurrences were noted in any of them. A multidisciplinary team approach resulted in a positive patient outcome. Vascular lesions should be considered in the differential diagnosis of a patient presenting with increasing dysphagia, dysphonia, or dyspnea. The cooperation of a skilled interventional radiologist cannot be over-emphasized.
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Affiliation(s)
- K. Gowthame
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
| | - Sanjeev Mohanty
- Department of Otorhinolaryngology, MGM Hospitals, Chennai, India
| | - L. Somu
- Department of Otorhinolaryngology, Sri Ramachandra Medical College and Research Institute, Chennai, India
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Horan KMH, Beijnen UEA, Upton J, Taghinia AH. Microsurgical Resection of Vascular Malformations of the Upper Extremity. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4974. [PMID: 37180988 PMCID: PMC10171708 DOI: 10.1097/gox.0000000000004974] [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: 10/17/2022] [Accepted: 03/08/2023] [Indexed: 05/16/2023]
Abstract
Vascular malformations that circumferentially surround end or near-end arteries are challenging to manage. Minimally invasive treatment options such as sclerotherapy can directly damage these vessels and cause ischemia. Surgical resection is desired without sacrificing or injuring a patent artery, especially in end organs like the upper limb. Microsurgical resection of these lesions provides a viable option for treatment. Methods The records of nine patients who presented with vascular malformations that circumferentially surrounded an artery in the upper limb were reviewed. The main indications for surgical intervention were pain or persistent growth. In each case, microsurgical technique using a microscope and microsurgical instruments was used to dissect the lesions free from the affected end arteries. Four digital arteries, three radial arteries, one brachial artery and one palmar arch were involved. Results There were six venous malformations, two fibro-adipose vascular anomalies, and one lymphatic malformation. There were no cases of distal ischemia, bleeding, or functional compromise. Two patients experienced delayed wound healing. After a minimum follow-up of 1 year, only one patient experienced a small area of recurrence but had no pain. Conclusions Microsurgical dissection using a microscope and microsurgical instruments is a viable technique for resection of difficult vascular malformations that surround major arterial channels in the upper limb. This technique allows preservation of maximum blood supply while treating problematic lesions.
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Affiliation(s)
- Katelyn M H Horan
- From the Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Usha E A Beijnen
- From the Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Joseph Upton
- From the Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Amir H Taghinia
- From the Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
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6
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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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Arasakumar DRB, Pang C, Evans N, Papadopoulou A, Khalifa M, Tsui J, Hamilton G, Brookes J, Lim CS. Efficacy and safety of foam sclerotherapy with sodium tetradecyl sulfate as preferred sclerosant of venous malformations based on experience from a single specialist center. J Vasc Surg Venous Lymphat Disord 2023; 11:379-388. [PMID: 36328136 DOI: 10.1016/j.jvsv.2022.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/13/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We have assessed the efficacy and safety of interventional therapy for venous malformations (VMs), with foam sclerotherapy as the treatment of choice according to our experience at a single specialist center. METHODS All the patients with VMs who had undergone interventional therapy (ie, embolo-sclerotherapy and/or open surgery) from January 1, 2015 to December 31, 2019 were identified through a prospective database. The VM types were classified according to the Puig classification. The outcome measures assessed included the efficacy and complications. The former was divided into four groups: no response, mild response, moderate response, and complete response. The complications were defined as any tissue or functional damage, distal embolization, or tissue reaction. The continuous variables were compared using the analysis of variance F test, and discrete variables were analyzed using the χ2 tests. P values < .05 were considered statistically significant. RESULTS A total of 207 patients were included. Puig type I lesions were significantly less likely to have received foam sclerotherapy using sodium tetradecyl sulfate (STS) 3% (P ≤ .001) and more likely to have been surgically excised (P ≤ .001). At the patient's first procedure during the study period, the volumes of foam STS 3% were significantly different across all types of VM (P ≤ .001). The patients with type I VMs had received a lower volume of STS 3% compared with those with type II and III VMs. The efficacy outcome categories were significantly different across all types of VMs (P ≤ .001). Overall, only 14 patients (6.8%) had reported no improvement in efficacy, and 38 patients (18%) had not attended follow-up. Therefore, 154 patients (74.8%) had experienced some form of efficacious outcome. Ten patients (4.8%) had developed complications such as hematoma, thrombophlebitis, and ulceration. The incidence of complications differed significantly across the categories (P = .030), with more complications reported for those with type I VMs. CONCLUSIONS We found that intervention with foam sclerotherapy using STS 3% is clinically effective and safe for patients with VMs and was most successful for those with Puig type I and II VMs.
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Affiliation(s)
| | - Calver Pang
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Nicholas Evans
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Anthie Papadopoulou
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Mohamed Khalifa
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Janice Tsui
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - George Hamilton
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Jocelyn Brookes
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Department of Interventional Radiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Chung Sim Lim
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, London, United Kingdom.
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Ishikawa K, Sasaki S, Furukawa H, Maeda T, Miura T, Sasaki Y, Yamamoto Y, Funayama E. Effectiveness and safety of percutaneous sclerotherapy using absolute ethanol and/or polidocanol for maxillofacial venous malformations involving the masticatory muscles: A case series. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:355-362. [PMID: 36241599 DOI: 10.1016/j.oooo.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study evaluated the effectiveness and safety of percutaneous sclerotherapy for maxillofacial venous malformations. STUDY DESIGN Patients who had venous malformations involving the masticatory muscles and who underwent sclerotherapy were enrolled in this retrospective study. RESULTS Twenty-four patients (13 female, 11 male; mean age 21 years) were analyzed. Major clinical symptoms were swelling (100%) and intralesional pain (54%). Intramuscular lesions involved the masseter muscle only in 38% of cases, both the masseter and temporalis muscles in 33%, all masticatory muscles in 21%, and the temporalis muscle only in 8%. Extramuscular involvement was observed in 58% of patients. Absolute ethanol and polidocanol were used as sclerosants. The mean number of sclerotherapy sessions per patient was 6.6 (range, 1-32). The mean follow-up duration after the first sclerotherapy session was 64.8 months (range, 6-178). The complications included paralysis of the facial nerve (25%), intraoral ulceration (8%), and hemoglobinuria (8%). The effectiveness of treatment was rated as excellent in 33% of cases, good in 46%, and fair in 21%. Better results were obtained in patients without extramuscular involvement. CONCLUSION Percutaneous sclerotherapy can be effective and safe for maxillofacial intramuscular venous malformations, especially for localized lesions of the masseter muscle.
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Affiliation(s)
- Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Satoru Sasaki
- Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Hiroshi Furukawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan; Department of Plastic and Reconstructive Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Taku Maeda
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takahiro Miura
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yuki Sasaki
- Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Emi Funayama
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
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9
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Punchak MA, Hollawell ML, Viaene AN, Cahill AM, Storm PB, Madsen PJ, Tucker AM. Large scalp venous malformation in a pediatric patient managed with sclerotherapy and surgery: a case report and review of literature. Childs Nerv Syst 2023; 39:295-299. [PMID: 35849142 DOI: 10.1007/s00381-022-05608-2] [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: 06/02/2022] [Accepted: 07/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Venous malformations (VMs) are slow-flow vascular anomalies present at birth that enlarge during adolescence, subsequently causing thrombosis, hemorrhage, and pain. CASE PRESENTATION We describe a case of an adolescent male presenting with a large scalp venous malformation. Given the size and location of the lesion, a hybrid approach employing both sclerotherapy and surgical resection was utilized. The VM was successfully removed without complication. CONCLUSION A hybrid approach is a safe and effective treatment consideration for immediate management of large venous malformation in higher-risk locations.
