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Fraissenon A, Fortin F, Durous V, Chauvel-Picard J, Gleizal A, Viremouneix L, Cabet S, Guibaud L. Percutaneous Sclerotherapy of Large Venous Malformations Using Consecutive Polidocanol and Bleomycin Foam: MR Imaging Volumetric and Quality-of-Life Assessment. J Vasc Interv Radiol 2024; 35:127-136.e1. [PMID: 37704038 DOI: 10.1016/j.jvir.2023.09.004] [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: 05/04/2023] [Revised: 08/23/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE To retrospectively evaluate sclerotherapy using consecutive polidocanol and bleomycin foam (CPBF) for large untreated venous malformations (VMs) and/or those resistant to prior treatment. MATERIALS AND METHODS This retrospective study included all patients treated with CPBF for untreated VMs larger than 10 mL and/or refractory to treatment between May 2016 and October 2019. Baseline and follow-up VM volumes were measured on fat-suppressed T2-weighted magnetic resonance (MR) imaging. Outcome was evaluated on postprocedural MR imaging volumetry and by a retrospective survey assessing clinical response and adverse events. Imaging response was considered good for volume reduction from 50% to 70% and excellent for volume reduction ≥70%. Symptoms and quality-of-life (QoL) scores were compared before and after CPBF sclerotherapy. RESULTS Forty-five patients (mean age, 16 years; range, 1-63 years; 25 males) with 57 VMs were analyzed and treated by 80 sclerotherapy. Sixty percent (27 of 45) of patients had undergone prior treatment for VM. Median VM volume was 36.7 mL (interquartile range, 84 mL) on pretherapy MR imaging. Good and excellent results after the last sclerotherapy were achieved in 36% (16 of 45) and 29% (13 of 45) of patients, respectively, corresponding to a decrease of >50% in 60% (34 of 57) of VMs. QoL score increased by at least 3 points, regardless of initial symptoms. Most patients did not desire additional sclerotherapy owing to near complete symptomatic relief, even for patients who did not achieve a good response. Swelling, pain, and motor impairment scores significantly improved after CPBF. Adverse events included fever (44%, 15 of 34) and nausea/vomiting (29%, 10 of 34). CONCLUSIONS CPBF sclerotherapy represents an effective therapy for large and/or refractory VMs with minimal adverse events.
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Affiliation(s)
- Antoine Fraissenon
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France; Service de Radiologie Mère-Enfant, Hôpital Nord, Saint Etienne, France
| | - Francis Fortin
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France; Département d'imagerie médicale, Hôpital Sainte-Justine, Montréal, Québec, Canada
| | - Vincent Durous
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France
| | - Julie Chauvel-Picard
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France; Service de chirurgie cranio-maxillo-faciale et plastique pédiatrique, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France
| | - Arnaud Gleizal
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France; Service de chirurgie cranio-maxillo-faciale et plastique pédiatrique, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France
| | - Loïc Viremouneix
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France
| | - Sara Cabet
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France
| | - Laurent Guibaud
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France.
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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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Altenbernd J, Kutta F, Forsting M, Theysohn J, Rohde S. Results of interventional treatment of peripheral slow-flow malformations. CVIR Endovasc 2023; 6:5. [PMID: 36763217 PMCID: PMC9918669 DOI: 10.1186/s42155-023-00352-3] [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] [Received: 10/20/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND In recent years sclerotherapy has increasingly become the treatment of choice for peripheral slow-flow malformations. However, the long-term effectiveness of sclerotherapy is still a matter of debate, especially when it comes to new sclerosing agents like polidocanol. This study aims at gathering further information concerning its long-term effectiveness and safety. RESULTS Most patients reported a reduction of symptoms which include pain (57,7%), swelling (65,4%) and functional impairment (60%). Cosmetic complaints were less likely to be reduced by sclerotherapy (44,4%). In most cases a relief of symptoms was stable for many years, especially after several consecutive treatment sessions. Complication rates were comparably low, with only 2 patients requiring additional treatment at hospital and no lasting damages. (…) (7) Most patients (70,9%) were at least partially satisfied with the treatment. Satisfaction was closely linked to a partial or complete relief of symptoms (p = 0.001). CONCLUSION Sclerotherapy is a promising way of treating slow-flow-malformations. Polidocanol has proved to be a save sclerosing agent. The reduction of major symptoms was substantial in most cases and lasted for many years.
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Affiliation(s)
- Jens Altenbernd
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 22, 45122, Essen, Germany.
| | - Felix Kutta
- grid.410718.b0000 0001 0262 7331Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 22, 45122 Essen, Germany
| | - Michael Forsting
- grid.410718.b0000 0001 0262 7331Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 22, 45122 Essen, Germany
| | - Jens Theysohn
- grid.410718.b0000 0001 0262 7331Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 22, 45122 Essen, Germany
| | - Stefan Rohde
- Radiology and Neuroradiology, Klinikum Dortmund gGmbH, Dortmund, Germany
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The Efficiency and Safety of Ethanol Sclerotherapy for Labial Arteriovenous Malformations. J Vasc Surg Venous Lymphat Disord 2021; 10:713-720.e1. [PMID: 34774812 DOI: 10.1016/j.jvsv.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE: Labial arteriovenous malformations, usually with accompanying cosmetic defects, pain, and bleeding, are aggressive with characteristics of high risk of recurrence and absence of effective treatment. This study presents a technique of sclerotherapy for labial arteriovenous malformations. METHODS Patients with labial arteriovenous malformations were treated with percutaneous ethanol sclerotherapy with or without polyvinyl alcohol particle embolization. The efficiency, complications, and recurrence rate were analyzed with imaging and clinical follow-up data. RESULTS Of the 15 patients, all patients received one or more treatment sessions, from which eight realized a cure (53.3%) and five had remission (33.3%). Two patients who did not achieve an effective result await further treatment. Four (26.7%) patients treated with ethanol sclerotherapy combined with polyvinyl alcohol particle embolization developed recurrence. No recurrence occurred in patients treated with only sclerotherapy (mean ± SD follow-up 17.2 ± 8.1 months). Thirteen patients developed transient complications: swelling, mild bleeding, and blistering. One patient had a postoperative scar of about 0.5 cm. CONCLUSIONS Ethanol sclerotherapy appears effective as a treatment for labial arteriovenous malformations. Careful application of the treatment can reduce the occurrence of complications.