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Affiliation(s)
- Maria A Punchak
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | - Madison L Hollawell
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Angela N Viaene
- Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anne Marie Cahill
- Division of Interventional Radiology, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Phillip B Storm
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Peter J Madsen
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexander M Tucker
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Waters MJ, Hinshelwood J, Chaudry MI. Interventional Treatment of Vascular Anomalies. Dermatol Clin 2022; 40:489-497. [DOI: 10.1016/j.det.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Cryoablation of Soft Tissues Low-Flow Vascular Malformations: Clinical Outcomes and Safety. Cardiovasc Intervent Radiol 2022; 45:1784-1792. [DOI: 10.1007/s00270-022-03247-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/29/2022] [Indexed: 11/02/2022]
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Lilje D, Wiesmann M, Hasan D, Riabikin A, Ridwan H, Hölzle F, Nikoubashman O. Interventional therapy of extracranial arteriovenous malformations of the head and neck—A systematic review. PLoS One 2022; 17:e0268809. [PMID: 35839171 PMCID: PMC9286278 DOI: 10.1371/journal.pone.0268809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/06/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The primary aim of this study was to conduct a meta-analysis of the literature on interventional treatment for patients with extracranial AVM of the head and neck to identify a superior treatment. The secondary aim was to evaluate the methodological quality of associated articles published between 2000–2020. Methods The literature search was conducted on PubMed, Embase, the Cochrane Library, and scholar.google.com. Studies, meeting the acceptable reference standard underwent meta-analysis. All identified literature underwent methodological quality analysis. Results Of 1560 screened articles, 56 were included in the literature review. Appropriate diagnostic tests were reported in 98% of included articles. 13% of included articles did not specify the embolization agent. Outcome analysis varied throughout. 45% of the authors used radiographic imaging for follow-up. 77% specified the span of follow-up of their entire patient collective. Two articles met the inclusion criteria for meta-analysis. Curing rate of transarterial ethanol embolization for intraosseous AVM was 83% with a complication rate of 58%. Curing rate of ethanol combined with NBCA or Onyx in soft tissue AVM was 18% with a complication rate of 87%. Conclusion Our literature review revealed an absence of treatment or reporting standards for extracranial AVM of the head and neck. The meta-analysis is comprised of two articles and methodological quality is heterogeneous. We recommend implementing consistent reporting standards to facilitate comparability of studies and to provide robust data for the development of an evidence-based treatment strategy. Advances in knowledge Meta-analysis showed a favorable radiological outcome for intraosseous AVM when treated with intraarterial ethanol embolization. Our analysis demonstrated that the published data on extracranial AVMs of the head and neck is lacking in consistency and quality, prompting agreement for the need of standardized reporting on AVM treatments.
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Affiliation(s)
- Daniel Lilje
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Dimah Hasan
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Alexander Riabikin
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Hani Ridwan
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Hölzle
- Department of Oral, Maxillofacial and Facial Plastic Surgery University Hospital RWTH Aachen, Aachen, Germany
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
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Long-Term Outcome of Single-Session, Ultrasound-Guided, Radiofrequency Ablation for Symptomatic Small, Lower Limb, Venous Malformations. J Belg Soc Radiol 2022; 106:68. [PMID: 35891680 PMCID: PMC9284999 DOI: 10.5334/jbsr.2801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/21/2022] [Indexed: 11/20/2022] Open
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Jan I, Shah A, Beigh SH. Therapeutic Effects of Intralesional Bleomycin Sclerotherapy for Non-Invasive Management of Low Flow Vascular Malformations - A Prospective Clinical Study. Ann Maxillofac Surg 2022; 12:151-156. [PMID: 36874789 PMCID: PMC9976851 DOI: 10.4103/ams.ams_65_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/10/2022] [Accepted: 09/21/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Bleomycin, a cytotoxic and antitumour drug, is safe and effective in the management of vascular anomalies prevalent in the head and neck region. The aim of our study was to evaluate the effect of intralesional bleomycin injection in vascular malformations (VMs), especially venous and lymphatic malformations present extracranially on the face, lips and intraorally. Subjects and Methods This prospective clinical study was conducted in the Department of Oral and Maxillofacial Surgery, Government Dental College, Srinagar. The study included 30 patients with low-flow VMs (LFVMs) wherein the effectiveness of intralesional bleomycin sclerotherapy was evaluated. The recorded data was compiled and continuous variables were expressed as mean ± standard deviation and categorical variables were summarised as frequency and percentages. Results Complete resolution (cure) was observed in 11 patients (36.66%), marked improvement in 17 patients (56.66%) and mild improvement in two patients (6.66%). Local complications were superficial ulcerations in 14 patients (46.66%) and hyperpigmentation in one patient (3.33%). Systemic complications in the form of flu like symptoms, nausea or vomiting were not reported in any of the above-mentioned patients. Signs of pulmonary fibrosis and/or hypertension were also not reported in any of the above cases. Conclusion Intralesional bleomycin injection is a potent and safe therapeutic alternative for the treatment of haemangiomas and LFVMs. Such patients can be managed on an outpatient basis without the need of any extensive surgery, expensive armamentarium and with only minor complications.
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Affiliation(s)
- Iram Jan
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Srinagar, Jammu and Kashmir, India
| | - Ajaz Shah
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Srinagar, Jammu and Kashmir, India
| | - Shahid Hassan Beigh
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Srinagar, Jammu and Kashmir, India
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Rabe E, Breu FX, Flessenkämper I, Gerlach H, Guggenbichler S, Kahle B, Murena R, Reich-Schupke S, Schwarz T, Stücker M, Valesky E, Werth S, Pannier F. Sclerotherapy in the treatment of varicose veins : S2k guideline of the Deutsche Gesellschaft für Phlebologie (DGP) in cooperation with the following societies: DDG, DGA, DGG, BVP. DER HAUTARZT 2021; 72:23-36. [PMID: 33252705 PMCID: PMC8692296 DOI: 10.1007/s00105-020-04705-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E Rabe
- Emeritus Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn (AöR), Venusberg-Campus 1, 53127, Bonn, Germany.
| | | | | | | | | | - B Kahle
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - R Murena
- Phlebologische Praxis, Köln, Germany
| | - S Reich-Schupke
- Privatpraxis für Haut- und Gefäßmedizin, Wundtherapie, Recklinghausen, Germany
| | - T Schwarz
- Praxis für Gefäßmedizin, Freiburg, Germany
| | - M Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, St. Josef Hospital, Bochum, Germany
| | - E Valesky
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinik Frankfurt, Frankfurt, Germany
| | - S Werth
- Universitäts-Gefäßzentrum, Innere Medizin III, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - F Pannier
- Praxis Dermatologie & Phlebologie Bonn und Dermatologische Universitätsklinik Köln, Bonn, Germany
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Zu W, Jiang B, Liu H. Establishment of a long-term hypertrophic scar model by injection of anhydrous alcohol: A rabbit model. Int J Exp Pathol 2021; 102:105-112. [PMID: 33710702 DOI: 10.1111/iep.12389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 12/16/2022] Open
Abstract
The processes of hypertrophic scar formation are extremely complex, and current animal models have limitations in terms of the complete characterization of lesions. An ideal animal model is indispensable for exploring the complex progression of scar formation to elucidate its pathophysiology and to perform therapeutic testing. This study aimed to establish a long-term, consistent and easily testable animal model by injecting anhydrous alcohol into the dorsal trunk dermis of rabbits. The rabbits were injected with different amounts of anhydrous alcohol. Anhydrous alcohol was infiltrated into the subcutaneous and superficial fascia. The optimal amount of anhydrous alcohol was determined by measuring the area and thickness of the scar. The typical model was established by determining the optimum dosage, and then we analysed the histological characteristics and fibrosis-associated protein expression. The dermal scar was generated by treating with 2 ml/kg anhydrous alcohol and displayed histopathologic features that characterize human hypertrophic scarring, including a parallel collagen fibre orientation, dermal and epidermal thickening, broad collagen deposition and the loss of dermal adnexal structures. The expression of fibrotic pan-markers was also enhanced. Moreover, the scar features and duration were compared between the anhydrous alcohol model and the rabbit ear model. Our results show that injecting anhydrous alcohol in the rabbit model thickened the dermal tissue, stimulated dermal fibroproliferation and resulted in hypertrophic scars with protein and histologic features similar to those seen in humans. Taken together, the findings from this study show that our model could be a feasible and useful tool for further research on the pathogenesis of hypertrophic scars.
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Affiliation(s)
- Wenxuan Zu
- Department of Anatomy, Bengbu Medical College, Bengbu, China
| | - Banghong Jiang
- Department of Plastic Surgery, 1st Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Plastic Surgery, 1st Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Hongwei Liu
- Department of Plastic Surgery, 1st Affiliated Hospital of Jinan University, Guangzhou, China
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[Guidelines for sclerotherapy of varicose veins : S2k guideline of the German Society of Phlebology (DGP) in cooperation with the following professional associations: DDG, DGA, DDG, BVP. German Version]. DER HAUTARZT 2021; 72:50-64. [PMID: 33151348 DOI: 10.1007/s00105-020-04707-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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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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Commentary on Effectiveness and Safety of Ethanol for the Treatment of Venous Malformations. Dermatol Surg 2020; 46:1519-1520. [PMID: 33252460 DOI: 10.1097/dss.0000000000002387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jiménez-Jiménez CE, Radial Tagliapetra L, Silva-Restrepo IE, Hossman-Galindo MA, Rueda JD, Quiroga Villalobos F. Tratamiento de malformaciones y tumores vasculares, en un centro de referencia en Bogotá. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introducción. Las malformaciones vasculares son anomalías que están presentes desde el nacimiento, no desaparecen y pueden crecer a lo largo de la vida. Se ha demostrado en estudios retrospectivos que la terminología para clasificar las anomalías vasculares es inexacta en un 69 % de casos, por lo que se hace un diagnostico inadecuado y en un 53 % de casos se brinda al paciente y su familia una información incorrecta del tratamiento y el curso clínico.
Métodos. Estudio prospectivo longitudinal, realizado entre 2016 y 2019, donde se incluyeron pacientes con anomalías vasculares, que consultaron a nuestra institución, fueron valorados por el servicio de cirugía vascular, se hizo un plan diagnóstico y manejo integral, vía endovascular, quirúrgica o mixta, de acuerdo con cada caso.
Resultados. La malformación más común fue la de tipo venoso, en el 40,3 % de los casos. Se realizó manejo endovascular en el 93,1 % de casos de malformaciones vasculares y quirúrgico en el 6,9 %. La mejoría de los síntomas que motivaron la consulta fue del 100 % para los tumores vasculares y del 70,8 % para las malformaciones. Sin embargo, los resultados son heterogéneos.
Discusión. Es necesario realizar un adecuado diagnóstico de las anomalías vasculares, para alcanzar un tratamiento eficaz, con mejoría de los síntomas.
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Huf VI, Wohlgemuth WA, Uller W, Piehler AP, Goessmann H, Stroszczynski C, Jung EM. Contrast-enhanced ultrasound with perfusion analysis in patients with venous malformations before and after percutaneous treatment with ethanol-gel. Clin Hemorheol Microcirc 2020; 76:161-170. [PMID: 32925019 DOI: 10.3233/ch-209215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Percutaneous sclerotherapy is a well-established treatment option for venous malformations (VM). A recently established sclerosing agent is ethanol-gel. Aim of this study was to identify, if contrast-enhanced ultrasound (CEUS) with an integrated perfusion analysis allows for differentiation between untreated VM, healthy tissue, and with gelified ethanol treated malformation tissue. MATERIAL AND METHODS In this institutional review board approved prospective study symptomatic VM patients underwent CEUS at exactly the same position before and after sclerotherapy with ethanol-gel. Two experienced sonographers performed all examinations after the bolus injection of microbubbles using a multi-frequency probe with 6 -9 MHz of a high-end ultrasound machine. An integrated perfusion analysis was applied in the center of the VM and in healthy, surrounding tissue. For both regions peak enhancement (peak), time to peak (TTP), area under the curve (AUC), and mean transit time (MTT) were evaluated. Wilcoxon signed rank test was executed; p-values <0.05 were regarded statistically significant. RESULTS In 23 patients including children (mean age 25.3 years, 19 females) before treatment all identified parameters were significantly higher in the VM center compared to healthy tissue (peak: p < 0.01; TTP: p < 0.01; AUC: p < 0.01; MTT: p < 0.01). Comparing the VM center before and after treatment, TTP (p < 0.02) and MTT (p < 0.01) reduced significantly after sclerotherapy. In surrounding tissue only peak changed after treatment in comparison to pre-treatment results (p = 0.04). Comparing data in the VM center with surrounding tissue after sclerotherapy, results still differed significantly for peak (p < 0.01), TTP (p < 0.01), and AUC (p < 0.01), but assimilated for MTT (p = 0.07). CONCLUSION All with CEUS identified parameters seem to be excellent tools for differentiating between VM and healthy tissue. TTP and MTT could distinguish between with ethanol-gel sclerotized VM portions and untreated malformation parts and thereby might assist the monitoring of sclerotherapy with ethanol-gel.
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Affiliation(s)
- V I Huf
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - W A Wohlgemuth
- Interdisciplinary Center for Vascular Anomalies, University Clinic and Polyclinic of Radiology, University Hospital Halle, Halle (Saale), Germany
| | - W Uller
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - A P Piehler
- OnkoMedeor, MVZ Freising Laboratory, Freising, Germany
| | - H Goessmann
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - C Stroszczynski
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - E M Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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Markovic JN, Nag U, Shortell CK. Safety and efficacy of foam sclerotherapy for treatment of low-flow vascular malformations in children. J Vasc Surg Venous Lymphat Disord 2020; 8:1074-1082. [PMID: 32284312 DOI: 10.1016/j.jvsv.2019.11.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/23/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Congenital vascular malformations are a heterogeneous group of lesions with the potential to cause significant lifelong morbidity in children. Diagnosis and treatment of these lesions may be complex and require a multidisciplinary approach. Sclerotherapy is widely used for the treatment of low-flow vascular malformations (LFVMs) as an alternative to surgical resection in adults; however, limited data of its use in a pediatric setting are available. The purpose of this study was to evaluate the efficacy and safety of sclerotherapy for pediatric LFVMs. METHODS In this retrospective study, we reviewed our multidisciplinary vascular malformations team database for all patients younger than 18 years treated for congenital vascular malformations from 2008 to 2017. Of these, patients with LFVM treated with foam sclerotherapy were included. Dynamic contrast-enhanced magnetic resonance imaging was used to select patients for sclerotherapy by the multidisciplinary team. Foam sclerotherapy was performed with either polidocanol or sodium tetradecyl sulfate. Patients' characteristics, including demographics, presenting symptoms, and anatomic location of malformation, were assessed. Outcomes included treatment response, number of procedures, and postprocedural complications. RESULTS The 61 patients with 61 LFVMs included 27 boys (44.3%) and 34 girls (55.7%), with mean age of 10.3 years (standard deviation, ± 5.3 years). The cohort included 32 venous (52.5%), 16 lymphatic (26.2%), and 8 mixed venous and lymphatic (13.1%) malformations along with 5 (8.2%) associated with Klippel-Trénaunay syndrome. Primary indications for intervention included pain and swelling (n = 12 [19.6%]), pain alone (n = 23 [37.7%]), swelling alone (n = 15 [24.6%]), functional impairment (n = 8 [13.1%]), and bleeding (n = 3 [4.9%]). Anatomic distributions varied, with 13 head and neck (21.3%), 5 truncal (8.2%), 10 upper extremity (16.4%), 27 lower extremity (44.3%), and 6 diffuse (9.8%). Among the head and neck lesions, 8 (13.1%) extended to the face; and of the extremity lesions, 5 (8.2%) extended to the hand and 17 (27.9%) to the foot. Overall, sclerotherapy resulted in significant improvement or complete resolution of symptoms in 53 patients (86.9%). Complications were observed in seven patients (11.4%); six cases (9.8%) of superficial skin ulceration resolved without intervention, and one infection (1.6%) required antibiotics. No patients experienced adverse hemodynamic consequences or venous thromboembolism. CONCLUSIONS This series of pediatric LFVMs, the largest of its kind to date, demonstrates that sclerotherapy with foam-based agents effectively reduces symptoms with an acceptable rate of complications. Further study is needed to determine the optimal sclerosing agents for individual subsets of LFVMs in the pediatric population.