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Jantz MA, Omballi M, Alzghoul BN, Fernandez Bussy S, Becnel D, Majid A, Mehta HJ. Utility of bronchoscopic intra-tumoral alcohol injection to restore airway patency. J Thorac Dis 2021; 13:4956-4964. [PMID: 34527334 PMCID: PMC8411124 DOI: 10.21037/jtd-20-3554] [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: 04/27/2021] [Accepted: 07/23/2021] [Indexed: 11/06/2022]
Abstract
Background In cases of malignant airway obstruction, achieving airway patency using conventional bronchoscopic modalities can be challenging and may not be satisfactory. We aim to present our experience of using intra-tumoral alcohol injection (ITAI) to help achieve airway patency in malignant airway obstruction. Methods A retrospective study of adult patients presenting with malignant airway obstruction who underwent bronchoscopy with ITAI at a university center between 2015 and 2020 was conducted. We present procedural and patients' characteristics along with any additional bronchoscopic or systemic interventions received. Patients were classified based on airway patency response (assessed qualitatively by an interventional pulmonologist) into those with good response (≥50% improvement in airway patency) vs. those with low response (<50% improvement in airway patency). Results Forty-two patients underwent ITAI, of which 34 (81%) had at least two bronchoscopies to evaluate response. The patient median age was 65.5 [interquartile range (IQR) 57.8-72]. Most patients had stage IV malignancy at the time of the bronchoscopy (57.1%) and had Eastern Cooperative Oncology Group (ECOG) performance status score of between 2-3. Eighty-two percent of the patients achieved good airway patency response at the conclusion of the procedures. The procedures were generally well-tolerated and only one patient had significant bleeding that was not directly related to ITAI and required intensive care unit monitoring for 24 hours after the procedure. Conclusions Dehydrated alcohol is readily available, inexpensive and a safe drug that can be potentially injected directly in malignant airway obstructive lesions in a multimodality approach to achieve airway patency when traditional modalities reach their limitation. Further studies are warranted to determine whether ITAI is superior to other interventional methods, explore its utilization to treat peripheral malignant tumors, as well as to standardize the treatment protocol and determine the effects of ITAI on patient symptoms and quality of life.
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Affiliation(s)
- Michael A Jantz
- Pulmonary Medicine, North Florida Regional Medical Center, Gainesville, FL, USA
| | - Mohamed Omballi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Bashar N Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | | | - David Becnel
- Division of Pulmonary, Critical Care and Sleep Medicine, Tulane University, New Orleans, LA, USA
| | - Adnan Majid
- Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess medical center, Boston, MA, USA
| | - Hiren J Mehta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
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Mimura H, Akita S, Fujino A, Jinnin M, Ozaki M, Osuga K, Nakaoka H, Morii E, Kuramochi A, Aoki Y, Arai Y, Aramaki N, Inoue M, Iwashina Y, Iwanaka T, Ueno S, Umezawa A, Ozeki M, Ochi J, Kinoshita Y, Kurita M, Seike S, Takakura N, Takahashi M, Tachibana T, Chuman K, Nagata S, Narushima M, Niimi Y, Nosaka S, Nozaki T, Hashimoto K, Hayashi A, Hirakawa S, Fujikawa A, Hori Y, Matsuoka K, Mori H, Yamamoto Y, Yuzuriha S, Rikihisa N, Watanabe S, Watanabe S, Kuroda T, Sugawara S, Ishikawa K, Sasaki S. Japanese clinical practice guidelines for vascular anomalies 2017. Jpn J Radiol 2020; 38:287-342. [PMID: 32207066 PMCID: PMC7150662 DOI: 10.1007/s11604-019-00885-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
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Affiliation(s)
- Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, Fukuoka University, School of Medicine, Fukuoka, Japan
| | - Akihiro Fujino
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Mine Ozaki
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroki Nakaoka
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Kuramochi
- Department of Dermatology, Saitama Medical University, Irumagun, Japan
| | - Yoko Aoki
- Department of Medical Genetics, Tohoku University School of Medicine, Sendai, Japan
| | - Yasunori Arai
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Noriko Aramaki
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Iwashina
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigeru Ueno
- Department of Pediatric Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Junko Ochi
- Department of Diagnostic Radiology, Tohoku University, Sendai, Japan
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masakazu Kurita
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shien Seike
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuyuki Takakura
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Masataka Takahashi
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Kumiko Chuman
- Department of Dermatology, Kanto Central Hospital, Tokyo, Japan
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke’s International Hospital, Tokyo, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St Luke’s International Hospital, Tokyo, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Satoshi Hirakawa
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsuko Fujikawa
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Matsuoka
- Department of Pathology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Japan
| | - Hideki Mori
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoaki Rikihisa
- Department of Plastic and Reconstructive Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Shoji Watanabe
- Department of Plastic and Reconstructive Surgery, Saitama Children’s Medical Center, Saitama, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Sasaki
- Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Japan
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Ethanol embolization of lingual arteriovenous malformations: Positive experience in 52 patients during 11 years. J Vasc Surg 2020; 72:651-657.e4. [DOI: 10.1016/j.jvs.2019.08.286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/16/2019] [Indexed: 11/19/2022]
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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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Mimura H, Akita S, Fujino A, Jinnin M, Ozaki M, Osuga K, Nakaoka H, Morii E, Kuramochi A, Aoki Y, Arai Y, Aramaki N, Inoue M, Iwashina Y, Iwanaka T, Ueno S, Umezawa A, Ozeki M, Ochi J, Kinoshita Y, Kurita M, Seike S, Takakura N, Takahashi M, Tachibana T, Chuman K, Nagata S, Narushima M, Niimi Y, Nosaka S, Nozaki T, Hashimoto K, Hayashi A, Hirakawa S, Fujikawa A, Hori Y, Matsuoka K, Mori H, Yamamoto Y, Yuzuriha S, Rikihisa N, Watanabe S, Watanabe S, Kuroda T, Sugawara S, Ishikawa K, Sasaki S. Japanese Clinical Practice Guidelines for Vascular Anomalies 2017. J Dermatol 2020; 47:e138-e183. [PMID: 32200557 PMCID: PMC7317503 DOI: 10.1111/1346-8138.15189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 01/19/2023]
Abstract
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety and systematizing treatment, employing evidence‐based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQ) were decided based on the important clinical issues. For document retrieval, key words for published work searches were set for each CQ, and work published from 1980 to the end of September 2014 was searched in PubMed, Cochrane Library and Japana Centra Revuo Medicina databases. The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System technique. A total of 33 CQ were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence‐based guidelines for the management of vascular anomalies.