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Affiliation(s)
- Jovan N Markovic
- Division of Vascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC.
| | - Uttara Nag
- Division of Vascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Cynthia K Shortell
- Division of Vascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC
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Meuli L, Galanis N, Dick F. Successful Endovascular Treatment of a Ruptured Giant Lumbar Arteriovenous Malformation. Vasc Specialist Int 2020; 36:33-37. [PMID: 32274373 PMCID: PMC7119147 DOI: 10.5758/vsi.2020.36.1.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/30/2020] [Accepted: 02/24/2020] [Indexed: 11/21/2022] Open
Abstract
Arteriovenous malformations (AVMs) are rare congenital vascular anomalies where rupture can be fatal. This report describes a case of a 69-year-old woman who presented with sudden severe lower back pain radiating to her left buttock and thigh and an inability to move her left leg. Computed tomography angiography (CTA) showed an extensive ruptured retroperitoneal AVM on the left paravertebral side with active bleeding and a large hematoma. Cardiopulmonary resuscitation with considerable blood transfusion was required. The AVM was effectively treated with coil embolization of the feeding lumbar arteries. Shortly after the intervention, the patient developed abdominal compartment syndrome. Urgent laparotomy with evacuation of the retroperitoneal hematoma was required. The patient was discharged 16 days after admission in a good physical condition and has been free of symptoms for more than a year after intervention. However, follow-up CTA showed residual contrast enhancement in the AVM and further surveillance is required.
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Affiliation(s)
- Lorenz Meuli
- Department of Vascular Surgery, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Nektarios Galanis
- Department of Vascular Surgery, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Florian Dick
- Department of Vascular Surgery, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
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Sclerotherapy for Venous Malformations of the Pharynx or the Tongue Base Without Tracheostomy: Treatment Protocol With Intubation and Outcomes. J Craniofac Surg 2020; 31:702-706. [PMID: 32149978 DOI: 10.1097/scs.0000000000006230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Venous malformations (VMs) occurring in the tongue base or pharynx are rare, but can cause airway obstruction. Considering the potential issues or morbidity related to surgical resection in the tongue or pharynx region, sclerotherapy is often preferred. We perform sclerotherapy for such lesions without conducting tracheotomy, but keep patients intubated for a certain period. Outcomes of sclerotherapy, and benefits and cautions related with our protocol were investigated.Our subjects were 10 cases in 9 patients who underwent sclerotherapy for VMs of the tongue base (6 patients) or pharynx (3 patients) from 2008 to 2017. One patient underwent treatment sessions twice. The sclerosants used were absolute ethanol (ET) (3 cases), 5% ethanolamine oleate (EO) (4 cases), or both ET and 5%EO (3 cases).In 5 of 9 patients, postoperative MRI was performed, which revealed lesion volume reduction by 12% to 47%. The intubation period varied according to the sclerosant used: ET, 5 to 11 days; 5% EO, 2 to 12 days; and combination of ET and 5% EO, 8 days. Postoperative complications included fever of unknown (n = 2), acute psychosis (n = 3), vocal cord paralysis (n = 2), and bradycardia induced from the use of a sedative agent (n = 1). One patient complained of mild transient swallowing difficulty that lasted for a month postoperatively.Although our method mandatorily requires careful postoperative management in an ICU, including sedation with anesthetic agents and artificial respiration by intubation for a certain period of time, no serious complications or post-therapeutic morbidities occurred.
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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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Sun Y, Gu H, Yang X, Cai R, Shang Y, Hu L, Wang Y, Chen H, Lin X. Bleomycin Polidocanol Foam (BPF) Stability - In Vitro Evidence for the Effectiveness of a Novel Sclerosant for Venous Malformations. Eur J Vasc Endovasc Surg 2020; 59:1011-1018. [PMID: 32063463 DOI: 10.1016/j.ejvs.2020.01.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/14/2019] [Accepted: 01/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study investigated the in vitro stability of a novel sclerosant, bleomycin polidocanol foam (BPF), for venous malformation (VM) sclerotherapy. METHODS The study was designed with control groups treated with polidocanol (0.5%, 1%, and 3%) only. The experimental groups included 21 BPFs, which was made by dissolving bleomycin at seven different concentrations (0.1%-1.5%) in polidocanol (0.5%, 1%, and 3%). The Tessari method was used to prepare sclerosant foam with a liquid:gas ratio of 1:4 at room temperature in vitro. The foam stability was measured for each group. The decay process, one component of foam stability, was recorded with a camera. Foam decay process experiments were performed 10 times per group. The stability indices included drainage rate, drainage time, half life, and microscopic measurement of the foams (mean bubble diameter, minimum and maximum bubble diameters, wall thickness, and bubble diameter distribution). RESULTS Compared with the control groups, the half lives of BPFs mainly increased significantly with the addition of bleomycin (p < .001). BPF with 3% polidocanol and 0.1% bleomycin recorded the highest half life (246 ± 1.6 sec), and this group also achieved the smallest bubble diameter and wall thickness (69.9 μm and 5.80 μm) among the experimental groups. For the same polidocanol concentration, the bubble diameter and wall thickness increased when bleomycin was added. CONCLUSION Bleomycin concentrations account for different BPF stability. BPF stability mainly increased significantly with the addition of a small amount of bleomycin but this advantage was no longer apparent with increasing bleomycin dose.
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Affiliation(s)
- Yi Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, Shanghai, PR China
| | - Hao Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, Shanghai, PR China
| | - Xi Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, Shanghai, PR China
| | - Ren Cai
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, Shanghai, PR China
| | - Ying Shang
- Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Li Hu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, Shanghai, PR China
| | - Yungying Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, Shanghai, PR China
| | - Hui Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, Shanghai, PR China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, Shanghai, PR China.
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Badarudeen B, Roy N, Pillai H. Management of a curious case of a large recurrent truncal vascular anomaly in a young adult. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Saphenous venous cavernous angioma masquerading as an aneurysm. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Ishikawa K, Yamamoto Y, Funayama E, Furukawa H, Sasaki S. Wound-Healing Problems Associated with Combined Vascular Malformations in Klippel-Trenaunay Syndrome. Adv Wound Care (New Rochelle) 2019; 8:246-255. [PMID: 31832274 DOI: 10.1089/wound.2018.0835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/18/2018] [Indexed: 01/19/2023] Open
Abstract
Significance: In Klippel-Trenaunay syndrome (KTS), management of a wound in the affected limb can be difficult because of the underlying vascular malformations present. This review describes the characteristics of KTS with wound complications in light of the genetic and molecular mechanisms of the disease. Recent Advances: KTS is a slow-flow combined vascular malformation characterized by the triad of capillary malformation, venous malformation with or without lymphatic malformation, and limb overgrowth. KTS is encompassed within the phosphatidylinositol-4,5-bisphosphate3-kinase catalytic subunit alpha (PIK3CA)-related overgrowth spectrum (PROS), having recently been linked to activating mutations in the PIK3CA gene. This clearly has implications for both molecular diagnosis and potential treatment strategies for the disease. Critical Issues: KTS should be distinguished from Parkes Weber syndrome, a fast-flow-type combined vascular malformation with limb overgrowth. Individualized management is needed for KTS and should be focused on the treatment of symptoms. Future Directions: Targeted therapies that inhibit the phosphoinositide 3-kinase signaling pathway are a potential treatment option for PROS.