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Affiliation(s)
- Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, Fukuoka University, School of Medicine, Fukuoka, Japan
| | - Akihiro Fujino
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Mine Ozaki
- Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroki Nakaoka
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Kuramochi
- Department of Dermatology, Saitama Medical University, Iruma-gun, Japan
| | - Yoko Aoki
- Department of Medical Genetics, Tohoku University School of Medicine, Sendai, Japan
| | - Yasunori Arai
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Noriko Aramaki
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Iwashina
- Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigeru Ueno
- Department of Pediatric Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Junko Ochi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masakazu Kurita
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shien Seike
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuyuki Takakura
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Masataka Takahashi
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Kumiko Chuman
- Department of Dermatology, Kanto Central Hospital, Tokyo, Japan
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Satoshi Hirakawa
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsuko Fujikawa
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Matsuoka
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hideki Mori
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoaki Rikihisa
- Department of Plastic and Reconstructive Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Shoji Watanabe
- Department of Plastic and Reconstructive Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Sasaki
- Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Japan
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Mimura H, Akita S, Fujino A, Jinnin M, Ozaki M, Osuga K, Nakaoka H, Morii E, Kuramochi A, Aoki Y, Arai Y, Aramaki N, Inoue M, Iwashina Y, Iwanaka T, Ueno S, Umezawa A, Ozeki M, Ochi J, Kinoshita Y, Kurita M, Seike S, Takakura N, Takahashi M, Tachibana T, Chuman K, Nagata S, Narushima M, Niimi Y, Nosaka S, Nozaki T, Hashimoto K, Hayashi A, Hirakawa S, Fujikawa A, Hori Y, Matsuoka K, Mori H, Yamamoto Y, Yuzuriha S, Rikihisa N, Watanabe S, Watanabe S, Kuroda T, Sugawara S, Ishikawa K, Sasaki S. Japanese clinical practice guidelines for vascular anomalies 2017. Pediatr Int 2020; 62:257-304. [PMID: 32202048 PMCID: PMC7232443 DOI: 10.1111/ped.14077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 01/19/2023]
Abstract
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
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Affiliation(s)
- Hidefumi Mimura
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Akihiro Fujino
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Mine Ozaki
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroki Nakaoka
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Kuramochi
- Department of Dermatology, Saitama Medical University, Irumagun, Japan
| | - Yoko Aoki
- Department of Medical Genetics, Tohoku University School of Medicine, Sendai, Japan
| | - Yasunori Arai
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Noriko Aramaki
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Iwashina
- Department of Plastic and Reconstructive, Aesthetic Surgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigeru Ueno
- Department of Pediatric Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Junko Ochi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiaki Kinoshita
- Department of Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masakazu Kurita
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shien Seike
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuyuki Takakura
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Masataka Takahashi
- Department of Reproductive Biology, Center for Regenerative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Kumiko Chuman
- Department of Dermatology, Kanto Central Hospital, Tokyo, Japan
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St Luke's International Hospital, Tokyo, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Satoshi Hirakawa
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsuko Fujikawa
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Matsuoka
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hideki Mori
- Department of Plastic Surgery, Ehime University Hospital, Toon, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoaki Rikihisa
- Department of Plastic and Reconstructive Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Shoji Watanabe
- Department of Plastic and Reconstructive Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Sasaki
- Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Japan
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Arteriovenous Malformations: Syndrome Identification and Vascular Management. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:67. [PMID: 30019284 DOI: 10.1007/s11936-018-0662-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Vascular malformations represent a poorly understood set of conditions that create considerable diagnostic and therapeutic confusion. Historically, extensive surgical resections yielded poor results. More recently, the treatment paradigm has shifted to endovascular therapy such that embolization and sclerotherapy are now considered the first line of treatment. Although there is still a role for traditional surgical techniques, it is now most commonly integrated with endovascular therapies in a hybrid fashion. The goal of this review is to provide a greater understanding of the diagnosis and treatment of vascular malformations. RECENT FINDINGS Vascular malformations can be high-flow (arteriovenous shunting) or low-flow (venous or lymphatic). Clinical presentation and treatment is different for each. Treatment of high-flow lesions must be directed at reducing or eliminating the nidus, usually via super-selective catheterization and embolization. Low-flow lesions are usually treated by direct injection of sclerosing agents under fluoroscopic or ultrasound guidance. The cornerstone of managing patients with vascular malformations is making the proper diagnosis, which is often challenging. Even after a diagnosis is made, therapy itself may be challenging and generate frustration among patients and providers. Frequently, the treatment of vascular malformations is characterized by only slow and incremental improvements without complete lesion eradication. By combining a thorough understanding of the vascular malformation disease process with an array of endovascular techniques, vascular interventionalists may contribute greatly to the care of these patients.
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12
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Abstract
Vascular anomalies of the head and neck region are a complex group of lesions that challenge the head and neck physicians. From the very understanding of the difference between its two distinct forms, hemangiomas and vascular malformations to its management remain confusing. The review of this anomaly attempts at comprehensively understanding the disease. Vascular anomalies are easily diagnosed by their clinical presentation, but choice of imaging and management for this spectrum of lesions is varied. The author attempts to categorize the required imaging for the lesion with suggestions on the management of both hemangiomas and vascular malformations. The available treatment options are discussed, and a comprehensive algorithm for management is suggested. Further research in developing drugs that could restrict the growth of these lesions would be the future of the management of vascular lesions.
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Affiliation(s)
- S. C. Nair
- Maxillofacial Surgery Department, Bangalore Institute of Dental Sciences, Bangalore, India
- Maxillofacial Surgery Department, B M Jain Hospital, Bangalore, India
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13
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Kitagawa A, Yamamoto T, Matsunaga N, Yamaji M, Ikeda S, Izumi Y, Hagihara M, Ota T, Ishiguchi T. Polidocanol Sclerotherapy Combined with Transarterial Embolization Using n-Butyl Cyanoacrylate for Extracranial Arteriovenous Malformations. Cardiovasc Intervent Radiol 2018; 41:856-866. [PMID: 29417264 PMCID: PMC5937878 DOI: 10.1007/s00270-017-1855-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022]
Abstract
Purpose To assess the safety and effectiveness of polidocanol sclerotherapy combined with transarterial embolization using a liquid adhesive agent (n-butyl cyanoacrylate, NBCA) for treatment of extracranial arteriovenous malformations (AVMs). Materials and Methods Twenty-three patients with symptomatic AVMs in the head and neck (6), upper (7) and lower extremity (10) with a mean age of 42 years (range 4–74) treated with polidocanol sclerotherapy were retrospectively assessed. AVMs were classified according to the angiographic morphology of the nidus. There were 2 type I, 6 type II, 6 type IIIa and 9 type IIIb. Arterial embolization using NBCA was performed to reduce arterial flow before sclerotherapy. Polidocanol mixed with contrast material or carbon dioxide was delivered by percutaneous direct puncture. Results Treatment was successfully performed in all patients. In the mean follow-up period of 38 months, symptoms resolved or improved in 20/23 patients (87.0%). AVMs were devascularized 100% in 2 patients, 76–99% in 13, 50–75% in 7 and < 50% in 1. More than 50% devascularization was seen in 22 patients (95.6%). Two (8%) patients had complete remission, 17 (74%) had partial remission and 3 (13%) had no remission. There was no aggravation. Treatment was considered effective (complete and partial remission) in 20 patients (87.0%). Minor complications including localized arterial thrombosis (2) and spontaneously healing skin ulcer (1) were seen in 2 patients (8.7%). There were no major procedure-related complications. Conclusion Polidocanol sclerotherapy combined with transarterial embolization using NBCA is safe and effective for treating extracranial AVMs with an acceptable risk of minor complications.
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Affiliation(s)
- Akira Kitagawa
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan.
| | - Takahiro Yamamoto
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Nozomu Matsunaga
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Mayako Yamaji
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Shuji Ikeda
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Yuichiro Izumi
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Makiyo Hagihara
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Toyohiro Ota
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Tsuneo Ishiguchi
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
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14
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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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15
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Kumar S, Bhavana K, Kumar S, Kumar P. Ultrasound-guided polidocanol foam sclerotherapy for treating venous malformations. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:23-31. [PMID: 29080330 DOI: 10.1002/jcu.22546] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 06/07/2023]
Abstract
AIM To evaluate clinical and imaging outcomes after ultrasound (US)-guided 3% polidocanol (POL) foam-sclerotherapy of venous malformations (VMs). METHODS We retrospectively evaluated consecutive VM cases over 1.5 years, with 6-month follow-up. US findings were used to classify VMs into four types depending upon extent of anechoic channels, connections to adjacent veins, and dysmorphism. Single or multiple needles were inserted depending upon lesion size, and used to inject up to 8 mL POL per session, every 2 to 4 weeks. We evaluated reduction in pain and swelling, lesion resolution on imaging, and patient satisfaction. RESULTS There were 15, 24, 9, and 5 patients (total 53) with type I, II, III, and IV VMs, respectively. The average number of sessions was 5.3, 4.3, and 4, and the average amount of POL injected was 14.24 mL, 16.1 mL, and 23.2 mL for type I, II, III VMs, respectively. The number of sessions correlated with lesion volume (P < .0001). Imaging showed good resolution in 4/15, 18/24, 6/9, and 4/5 patients respectively with type I, II, III, and IV VMs. Patient satisfaction was not related to lesion type (P = .1). ROC analyses showed cut-off values of 4.9 mL lesion volume, three sessions, and 12 mL POL volume for patient satisfaction. At 6 months, 23 patients having pain had significant improvement (P < .00001). Local (n = 30) and chest pain (n = 2) were the only complications. CONCLUSIONS US-guided sclerotherapy with 3% POL foam is safe and effective. Lesions with up to 50% anechoic areas had better resolution, without correlation with patient satisfaction.
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Affiliation(s)
- Subhash Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Kranti Bhavana
- Department of ENT, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Sanjeev Kumar
- Department of Trauma and Emergency (CTVS), All India Institute of Medical Sciences, Patna, Bihar, India
| | - Prem Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
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16
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Nassiri N, Crystal DT, Hoyt C, Shafritz R. Regarding the commentary for “Chronic refractory venous ulcer exacerbated by a congenital pelvic arteriovenous malformation successfully treated via transarterial Onyx embolization”. J Vasc Surg Venous Lymphat Disord 2017; 5:772-773. [DOI: 10.1016/j.jvsv.2017.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/25/2017] [Indexed: 11/26/2022]
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17
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Sujlana P, Skrok J, Fayad LM. Review of dynamic contrast‐enhanced MRI: Technical aspects and applications in the musculoskeletal system. J Magn Reson Imaging 2017; 47:875-890. [DOI: 10.1002/jmri.25810] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/20/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Parvinder Sujlana
- The Russell H. Morgan Department of Radiology and Radiological ScienceBaltimore Maryland USA
| | - Jan Skrok
- The Russell H. Morgan Department of Radiology and Radiological ScienceBaltimore Maryland USA
| | - Laura M. Fayad
- The Russell H. Morgan Department of Radiology and Radiological ScienceBaltimore Maryland USA
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Woolen S, Gemmete JJ. Treatment of Residual Facial Arteriovenous Malformations after Embolization with Percutaneous Cryotherapy. J Vasc Interv Radiol 2017; 27:1570-5. [PMID: 27670993 DOI: 10.1016/j.jvir.2016.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/20/2016] [Accepted: 05/21/2016] [Indexed: 01/23/2023] Open
Abstract
This report presents 4 patients (mean age, 22 y; range, 17-26 y) with facial arteriovenous malformations (AVMs) who underwent arterial ethanol and N-butyl cyanoacrylate embolization followed by percutaneous cryoablation of residual inaccessible AVMs. After the procedure, minor complications classified as type B according to the Society of Interventional Radiology (SIR) classification system occurred in 75% (3/4) of patients. One patient achieved 90% obliteration of AVM, and 3 patients had complete obliteration of AVM at 1-year follow-up. This reports shows that percutaneous ablation may be a viable treatment option for residual facial AVMs after ethanol and glue embolization.
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Affiliation(s)
- Sean Woolen
- From the Departments of Radiology, University of Michigan Health System, UH B1D 328, 1500 East Medical Center Drive, Ann Arbor, MI 48109
| | - Joseph J Gemmete
- From the Departments of Radiology, University of Michigan Health System, UH B1D 328, 1500 East Medical Center Drive, Ann Arbor, MI 48109; Neurosurgery, University of Michigan Health System, UH B1D 328, 1500 East Medical Center Drive, Ann Arbor, MI 48109; Otolaryngology, University of Michigan Health System, UH B1D 328, 1500 East Medical Center Drive, Ann Arbor, MI 48109.
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Compartment Syndrome after Embolization of Arteriovenous Malformation. Cardiovasc Intervent Radiol 2017; 40:1950-1953. [PMID: 28584943 DOI: 10.1007/s00270-017-1716-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
Management of arteriovenous malformations (AVMs) remains challenging because of their unpredictable course and high morbidity rate. In this case report, we present a patient with a huge AVM on the right calf who suffered complications of compartment syndrome, rhabdomyolysis, skin necrosis, and nerve damage after sclerotherapy. Limb salvage was achieved in spite of these devastating complications. A multidisciplinary team approach is important especially when making decisions for the management of a complicated AVM.
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Abstract
Venous malformations are the most common vascular anomalies. When they are superficial and large, they are easily recognized. However, when the malformation is deep or involves normally occurring veins, the diagnosis can be challenging. Extremity varicosities may be the only visible signs of the problem. Unfortunately, varicosities are often presumed to be the result of superficial venous insufficiency and the underlying venous malformation is overlooked. The phlebologist must be cognizant of the possibility that a venous malformation may be the cause of the patient's symptoms and varicosities. Ultrasound and magnetic resonance imaging can help to confirm the correct diagnosis. Treatment involves image-guided endovenous occlusion of the malformation, most commonly with potent liquid sclerosing agents. Some of these agents can cause severe complications. A thorough knowledge of the sclerosing solutions and the endovascular techniques to properly deliver them to the malformation is essential. This article will review the basic principle surrounding endovascular management of venous malformations.
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Affiliation(s)
- M Rosenblatt
- Connecticut Image Guided Surgery, Fairfield, CT, USA
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21
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Benoiton LA, Chan K, Steiner F, FitzJohn T, Tan ST. Management of Orbital and Periorbital Venous Malformation. Front Surg 2017; 4:27. [PMID: 28611988 PMCID: PMC5447072 DOI: 10.3389/fsurg.2017.00027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 05/08/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To review our management of common venous malformation (VM) affecting the orbit and/or periorbital area. METHODS Consecutive patients with orbital and/or periorbital VM were identified from our vascular anomalies database. Demographic details of the patients, anatomic site(s) affected, symptoms and signs, presence of a family history of VM, and types of treatment(s) were collected, supplemented by chart review. RESULTS A total of 24 patients' age 1-68 (mean, 30) years with orbital and/or periorbital VM presented with cosmetic concerns (n = 17, 71%), distensibility (n = 15, 63%), pain (n = 9, 38%), diplopia (n = 4, 17%), and spontaneous thrombosis (n = 1, 8%). The VM caused globe dystopia (n = 13, 54%), enophthalmos (n = 6, 25%), proptosis (n = 3, 12%), exotropia (n = 3, 12%), and pseudoptosis with visual obstruction (n = 3, 13%). A total of 11 (46%) patients were managed conservatively. 13 (54%) patients underwent active treatment. Ethanol sclerotherapy (ES) was performed in six patients with extensive facial VM associated with orbital/periorbital involvement, resulting in symptomatic improvement in five patients, one of whom developed skin necrosis and another patient developed reduced infraorbital nerve sensation. Surgery was performed for localized lesion (n = 3, 23%), for extensive lesions (n = 4, 31%) and as an adjunct to ES (n = 6, 46%) resulting in symptomatic improvement in all patients. One patient required correction of lower lid ectropion. CONCLUSION Orbital and/or periorbital VMs are heterogeneous, and management needs to be individualized. Surgery is used for localized lesions aiming for complete excision, as a debulking procedure for extensive orbital/periorbital VM when ES was not possible, or following ES for extensive facial VM with orbital and/or periorbital involvement.