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Affiliation(s)
- Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Emi Funayama
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Furukawa
- Department of Plastic and Reconstructive Surgery, Aichi Medical University, Nagakute, Japan
| | - Satoru Sasaki
- Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Japan
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Bhalla S, Acharya V, Ally M, Taghi A. Acute presentation of an intraoral dermoid cyst causing airway compromise in a young child. BMJ Case Rep 2019; 12:12/4/e228421. [PMID: 31023732 DOI: 10.1136/bcr-2018-228421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 4-month-old boy presented with a cystic swelling at the floor of the mouth causing acute airway compromise. The only previous history of note, was a tongue tie release at 3 days old. CT scan suggested a dermoid cyst with extensive floor of mouth abscess. He had an excision of the cyst and drainage of the superimposed abscess and made a good recovery. The histology report revealed a dermoid cyst which is a rare diagnosis in a child, particularly within the oral cavity. Early treatment is required to remove these lesions especially when they cause airway compromise or swallowing difficulties. This is the first case to our knowledge which suggests tongue tie release procedures causes a predisposition to the development of dermoid cysts in the oral cavity.
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Affiliation(s)
- Sanjana Bhalla
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Vikas Acharya
- General Surgery, Luton and Dunstable Hospital NHS Trust, Luton, UK
| | - Munira Ally
- Department of Otolaryngology, Charing Cross Hospital, London, UK
| | - Ali Taghi
- Ear, Nose and Throat Surgery, Imperial College Healthcare NHS Trust, London, UK
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Li HB, Zhang J, Li XM, Zhou SY, Niu CQ, Liu ZY, Lu LG. Clinical efficacy of absolute ethanol combined with n-butyl cyanoacrylate sclerotherapy in the treatment of Puig's classified advanced venous malformation in children. Exp Ther Med 2019; 17:1276-1281. [PMID: 30680003 PMCID: PMC6327634 DOI: 10.3892/etm.2018.7051] [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] [Received: 05/01/2018] [Accepted: 11/07/2018] [Indexed: 12/27/2022] Open
Abstract
The aim of the present retrospective study was to investigate the clinical safety and efficacy of absolute ethanol combined with n-butyl cyanoacrylate sclerotherapy in the treatment of Puig's classified advanced venous malformation. Sclerotherapy was performed in 121 children (52 males and 69 females; age range, 5 months to 16 years) with venous malformations under general anesthesia between April 2009 and October 2014 at the Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China. The patients with venous malformations were diagnosed and classified according to the diagnostic criteria of the International Society for the Study of Vascular Anomalies. According to the characteristics of intraoperative percutaneous angiography, 21 patient cases (9 males and 12 females; age range, 6 months to 14 years) were classified as advanced Puig's venous malformation. These 21 patients were treated with absolute ethanol combined with n-butyl cyanoacrylate. The patients were followed-up for 6–24 months (average, 15 months) after treatment. Following treatment with absolute ethanol combined with n-butyl cyanoacrylate, 15 cases were controlled and the total effective rate was 71% (15/21). However, 1 patient developed skin ulcerations, which was classed as a minor complication, 1 patient developed ectopic embolism caused by n-butyl cyanoacrylate reflux, and 1 patient developed transient pulmonary hypertension, the latter two complications were classified as major. Notably, the incidence rate of minor and major complications were 14.3%. To conclude, the present findings indicated that absolute ethanol combined with n-butyl cyanoacrylate sclerotherapy was a safe and effective method with a low complication rate in the treatment of Puig's classified advanced venous malformation in patients.
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Affiliation(s)
- Hai-Bo Li
- Department of Interventional Radiology, Affiliated South China Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China.,Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou Medical Univercity, Guangzhou, Guangdong 510120, P.R. China
| | - Jing Zhang
- Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou Medical Univercity, Guangzhou, Guangdong 510120, P.R. China
| | - Xiao-Mei Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Shao-Yi Zhou
- Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou Medical Univercity, Guangzhou, Guangdong 510120, P.R. China
| | - Chuan-Qiang Niu
- Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou Medical Univercity, Guangzhou, Guangdong 510120, P.R. China
| | - Zhen-Yin Liu
- Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou Medical Univercity, Guangzhou, Guangdong 510120, P.R. China
| | - Li-Gong Lu
- Department of Interventional Radiology, Affiliated South China Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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Preliminary Experience With More Stable Polidocanol Foam in Sclerotherapy of Head and Neck Venous Malformations. Dermatol Surg 2018; 44:1421-1426. [PMID: 29933299 DOI: 10.1097/dss.0000000000001587] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Foam sclerotherapy is an effective treatment strategy for venous malformations (VMs). Stability is one of the characteristics of sclerosant foams that determine the sclerosing power. OBJECTIVE To evaluate the clinical outcomes of sclerotherapy with prolonged half-life of hyaluronic acid (HA)-polidocanol (POL) foam for treating head and neck VMs. MATERIALS AND METHODS Seventy patients with head and neck VMs were enrolled between October 2013 and January 2015 in Qilu Hospital Shandong University. Sclerotherapy was performed with prolonged half-life POL foam by addition of 0.05% HA. All patients were followed up at 1, 3, and 6 months. Reviews on the site and size of the lesion, times and duration of treatments, therapeutic response, and complications were performed to evaluate the end result. RESULTS Sites of lesions included face, bucca, parotid region, neck, tongue, floor of mouth, lip, forehead, palate, and nose. An overall average of 2.5 treatments was required. Total response rate was 100%. "Resolution" was achieved in 21 cases (30%) and a significant response in 49 patients (70%). Immediate swelling was the most common complication. Epidermal extravasation was seen in 1 patient. Mucosal ulcer was observed in 1 patient. No generalized complications occurred. CONCLUSION The prolonged half-life of HA-POL foam sclerotherapy of VMs in the head and neck is safe and effective.
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Regarding “An institution-wide algorithm for direct-stick embolization of peripheral venous malformations”. J Vasc Surg Venous Lymphat Disord 2018; 6:677. [DOI: 10.1016/j.jvsv.2018.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/25/2018] [Indexed: 11/20/2022]
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34
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Morresey PR. Traditional Chinese veterinary medicine: Basis for treatment of iatrogenic rectal paralysis. EQUINE VET EDUC 2018. [DOI: 10.1111/eve.12709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wang SK, Drucker NA, Gupta AK, Marshalleck FE, Dalsing MC. Diagnosis and management of the venous malformations of Klippel-Trénaunay syndrome. J Vasc Surg Venous Lymphat Disord 2018. [PMID: 28624001 DOI: 10.1016/j.jvsv.2016.10.084] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE A dearth of information exists in the literature regarding current practice in the management of Klippel-Trénaunay syndrome (KTS), a rare condition. We review and describe the etiology, diagnosis, and treatment of KTS. METHODS Relevant data were synthesized from a Medline review using a combination of the keyterms "Klippel" and "Trénaunay." The majority of hits described singular case reports and were subsequently excluded. The remaining papers were then reviewed and included on the basis of the quality of evidence and the authors' discretion. CONCLUSIONS KTS is characterized by a clinical triad of extremity varicosities, cutaneous vascular malformations, and hypertrophy of soft tissues and long bones. The diagnosis is clinically supplemented with magnetic resonance imaging and computed tomography. Although this syndrome is associated with significant comorbidities, such as pain, edema, ulcerations, and pruritus, it is rarely the cause of death. The backbone of treatment is nonoperative in nature but should be supplemented with minimally invasive, endovascular, and rarely open surgical procedures for refractory cases.
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Affiliation(s)
- S Keisin Wang
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind; Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Natalie A Drucker
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Alok K Gupta
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind; Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | | | - Michael C Dalsing
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind; Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind.