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Affiliation(s)
- Lara A. Benoiton
- Centre for the Study & Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
| | - Kenneth Chan
- Centre for the Study & Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
- Department of Ophthalmology, Hutt Hospital, Wellington, New Zealand
| | | | - Trevor FitzJohn
- Centre for the Study & Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
| | - Swee T. Tan
- Centre for the Study & Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
- Gillies McIndoe Research Institute, Wellington, New Zealand
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22
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Hwang JH, Do YS, Park KB, Chung HH, Park HS, Hyun D. Embolization of Congenital Renal Arteriovenous Malformations Using Ethanol and Coil Depending on Angiographic Types. J Vasc Interv Radiol 2016; 28:64-70. [PMID: 27865576 DOI: 10.1016/j.jvir.2016.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/04/2016] [Accepted: 09/06/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate effectiveness and safety of embolization of congenital renal arteriovenous malformations (AVMs) using ethanol and/or coil according to angiographic type. MATERIALS AND METHODS Between August 2010 and October 2015, 11 patients (13 sessions; 10 women and 1 man; mean age, 50.8 y) with congenital renal AVMs were treated using ethanol and/or coils via 2 approaches (transarterial access or direct puncture). Demographics, clinical findings, diagnostic modalities, angiographic types, technical and clinical success rates, and complications were reviewed. Renal AVMs were classified into 3 angiographic types, and treatment was based on this classification. RESULTS Technical success rate was 91% (10/11), and clinical success rate was 100% (11/11). Of patients, 7 had type III AVMs, 3 had type I AVMs, and 1 had type II AVM. Embolic agents were ethanol in 5 patients, coils with ethanol in 3 patients, and coils in 3 patients. Of the 8 patients treated with ethanol, 6 had infarcted renal areas of 3.5%-30% (mean, 14.6%). After a mean follow-up period of 16.3 months, there was no evidence of recurrent AVMs on imaging or laboratory studies. CONCLUSIONS Embolization of congenital renal AVMs via transarterial or direct percutaneous approaches using ethanol and/or coils based on a simple angiographic classification was safe and effective and elicited good outcomes. Most of the patients with congenital renal AVMs were women.
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Affiliation(s)
- Jin Ho Hwang
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Young Soo Do
- Department of Radiology, Samsung Medical Center, 50 Irwon-Dong, Gangnam Gu, Seoul 135-710, Korea.
| | - Kwang Bo Park
- Department of Radiology, Samsung Medical Center, 50 Irwon-Dong, Gangnam Gu, Seoul 135-710, Korea
| | - Hwan Hoon Chung
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea
| | - Hong Suk Park
- Department of Radiology, Samsung Medical Center, 50 Irwon-Dong, Gangnam Gu, Seoul 135-710, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, 50 Irwon-Dong, Gangnam Gu, Seoul 135-710, Korea
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Wang D, Su L, Han Y, Wang Z, Zheng L, Li J, Fan X. Direct intralesional ethanol sclerotherapy of extensive venous malformations with oropharyngeal involvement after a temporary tracheotomy in the head and neck: Initial results. Head Neck 2016; 39:288-296. [PMID: 27653619 DOI: 10.1002/hed.24588] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Deming Wang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital and Faculty of Dentistry; Harbin Medical University; Harbin People's Republic of China
- Department of Interventional Radiology, Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai People's Republic of China
| | - Lixin Su
- Department of Interventional Radiology, Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai People's Republic of China
| | - Yifeng Han
- Department of Interventional Radiology, Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai People's Republic of China
| | - Zhenfeng Wang
- Department of Interventional Radiology, Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai People's Republic of China
| | - Lianzhou Zheng
- Department of Interventional Radiology, Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai People's Republic of China
| | - Jichen Li
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital and Faculty of Dentistry; Harbin Medical University; Harbin People's Republic of China
| | - Xindong Fan
- Department of Interventional Radiology, Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai People's Republic of China
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Settecase F, Hetts SW, Nicholson AD, Amans MR, Cooke DL, Dowd CF, Higashida RT, Halbach VV. Superselective Intra-Arterial Ethanol Sclerotherapy of Feeding Artery and Nidal Aneurysms in Ruptured Cerebral Arteriovenous Malformations. AJNR Am J Neuroradiol 2016; 37:692-7. [PMID: 26564434 DOI: 10.3174/ajnr.a4584] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/10/2015] [Indexed: 01/19/2023]
Abstract
In the endovascular treatment of cerebral arteriovenous malformations, ethanol sclerotherapy is seldom used due to safety concerns. However, when limited reflux of an embolic agent is permissible or when there is a long distance to the target, ethanol may be preferable. We reviewed 10 patients with 14 cerebral AVM feeding artery aneurysms or intranidal aneurysms treated with intra-arterial ethanol sclerotherapy at our institution between 2005 and 2014. All patients presented with acute intracranial hemorrhage. Thirteen of 14 aneurysms were treated primarily with 60%-80% ethanol into the feeding artery. Complete target feeding artery and aneurysm occlusion was seen in all cases; 8/13 (62%) were occluded by using ethanol alone. No retreatments or recurrences were seen. One permanent neurologic deficit (1/13, 7.7%) and no deaths occurred. In a subset of ruptured cerebral AVMs, ethanol sclerotherapy of feeding artery aneurysms and intranidal aneurysms can be performed with a high degree of technical success and a low rate of complication.
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Affiliation(s)
- F Settecase
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
| | - S W Hetts
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - A D Nicholson
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - M R Amans
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - D L Cooke
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - C F Dowd
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - R T Higashida
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - V V Halbach
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
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Goel S, Gupta S, Singh A, Prakash A, Ghosh S, Narang P, Gupta S. The current approach to the diagnosis of vascular anomalies of the head and neck: A pictorial essay. Imaging Sci Dent 2015; 45:123-31. [PMID: 26125008 PMCID: PMC4483619 DOI: 10.5624/isd.2015.45.2.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/11/2015] [Accepted: 03/21/2015] [Indexed: 11/19/2022] Open
Abstract
Throughout the years, various classifications have evolved for the diagnosis of vascular anomalies. However, it remains difficult to classify a number of such lesions. Because all hemangiomas were previously considered to involute, if a lesion with imaging and clinical characteristics of hemangioma does not involute, then there is no subclass in which to classify such a lesion, as reported in one of our cases. The recent classification proposed by the International Society for the Study of Vascular Anomalies (ISSVA, 2014) has solved this problem by including non-involuting and partially involuting hemangioma in the classification. We present here five cases of vascular anomalies and discuss their diagnosis in accordance with the ISSVA (2014) classification. A non-involuting lesion should not always be diagnosed as a vascular malformation. A non-involuting lesion can be either a hemangioma or a vascular malformation depending upon its clinicopathologic and imaging characteristics.
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Affiliation(s)
- Sinny Goel
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, Delhi, India
| | - Swati Gupta
- Department of Radiodiagnosis, Lok Nayak Jaiprakash Hospital, Delhi, India
| | - Aarti Singh
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, Delhi, India
| | - Anjali Prakash
- Department of Radiodiagnosis, Lok Nayak Jaiprakash Hospital, Delhi, India
| | - Sujoy Ghosh
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, Delhi, India
| | - Poonam Narang
- Department of Radiodiagnosis, Govind Ballabh Pant Hospital, Delhi, India
| | - Sunita Gupta
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, Delhi, India
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26
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Chen AW, Liu YR, Li K, Zhang K, Wang T, Liu SH. Efficacy of sclerotherapy with radio-opaque foam guided by digital subtraction angiography for the treatment of complex venous malformations of the head and neck. Br J Oral Maxillofac Surg 2015; 53:809-13. [PMID: 26113044 DOI: 10.1016/j.bjoms.2015.05.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 05/31/2015] [Indexed: 10/23/2022]
Abstract
Our aim was to evaluate the efficacy of sclerotherapy using radio-opaque foam and guided by digital subtraction angiography (DSA) for complex venous malformations in the head and neck in 11 selected patients between 2011 and 2013. The sclerosing foam was manufactured by the classic Tessari method and consisted of air, 1% polidocanol, and radio-opaque media iopromide (Ultravist(®)300) in a ratio of 7:2:1. We recorded the site and size of the lesion, time and duration of treatment, and therapeutic response. The lesions were on the face, cheek, temporal region, parotid region, neck, tongue, floor of the mouth, parapharyngeal space, and soft palate. The sclerosing foam was radio-opaque under DSA, and the mean (range) dose was 21 (3-65) ml. A mean (range) of 4 (2-7) treatments was required, and 10 of the 11 patients responded well. In 4 of the 11 cases the lesion resolved completely and in 6 there was a good response. Only one lesion recurred. Early complications included immediate swelling in injected areas, snoring, and pain on swallowing, but there were no air emboli or signs of cutaneous necrosis, and the complications were self-limiting. DSA-guided sclerotherapy with radio-opaque foam was safe and effective for the treatment of complex vascular malformations of the head and neck.
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Affiliation(s)
- A-W Chen
- School of Stomatology, Shandong University, Jinan, China; Department of Oral & Maxillofacial Surgery, Qilu Hospital, and Institute of Stomatology, Shandong University, Jinan, China
| | - Y-R Liu
- School of Medicine, Shandong University, Jinan, China
| | - K Li
- Department of Oral & Maxillofacial Surgery, Qilu Hospital, and Institute of Stomatology, Shandong University, Jinan, China
| | - K Zhang
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, China
| | - T Wang
- Department of Oral & Maxillofacial Surgery, Qilu Hospital, and Institute of Stomatology, Shandong University, Jinan, China
| | - S-H Liu
- Department of Oral & Maxillofacial Surgery, Qilu Hospital, and Institute of Stomatology, Shandong University, Jinan, China.
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Madani H, Farrant J, Chhaya N, Anwar I, Marmery H, Platts A, Holloway B. Peripheral limb vascular malformations: an update of appropriate imaging and treatment options of a challenging condition. Br J Radiol 2014; 88:20140406. [PMID: 25525685 DOI: 10.1259/bjr.20140406] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Peripheral vascular malformations encompass a wide spectrum of lesions that can present as an incidental finding or produce potentially life- or limb-threatening complications. They can have intra-articular and intraosseous extensions that will result in more diverse symptomology and present greater therapeutic challenges. Developments in classification, imaging and interventional techniques have helped to improve outcome. The onus is now placed on appropriate detailed preliminary imaging, diagnosis and classification to direct management and exclude other more common mimics. Radiologists are thus playing an increasingly important role in the multidisciplinary teams charged with the care of these patients. By fully understanding the imaging characteristics and image-guided procedures available, radiologists will be armed with the tools to meet these responsibilities. This review highlights the recent advances made in imaging and the options available in interventional therapy.
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Affiliation(s)
- H Madani
- Department of Radiology, Royal Free Hospital, London, UK
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Sanders P, Spouge RJ, Akbari M, Spouge DJ. Ethanol ablation of extradigital solid glomus tumors. Skeletal Radiol 2014; 43:1755-9. [PMID: 25022808 DOI: 10.1007/s00256-014-1956-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 06/12/2014] [Accepted: 06/26/2014] [Indexed: 02/02/2023]
Abstract
Glomus tumors are predominantly benign neoplasms accounting for less than 2% of all soft tissue tumors. While generally solitary, multiple lesions have been reported in approximately 10% of cases. Glomus tumors are typically under 1 cm in dimension accompanied by the classic triad of symptoms: debilitating pain, pinpoint tenderness, and hypersensitivity to cold temperatures. Excisional therapy is the accepted standard of care, however, past reports of non-invasive treatments for multiple glomangiomata variant tumors include laser therapy, irradiation, and sclerotherapy with STS and hypertonic saline. We present a case of a patient with multiple subcutaneous and intramuscular, lower-extremity benign solid glomus tumors treated successfully utilizing ethanol ablation, which has not been previously reported. This minimally invasive treatment allowed for control of symptoms from a benign condition previously requiring multiple invasive surgeries.
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Affiliation(s)
- Paul Sanders
- Department of Radiology, Queen's University, Kingston, Ontario, Canada
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Hogendoorn W, Lavida A, Hunink MGM, Moll FL, Geroulakos G, Muhs BE, Sumpio BE. Open repair, endovascular repair, and conservative management of true splenic artery aneurysms. J Vasc Surg 2014; 62:1667-76. [PMID: 25264364 DOI: 10.1016/j.jvs.2015.08.052] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/03/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE True splenic artery aneurysms (SAAs) are a rare but potentially fatal pathology. For many years, open repair (OPEN) and conservative management (CONS) were the treatments of choice, but throughout the last decade endovascular repair (EV) has become increasingly used. The purpose of the present study was to perform a systematic review and meta-analysis evaluating the outcomes of the three major treatment modalities (OPEN, EV, and CONS) for the management of SAAs. METHODS A systematic review of all studies describing the outcomes of SAAs treated with OPEN, EV, or CONS was performed using seven large medical databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to ensure a high-quality review. All articles were subject to critical appraisal for relevance, validity, and availability of data regarding characteristics and outcomes. All data were systematically pooled, and meta-analyses were performed on several outcomes, including early and late mortality, complications, and number of reinterventions. RESULTS Original data of 1321 patients with true SAAs were identified in 47 articles. OPEN contained 511 patients (38.7%) in 31 articles, followed by 425 patients (32.2%) in CONS in 16 articles and 385 patients (29.1%) in EV in 33 articles. The CONS group had fewer symptomatic patients (9.5% vs 28.7% in OPEN and 28.8% in EV; P < .001) and fewer ruptured aneurysms (0.2% vs 18.4% in OPEN and 8.8% in EV; P < .001), but no significant differences were found in existing comorbidities. CONS patients were usually older and had smaller-sized aneurysms than patients in the OPEN and EV groups. The only identified difference in baseline characteristics between OPEN and EV was the number of ruptured aneurysms (18.4% vs 8.8%; P < .001). OPEN had a higher 30-day mortality than EV (5.1% vs 0.6%; P < .001), whereas minor complications occurred in a larger number of the EV patients. EV required more reinterventions per year (3.2%) compared with OPEN (0.5%) and CONS (1.2%; P < .001). The late mortality rate was higher in patients treated with CONS (4.9% vs 2.1% in OPEN and 1.4% in EV; P = .04). CONCLUSIONS EV of SAA has better short-term results compared with OPEN, including significantly lower perioperative mortality. OPEN is associated with fewer late complications and fewer reinterventions during follow-up. Patients treated with CONS showed a higher late mortality rate. Ruptured SAAs are predictors of a significantly higher perioperative mortality compared with nonruptured SAAs in the OPEN and EV groups.