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Gorman J, Zbarsky SJ, Courtemanche RJM, Arneja JS, Heran MKS, Courtemanche DJ. Image guided sclerotherapy for the treatment of venous malformations. CVIR Endovasc 2018; 1:2. [PMID: 30652135 PMCID: PMC6319514 DOI: 10.1186/s42155-018-0009-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/02/2018] [Indexed: 11/20/2022] Open
Abstract
Background Percutaneous sclerotherapy is the preferred method of treatment for VMs (venous malformations). However, treatment protocols vary, and research on the most effective sclerosant is conflicting. Additionally, there is limited knowledge on the effect of sclerosant volume on treatment outcome. This study aims to determine the outcomes and complications of image-guided sclerotherapy for VMs with respect to sclerosant and sclerosant volume. Towards this, a 10-year retrospective chart review was conducted of patients with VMs treated with sclerotherapy at the Vascular Anomalies Clinic at British Columbia Children’s Hospital. Results Thirty-four patients with VMs were treated of which 15 had a successful outcome, 13 had a failed outcome, and 6 had additional planned treatments after the study time period. Lesions on the head and neck or classified as type I or II had the highest success rates. Combination therapy with both ethanol and 3% STS (sodium tetradecyl sulphate), and ethanol alone had a higher success rate (64% and 60%) compared to 3% STS (11%). Major complications were most associated with 3% STS (17%) followed by ethanol (9%), and no major complications were found with combination. No relationship between the volume of sclerosant per lesion volume and outcome was found. Conclusions Combination and ethanol were the most effective sclerosants in terms of highest success rates and lowest complication rates, and sclerosant volume per lesion volume had no effect on outcomes. Future work should aim at studying larger sample sizes to account for the multiple factors that may influence the choice of sclerosant and treatment outcomes.
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Affiliation(s)
| | | | - Rebecca J M Courtemanche
- 2Department of Surgery, University of British Columbia, British Columbia Children's Hospital, Vancouver, BC V6H 3V4 Canada
| | - Jugpal S Arneja
- 3Department of Surgery, Division of Plastic Surgery, University of British Columbia, British Columbia Children's Hospital, K3-131 4480 Oak St., Vancouver, BC V6H 3V4 Canada
| | - Manraj K S Heran
- 4Department of Radiology, University of British Columbia, British Columbia Children's Hospital, Vancouver, BC V6H 3V4 Canada
| | - Douglas J Courtemanche
- 3Department of Surgery, Division of Plastic Surgery, University of British Columbia, British Columbia Children's Hospital, K3-131 4480 Oak St., Vancouver, BC V6H 3V4 Canada
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Complications After Treatment of Head and Neck Venous Malformations With Sodium Tetradecyl Sulfate Foam. J Craniofac Surg 2018; 28:e388-e392. [PMID: 28328612 DOI: 10.1097/scs.0000000000003723] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate complications in patients with head and neck venous malformations (VMs) treated with foam sclerotherapy using sodium tetradecyl sulfate (STS). METHODS The authors retrospectively evaluated the complications, pain. and degree of satisfaction in 69 consecutive patients affected by cervicofacial VM managed with STS using the Tessari method in a single institution. RESULTS The average number of procedures for each patient was 2.1. The most frequent complication was blistering. We observed 1 patient of temporary weakness of a facial nerve branch, 1 paradoxical embolism, and 1 orbital compartment syndrome.The average pain score was 0 (no pain at all) (51.5%). There was no statistically significant correlation between patient satisfaction and the presence of complications or the degree of pain. CONCLUSIONS Sclerotherapy with STS is an effective treatment that yields to very high patient satisfaction. This procedure has an overall low complication rate and is usually effective within a few sessions. However, severe complications may occur; these must be pointed out in the informed consent and the surgeon must be aware of and ready to quickly treat them to prevent long-term sequelae.
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Jiang B, Zu W, Xu J, Xiong Z, Zhang Y, Gao S, Ge S, Zhang L. Botulinum toxin type A relieves sternocleidomastoid muscle fibrosis in congenital muscular torticollis. Int J Biol Macromol 2018; 112:1014-1020. [PMID: 29447964 DOI: 10.1016/j.ijbiomac.2018.02.077] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 12/20/2022]
Abstract
Congenital muscular torticollis (CMT) is a neck deformity that involves shortening of sternocleidomastoid muscle (SCM) characterized by muscle atrophy and interstitial fibrosis. To investigate wheatear Botulinum toxin type A (BTA) has anti-fibrotic effects in CMT, we established acquired muscular torticollis that mimetics CMT in rabbit by intra-SCM injection of anhydrous alcohol. The treatment groups received BTA (2.5units or 5units) injection into the fibrotic SCM. The shortening and thickening of SCM were recorded by B-mode ultrasound. Changes in Col1A1, Fn, α-SMA expression were determined by immunohistochemistry. In vitro studies, TGF-β induced NIH3T3 fibroblasts were used to evaluate anti-fibrosis effect of BTA. Expression of the myofibroblast marker α-SMA and fibrosis markers Col1A1 and Fn were detected by Western blotting and quantitative RT-PCR. Our results showed that BTA injection attenuated shortening and thickening of fibrotic SCM. Elevated expression of Col1A1, Fn, α-SMA were confirmed in this fibrotic muscle model but reversed after BTA injection. Similar results observed in TGF-β induced NIH3T3 fibroblasts in both mRNA and protein levels. In conclusion, our results suggested that BTA could be a promising agent against SCM fibrosis in CMT through regulating fibroblast and inhibiting myofibroblast differentiation.
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Affiliation(s)
- Banghong Jiang
- Department of Plastic Surgery, 1st Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui 233000, PR China
| | - Wenxuan Zu
- Department of Anatomy, Bengbu Medical College, Bengbu, Anhui 233000, PR China
| | - Jing Xu
- Department of Plastic Surgery, 1st Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui 233000, PR China
| | - Zhuyou Xiong
- Department of Plastic Surgery, 1st Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui 233000, PR China
| | - Yichao Zhang
- Department of Ultrasonography, Bengbu Second People's Hospital, Bengbu, Anhui 233004, PR China
| | - Song Gao
- Department of Plastic Surgery, 1st Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui 233000, PR China
| | - Shuxing Ge
- Department of Plastic Surgery, 1st Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui 233000, PR China
| | - Li Zhang
- Department of Plastic Surgery, 1st Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui 233000, PR China.
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Seront E, Vikkula M, Boon LM. Venous Malformations of the Head and Neck. Otolaryngol Clin North Am 2018; 51:173-184. [DOI: 10.1016/j.otc.2017.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Nassiri N, Huntress LA, Simon M, Murphy S. An institution-wide algorithm for direct-stick embolization of peripheral venous malformations. J Vasc Surg Venous Lymphat Disord 2018; 6:351-357. [PMID: 29396158 DOI: 10.1016/j.jvsv.2017.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/20/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE No standardized therapeutic algorithm or embolic agent of choice has yet been identified for management of congenital peripheral venous malformations (VMs). Treatment options and reported outcomes therefore vary widely. Herein, we present an institution-wide algorithm for management of symptomatic congenital peripheral VMs using a single embolotherapeutic modality. METHODS During 36 months, patients with symptomatic congenital peripheral VMs underwent contrast-enhanced magnetic resonance imaging. Hematologic monitoring for localized intravascular coagulopathy was performed in all. Perioperative anticoagulation was administered accordingly. When applicable, venous duplex ultrasound was performed to assess for presence and patency of a deep venous system and superficial venous reflux. If superficial venous reflux was identified, radiofrequency ablation was performed per standard protocol before or at the time of initial embolization. Direct-stick embolizations (DSEs) were performed by a single operator using two concentrations (1% and 3%) of sodium tetradecyl sulfate (STS; Sotradecol; AngioDynamics, Latham, NY) without foam preparation. Patients were followed up clinically for resolution of symptoms, coagulopathic monitoring, and development of complications. All data were prospectively maintained and retrospectively reviewed. RESULTS There were 71 DSEs performed in 40 patients (1.8 procedures per patient [range, 1-8]; 12 male patients; mean age, 22 years [range, 2-53 years]). Mean follow-up was 17.1 months (range, 0.8-31.6 months). Presenting symptoms included pain (n = 40 [100%]), swelling (n = 36 [90%]), and cosmetic disfigurement (n = 32 [80%]). Anatomic distribution was upper extremity (n = 16 [23%]), lower extremity (n = 37 [52%]), head and neck (n = 7 [10%]), trunk (n = 10 [14%]), and visceral (n = 1 [1%]). There were 33 sporadic cases, 4 (10%) Klippel-Trénaunay syndrome cases, 2 (5%) blue rubber bleb nevus syndrome cases, and 1 (2.5%) CLOVES (congenital lipomatous overgrowth, vascular malformations, epidermal nevus, and skeletal deformities) syndrome case. Four patients presented with localized intravascular coagulopathy, two of whom required perioperative enoxaparin. Twenty-six patients (65%) required a single DSE session with complete symptom relief. Fourteen patients (35%) required repeated DSE. Two patients (5%) required adjunctive surgical excision. There was one postoperative death (1.4%) secondary to massive pulmonary embolism. Complications were otherwise limited to skin necrosis (n = 2 [3%]). Mean volume of sclerosant per session was 7 mL of 1% STS (range, 3-14 mL), and 15 mL of 3% STS (range, 3-42.5 mL). CONCLUSIONS In the absence of allergic reactions, most congenital peripheral VMs can be safely embolized with liquid STS, thereby avoiding the well-documented toxicity of ethanol. Venous thromboembolism remains a major source of morbidity and mortality in this population of patients despite close hematologic scrutiny. Prospective randomized trials are needed for embolotherapeutic standardization.