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Affiliation(s)
- Wouter Hogendoorn
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn; Section of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - Anthi Lavida
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn; Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - M G Myriam Hunink
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Health Policy & Management, Harvard School of Public Health, Boston, Mass
| | - Frans L Moll
- Section of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - George Geroulakos
- Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Bart E Muhs
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn
| | - Bauer E Sumpio
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn.
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Steiner F, FitzJohn T, Tan ST. Ethanol sclerotherapy for venous malformation. ANZ J Surg 2014; 86:790-795. [PMID: 25182969 DOI: 10.1111/ans.12833] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ethanol sclerotherapy (ES) is the preferred treatment for venous malformation (VM) with surgery playing an adjunctive role. Results of ES, however, are not well documented in the literature. METHODS VM patients were identified from our vascular anomalies database from 1996 to 2011. After treatment completion, patients completed questionnaires evaluating symptoms and their severity and effect on appearance, function and overall quality of life (QoL), before and >6 months after treatment, using visual analogue scales of 0-10. Patients rated their overall satisfaction with ES using a scale of 0-10. RESULTS Fifty-four (23.9%) of the 226 VM patients underwent a total of 90 ES sessions (average 1.7 sessions per patient). Complications occurred in 12 (22.2%) patients in 12 (13.3%) ES sessions. Minor complications occurred in nine (16.7%) patients including transient paraesthesia (n = 3), transient weakness of facial nerve branch(es) (n = 3), skin blistering (n = 2) and spontaneously healing ulceration (n = 1). Major complications occurred in three (5.6%) patients in three (3.3%) ES sessions including skin necrosis (n = 1), Horner's syndrome (n = 1) and finger paraesthesia with joint stiffness (n = 1). ES improved the severity of background pain, episodic pain, contour deformity and skin discoloration in 86.0%, 72.4%, 83.0% and 72.2% of patients respectively. It reduced the effect of VM on appearance, function and overall QoL in 69.8%, 73.0% and 64.3% of patients. Mean treatment satisfaction was 7.9 (range, 0-10). CONCLUSION ES reduces pain, contour deformity and skin discoloration, and improves appearance, function and QoL. Our complication rates are consistent with the literature.
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Affiliation(s)
| | - Trevor FitzJohn
- Centre for the Study & Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand
| | - Swee T Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand. .,Centre for the Study & Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand.
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Yakes W, Baumgartner I. Interventional treatment of arterio-venous malformations. GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00772-013-1303-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Hatzidakis A, Rossi M, Mamoulakis C, Kehagias E, Orgera G, Krokidis M, Karantanas A. Management of renal arteriovenous malformations: A pictorial review. Insights Imaging 2014; 5:523-30. [PMID: 24996396 PMCID: PMC4141337 DOI: 10.1007/s13244-014-0342-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 05/28/2014] [Accepted: 06/05/2014] [Indexed: 11/29/2022] Open
Abstract
Background Arteriovenous malformations (AVMs) are communications between an artery and a vein outside the capillary level. This pathologic communication may be either a fistula, a simple communication between a single artery and a dilated vein, or a more complex communication, a nidus of tortuous channels between one or more arteries/arterioles and one or more draining veins. The latter type of lesion is most frequently seen in the extremities; in the kidney they tend to appear more rarely. The most common clinical presentation of renal arteriovenous malformations (RAVMs) is haematuria. Percutaneous treatment with selective endovascular techniques offers a minimally invasive, nephron-sparing option in comparison to the more invasive surgical approaches. The purpose of this pictorial review is to highlight the general lines of management and to show the range of imaging findings of the percutaneous treatment of RAVMs. Methods The imaging characteristics of a selection of cases of percutaneously managed congenital RAVMs are presented and the most common lines of approach are discussed. Conclusion The imaging spectrum of diagnosis and percutaneous treatment of RAVMs is presented in order to aid interpretation and endovascular management. Teaching points • Renal arteriovenous malformations are very rare lesions. • Clinical expression is usually haematuria. • Diagnosis is made with CT or MRI but the gold standard is digital subtraction angiography. • Catheter-directed treatment with the use of coils or liquid embolics is minimally invasive, safe and effective.
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Affiliation(s)
- Adam Hatzidakis
- Department of Medical Imaging, University Hospital of Heraklion, Medical School of Crete, 71110, Heraklion, Greece,
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Colletti G, Colombo V, Mattassi R, Frigerio A. Strangling technique to treat large cervicofacial venous malformations: A preliminary report. Head Neck 2014; 36:E94-8. [DOI: 10.1002/hed.23585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/20/2013] [Accepted: 12/19/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Giacomo Colletti
- Division of Maxillo-Facial Surgery; Department of Biomedical; Surgical and Dental Sciences; San Paolo Hospital; Università degli Studi di Milano; Milan Italy
| | - Valeria Colombo
- Division of Maxillo-Facial Surgery; Department of Biomedical; Surgical and Dental Sciences; San Paolo Hospital; Università degli Studi di Milano; Milan Italy
| | - Raul Mattassi
- Department of Vascular Surgery; Center for Vascular Malformations “Stefan Belov”; Clinical Institute Humanitas “Mater Domini”; Castellanza Varese Italy
| | - Alice Frigerio
- Carolyn and Peter Lynch Center for Laser and Reconstructive Surgery; Division of Facial Plastic and Reconstructive Surgery; Department of Otology and Laryngology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston Massachusetts
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Ogi T, Matsui O, Sanada J, Minami T, Kozaka K, Inoue D, Gabata T. Forcible intraarterial injection of a nonadhesive liquid embolic agent under microballoon occlusion: experimental study in swine liver. J Vasc Interv Radiol 2014; 25:579-585.e2. [PMID: 24508348 DOI: 10.1016/j.jvir.2013.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 11/28/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate the feasibility and effectiveness of transcatheter embolization by forcible intraarterial injection of a mixture of ethylene vinyl alcohol copolymer (EVAL) and ethanol under microballoon occlusion compared with conventional transcatheter arterial embolization methods in nontumoral swine liver. MATERIALS AND METHODS Nine swine were divided into three groups: embolization with EVAL/ethanol mixture (EVAL group, n = 5), with ethiodized oil (ethiodized oil group, n = 2), and with microspheres (microspheres group, n = 2). Embolization was performed at the subsegmental hepatic artery. The EVAL/ethanol mixture was injected forcibly through a microcatheter with a balloon, which was inflated to prevent backflow of the mixture during the injection. Ethiodized oil or microspheres were injected into the artery using a microcatheter without balloon occlusion. Two animals of the EVAL group were euthanized immediately after embolization, and the distribution of EVAL was assessed microscopically. The remaining seven animals were euthanized 4 weeks after embolization, and the histopathologic changes were assessed. RESULTS All procedures were technically successful. EVAL occupied > 80% of the hepatic arterial, portal venous, and sinusoidal lumens after embolization. Ischemic coagulation necrosis was observed 4 weeks after embolization in the EVAL group. Parenchymal necrosis was not observed in the ethiodized oil and microspheres groups. CONCLUSIONS Transcatheter embolization by forcible intraarterial injection of an EVAL/ethanol mixture under microballoon occlusion was feasible and achieved the simultaneous embolization of hepatic artery, portal vein, and sinusoids in swine liver, resulting in complete necrosis of the segment that received embolization.