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Affiliation(s)
- Naiem Nassiri
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine and Yale New Haven Hospital, New Haven, Conn.
| | | | - Mitchell Simon
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Susan Murphy
- Division of Hematology, Department of Medicine, Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Leung YCL, Leung MWY, Yam SD, Hung JWS, Liu CSW, Chung LY, Tang MY, Fung HS, Poon WL, Chao NSY, Liu KKW. D-dimer level correlation with treatment response in children with venous malformations. J Pediatr Surg 2018; 53:289-292. [PMID: 29221638 DOI: 10.1016/j.jpedsurg.2017.11.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/08/2017] [Indexed: 01/19/2023]
Abstract
AIM Localized intravascular coagulopathy is present in children with venous malformations (VMs) as evidenced by elevated D-dimer levels. Few studies have looked into the changes in D-dimer after sclerotherapy and its correlation with treatment outcome and complications. Our study aims to investigate changes in D-dimer in children with VMs undergoing alcohol sclerotherapy. METHODS A prospective cohort study from 2014 to 2016, which included children (<18years) with VM undergoing alcohol sclerotherapy, was completed. Demographics and lesion characteristics were recorded. Perioperative D-dimer levels were collected 2weeks prior to treatment (baseline) and on postoperative days 1, 2, 5, and 14, respectively. A raised postoperative D-dimer was defined as a peak level of at least 50% increase of baseline D-dimer. Children were followed up with documentation of lesional size at 6months and long-term recurrence beyond 6months of treatment. RESULTS Eighteen children were identified (10 females, 8 males) with a median follow up of 21months. Overall, 15 patients (83%) had a satisfactory outcome. Baseline D-dimer levels were high in 8 patients (44%). Postoperative D-dimer level was raised in 12 patients irrespective of their baseline levels, with 92% peaking on postoperative day one (n=11). In the elevated D-dimer group, 11 patients had a satisfactory outcome, and 10 patients did not have long-term recurrence. We did not encounter any complications in our cohort. CONCLUSION Changes in perioperative D-dimer levels may predict early treatment response and long-term recurrence after alcohol sclerotherapy. With a standardized protocol, alcohol sclerotherapy for venous malformation is safe with minimal complications. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yvonne Chi-Lun Leung
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China.
| | - Michael Wai-Yip Leung
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
| | - Shi-Da Yam
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
| | - Judy Wing-Suet Hung
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
| | - Clarence Sze-Wai Liu
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
| | - Lap-Yan Chung
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
| | - Man-Yee Tang
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
| | - Hon-Shing Fung
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong, China
| | - Wai-Lun Poon
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong, China
| | - Nicholas Sih-Yin Chao
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
| | - Kelvin Kam-Wing Liu
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
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42
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Abstract
OBJECTIVE In the treatment of venous malformations, ethanol may be administered in a gelified form to increase local effects and reduce systemic ones. The purpose of this prospective study was to evaluate the efficacy and safety of a commercially available viscous ethanol gel in the treatment of venous malformations. SUBJECTS AND METHODS Thirty-one patients (mean age, 23.4 years; age range, 6.6-46.5 years) with venous malformations were prospectively scheduled for two ethanol-gel sclerotherapy sessions. Venous malformations were located at the lower extremity (n = 18), the upper extremity (n = 9), and the face (n = 4). Questionnaires to assess pain, clinical examinations, professional photographs, and contrast-enhanced MRI of the venous malformations were performed before and after therapy to measure therapy-induced changes. Two experienced radiologists blinded to the examination date and clinical status compared photographs and MR images before and after treatment. RESULTS A mean of 4.2 mL of ethanol gel were administered per session. The technical success rate was 100%. Clinical success, defined as improvement or resolution of symptoms, was noted in 81% of patients. Mean pain score decreased, and the difference was statistically significant (3.9 vs 3.1, p = 0.005). In 54 treatment sessions where follow-up was available, four minor complications occurred. Comparison of photographs and MR images before and after treatment showed improvement in 35% and 93% of patients, respectively. CONCLUSION Ethanol gel is an effective and safe sclerosing agent in the treatment of venous malformations.
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Ali S, Mitchell SE. Outcomes of Venous Malformation Sclerotherapy: A Review of Study Methodology and Long-Term Results. Semin Intervent Radiol 2017; 34:288-293. [PMID: 28955118 DOI: 10.1055/s-0037-1604300] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
It is very important that patients seeking sclerotherapy for the treatment of venous malformations are aware of the expected course of the therapy. They should be thoroughly counseled about the complications, the need for multiple sessions of therapy, and also about the expected clinical outcome. The aim of this review is to discuss the long-term outcomes of sclerotherapy for the treatment of venous malformation. Many studies have discussed their individual center's experiences and short-midterm results, but there is a relative paucity of data on long-term outcomes. We have reviewed the literature and also shared our experience of a large cohort of patients ( n = 116) with a relatively longer follow-up period of more than 1 year. Venous malformations are very complex lesions and their treatment is quite variable depending on its extent and complexity. As a result, outcome studies vary considerably in the choice of sclerosant, study methodology, outcome assessment (clinical vs. imaging), and grading scales. This review also highlights this extreme heterogeneity in the literature of the sclerotherapy outcome and summarizes a few national and international studies for comparison.
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Affiliation(s)
- Sumera Ali
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sally E Mitchell
- Division of Interventional Radiology, Johns Hopkins Medicine, Baltimore, Maryland
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Teusch V, Piehler A, Uller W, Müller-Wille R, Prantl L, Stroszczynski C, Wohlgemuth W, Jung E. Value of different ultrasound elastography techniques in patients with venous malformations prior to and after sclerotherapy. Clin Hemorheol Microcirc 2017; 66:347-355. [DOI: 10.3233/ch-179106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- V.I. Teusch
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
- Department of Radiology, Klinikum Schwabing, Städtisches Klinikum München, Munich, Germany
| | - A.P. Piehler
- Bioscientia Institute for Medical Diagnostics GmbH, Karlsfeld, Germany
| | - W. Uller
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - R. Müller-Wille
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - L. Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - C. Stroszczynski
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - W.A. Wohlgemuth
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - E.M. Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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Cornelis FH, Marin F, Labrèze C, Pinsolle V, Le Bras Y, Midy D, Grenier N. Percutaneous cryoablation of symptomatic venous malformations as a second-line therapeutic option: a five-year single institution experience. Eur Radiol 2017; 27:5015-5023. [PMID: 28677056 DOI: 10.1007/s00330-017-4892-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 04/17/2017] [Accepted: 05/11/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE To report the mid-term outcomes of percutaneous cryoablation (PCA) performed as second-line therapeutic option of venous malformations (VM). MATERIAL AND METHODS From 2011 to 2015, PCA was offered in 24 patients (mean age: 31 years, range: 12-64) as second-line treatment for recurrence of symptoms after sclerotherapy and when resection was not possible (due to lesion location or previous failure) or refused by the patient. Adverse effects were recorded, disease-free survival (DFS) and local tissue control (LTC) rates were calculated based on symptoms and volume evolution. RESULTS Mean follow-up was 18.7 months (6-48). Nine (37.5%, 9/24) adverse effects occurred and three (12.5%, 3/24) were severe. Mean pain assessed by visual analog scale (VAS) was 41.7 mm (0-80) before treatment and 20.3 mm (0-80) (p=0.01) after. Mean volume decreased significantly after treatment from 22.4 cm3 (0.9-146) to 8.35 cm3 (0-81.3) (p<0.001). Pain recurred in nine patients and size of one lesion increased. The DFS and LTC rates were 54% [95%CI: 22.94-77.27] and 93.33% [61.26-99.03] at 24 months, respectively. Only VM volume >10 cm3 was associated with a higher risk of local recurrence (p=0.05). CONCLUSION PCA as second-line treatment appears to be safe and effective for local control of VM according to mid-term results. KEY POINTS • Percutaneous cryoablation of venous malformations appeared well tolerated. • Size of venous malformations decreased significantly after percutaneous cryoablation (p<0.001). • Pain decreased significantly after percutaneous cryoablation of venous malformations (p=0.01).
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Affiliation(s)
- F H Cornelis
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France. .,Department of Radiology, Tenon Hospital, APHP, 4 rue de la Chine, 75020, Paris, France.
| | - F Marin
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - C Labrèze
- Department of Pediatric Dermatology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - V Pinsolle
- Department of Aesthetic Surgery, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Y Le Bras
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - D Midy
- Department of Vascular Surgery, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - N Grenier
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
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Homa LD, Smorgick-Rosenbaum N, Smith YR, Gemmete JJ, Quint EH. Congenital Venous Lymphatic Malformation as an Unusual Source of Premenarchal Vaginal Bleeding. J Pediatr Adolesc Gynecol 2017; 30:367-369. [PMID: 26880044 DOI: 10.1016/j.jpag.2016.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Premenarchal vaginal bleeding can present a diagnostic challenge and has not been previously reported in association with congenital venous lymphatic malformation. CASE A 3-year-old girl presented with intermittent vaginal bleeding since birth. Evaluation showed premenarchal estradiol and gonadotropin hormones, a normal pelvic ultrasound and normal colonoscopy. Examination under anesthesia and vaginoscopy showed a congested appearance of the hymen and vaginal petechiae. Sudden development of a vulvar cyst led to a pelvic magnetic resonance imaging scan, which revealed a venous malformation of the pelvis and vulvar lymphatic cyst. Vaginal bleeding stopped for approximately 6 months after sclerotherapy with doxycycline and ethanol, however recurred and required repeat sclerotherapy. SUMMARY AND CONCLUSION Congenital venous lymphatic malformations can rarely be associated with premenarchal vaginal bleeding and should be considered when all more common etiologies have been ruled out. Diagnosis is made using magnetic resonance imaging, and treatment might include doxycycline and ethanol sclerotherapy.
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Affiliation(s)
- Lori D Homa
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
| | | | - Yolanda R Smith
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Joseph J Gemmete
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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47
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Lee BB, Laredo J, Kim YW, Neville R. Congenital Vascular Malformations: General Treatment Principles. Phlebology 2017; 22:258-63. [DOI: 10.1177/026835550702200606] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The era where surgical excision alone was the sole treatment of venous malformation (VM) is now over. A multidisciplinary approach that utilizes both traditional surgical therapy and endovascular therapy is now the standard of care. Endovascular therapy utilizing primarily both embolization therapy and sclerotherapy is the treatment of choice for surgically ‘inaccessible' VM lesions. Surgical therapy of VM lesions has been shown to be more effective when combined with supplemental endovascular therapy.
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Affiliation(s)
- B B Lee
- Department of Surgery, Georgetown University, Washington, DC, USA
| | - J Laredo
- Department of Surgery, Georgetown University, Washington, DC, USA
| | - Y W Kim
- Department of Surgery, SungKyunKwan University
- SamSung Medical Centre, Seoul, Korea
| | - R Neville
- Department of Surgery, Georgetown University, Washington, DC, USA
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48
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Lee BB, Laredo J, Lee SJ, Huh SH, Joe JH, Neville R. Congenital Vascular Malformations: General Diagnostic Principles. Phlebology 2017. [DOI: 10.1177/026835550702200605] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Venous malformation (VM) is the most common congenital vascular malformation (CVM), which usually presents as a single lesion in the majority of cases. It also presents as a mixed lesion combined with other CVMs (e.g. lymphatic malformation and arteriovenous malformation [AVM]). Therefore, the diagnosis of VM should include an appropriate work-up, to not only confirm and characterize the VM as either extratruncular or truncular but also to diagnose or exclude the presence of other CVMs. The diagnosis of VM can be made safely using non-invasive to minimally invasive studies, which can also distinguish VM from infantile haemangioma. Invasive studies, such as venography and arteriography, are generally reserved for therapeutic planning and diagnosis of more virulent CVMs (e.g. AVM). The work-up of VM should include a complete assessment of the extent and severity of the primary VM lesion. In addition, its embryologic origin, as well as its haemodynamic characteristics and secondary effects should also be determined.
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Affiliation(s)
- B B Lee
- Department of Surgery, Georgetown University, Washington, DC, USA
| | - J Laredo
- Department of Surgery, Georgetown University, Washington, DC, USA
| | - S J Lee
- Department of Surgery, SungKyunKwan University
- Department of Surgery, SamSung Medical Centre, Seoul, Republic of Korea
| | - S H Huh
- Department of Surgery, SungKyunKwan University
- Department of Surgery, SamSung Medical Centre, Seoul, Republic of Korea
| | - J H Joe
- Department of Surgery, SungKyunKwan University
- Department of Surgery, SamSung Medical Centre, Seoul, Republic of Korea
| | - R Neville
- Department of Surgery, Georgetown University, Washington, DC, USA
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49
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Abstract
Klippel–Trenaunay syndrome (KTS) is a rare, sporadic, complex malformation characterized by the clinical triad of (1) capillary malformations (port wine stain); (2) soft tissue and bone hypertrophy or, occasionally, hypotrophy of usually one lower limb; and (3) atypical, mostly lateral varicosity. KTS is a mixed vascular malformation, with predominant capillary, venous and lymphatic components, without significant arteriovenous shunting. Management is largely conservative and the extent of diagnostic evaluation is determined by the planned treatment. Compression is the hallmark of conservative management; laser can be used to treat port wine stains. Imaging before vascular interventions must confirm venous anatomy and deep venous drainage. Techniques for ablation of superficial veins and malformations are individualized and may include sclerotherapy with alcohol or foam, endovenous thermal ablation or, as used most frequently in our practice, surgical stripping and phlebectomy. Intraoperative use of tourniquet will decrease bleeding, selective use of an inferior vena cava filter will prevent pulmonary embolism. A multidisciplinary approach to management of KTS is warranted.
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Affiliation(s)
- P Glovkzki
- Division of Vascular Surgery
- Gonda Vascular Center, Mayo Clinic
| | - D J Driscoll
- Department of Paediatrics
- Vascular Malformation Clinic, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
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50
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Abstract
Venous malformations may occur either as localized or segmental lesions. Radiologic imaging defines the extent of involvement but magnetic resonance imaging is the best modality: it gives a bright hypersignal on T2-weighted spin-echo sequences. During a 30-month period, 1427 patients were investigated for venous disorders and 1% were found to have venous angiomata (9 women and 5 men). The age range was 15 to 76 years (mean 30.8 ± 18.6 years). Foam was produced by the Tessari technique using 1% or 2% concentration of polidocanol. The duplex Doppler was used for ultrasound guidance to insure intravenous flow of foam and to monitor effects of treatment. A goal of pain-free healing of ulcers or cosmetic improvement was set for each patient. The mean number of treatments was 3.6 ± 2.8 (range 1–10). Pain-free healing was achieved in patients with non-healing ulcerations and cosmetically, all of the patients were improved. Sclerosant foam is useful in treating low-flow venous malformations.
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Affiliation(s)
- J Bergan
- Vein Institute of La Jolla, La Jolla
| | - V Cheng
- Department of Surgery, UCSD School of Medicine, San Diego, CA, USA
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