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Affiliation(s)
- Takahiro Ogi
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-8640, Japan.
| | - Osamu Matsui
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-8640, Japan
| | - Junichiro Sanada
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-8640, Japan
| | - Tetsuya Minami
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-8640, Japan
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-8640, Japan
| | - Dai Inoue
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-8640, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-8640, Japan
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Sclerotherapy: a novel bloodless approach to treat recurrent oral pyogenic granuloma associated with port-wine stain. Ann Vasc Surg 2014; 28:1564.e9-14. [PMID: 24509379 DOI: 10.1016/j.avsg.2014.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/22/2013] [Accepted: 01/02/2014] [Indexed: 11/24/2022]
Abstract
Pyogenic granuloma (PG) is a commonly occurring nonneoplastic inflammatory lesion in the oral cavity. Recent reports have demonstrated a rare association between skin PG and port-wine stain (PWS). Various treatment modalities such as complete excision, curettage, cryotherapy, chemical and electric cauterizations, lasers, and intralesional corticosteroids have been used to treat the lesion. In this case report, we present a novel method for the treatment of recurrent PG in a woman with concurrent presentation of PWS. In this patient, sclerotherapy with sodium tetradecyl sulfate (STS) was used as a treatment modality with successful resolution of the lesion. The authors thus conclude that sclerotherapy with STS can be an effective alternative for the treatment of recurrent PG associated with PWS.
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Ethanol Embolotherapy of Vascular Malformations: Clinical Outcomes at a Single Center. J Vasc Interv Radiol 2014; 25:206-13; quiz 214. [DOI: 10.1016/j.jvir.2013.10.055] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 10/23/2013] [Accepted: 10/25/2013] [Indexed: 12/19/2022] Open
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Murata S, Onozawa S, Nakazawa K, Akiba A, Mine T, Ueda T, Yasui D, Sugihara F, Kondoh Y, Kumita SI. Endovascular embolization strategy for renal arteriovenous malformations. Acta Radiol 2014; 55:71-7. [PMID: 23904088 DOI: 10.1177/0284185113493085] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Renal arteriovenous malformations (AVMs) are rare vascular malformations that cause hematuria. Treatment for renal AVMs has evolved from open nephrectomy to transcatheter arterial embolization (TAE). PURPOSE To retrospectively evaluate efficacy and adverse events of TAE for renal AVMs. MATERIAL AND METHODS We examined 12 patients (three men, nine women; mean age, 56 years) with renal AVM with gross hematuria, who underwent 14 sessions of treatment, using various embolization materials (liquid embolization agents, gelatin sponge, and coils). Among the 12 patients, 10 had cirsoid AVMs, eight of which were high-flow lesions. The remaining two patients had aneurismal AVMs. We assessed technical and clinical success, and also complications. All patients were followed for 7-92 months (mean, 48 months). RESULTS Technical success was obtained in all patients. Primary clinical success was obtained in all patients; however, recurrence was observed in two patients who were treated with coils alone. A second session of TAE led to the sustained relief of symptoms. Clinical success rate was significant better (P = 0.045) when coils combined with other agents or liquid agents were used, than when only coils were used. No major complications occurred in any of patients; post-embolization syndrome and deterioration of renal function were not observed. CONCLUSION TAE treatment was safe, effective, and provided a good outcome, except when only coils were used as the embolization agent.
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Affiliation(s)
- Satoru Murata
- Department of Radiology/Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
| | - Shiro Onozawa
- Department of Radiology/Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
| | - Ken Nakazawa
- Department of Radiology/Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
| | - Ayako Akiba
- Department of Radiology/Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
| | - Takahiko Mine
- Department of Radiology/Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
| | - Tatsuo Ueda
- Department of Radiology/Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
| | - Daisuke Yasui
- Department of Radiology/Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
| | - Fumie Sugihara
- Department of Radiology/Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
| | | | - Shin-ichiro Kumita
- Department of Radiology/Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
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Wang D, Su L, Fan X. Cardiovascular Collapse and Disseminated Intravascular Coagulation as Complications of Ethanol Embolization of Arteriovenous Malformations in the Upper Lip: Case Report and Literature Review. J Oral Maxillofac Surg 2014; 72:346-51. [DOI: 10.1016/j.joms.2013.07.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 07/27/2013] [Accepted: 07/29/2013] [Indexed: 12/26/2022]
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Ethanol embolotherapy of foot arteriovenous malformations. J Vasc Surg 2013; 58:1619-26. [DOI: 10.1016/j.jvs.2013.06.074] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 06/23/2013] [Accepted: 06/26/2013] [Indexed: 11/19/2022]
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Clinical validation of semi-automated software for volumetric and dynamic contrast enhancement analysis of soft tissue venous malformations on Magnetic Resonance Imaging examination. Eur Radiol 2013; 24:542-51. [DOI: 10.1007/s00330-013-3066-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/06/2013] [Accepted: 10/19/2013] [Indexed: 12/15/2022]
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Ergun O, Atlı E, Gulek B, Ciftci T, Cil B, Vargel I, Peynircioğlu B. Intraarterial polidocanol injection for the treatment of peripheral arteriovenous malformations. Surg Today 2013; 44:1232-41. [PMID: 23904047 DOI: 10.1007/s00595-013-0680-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the efficacy and safety of intraarterial transcatheter administration of polidocanol as an alternative treatment for peripheral arteriovenous malformations (AVMs). METHODS The study comprised 10 patients (six males and four females) with a mean age of 28.8 years (range 8-52 years). All patients had trunk or extremity AVMs. Following the administration of general anesthesia or intravenous (IV) sedation, the patients underwent staged intraarterial polidocanol sclerotherapy with or without additional embolizations for their AVMs. The administration of polidocanol was executed by intraarterial infusion through a microcatheter or by direct percutaneous entry into the nidus under ultrasound guidance. RESULTS A total of 19 sessions were accomplished in 10 patients. Polidocanol was used alone in six of the 19 sessions. In 13 sessions, polidocanol was used in combination with another agent (including n-butyl cyanoacrylate (NBCA), lipiodol, and ethanol) and/or coils. In two sessions, polidocanol was administered percutaneously under ultrasound guidance directly into the nidus documented by arteriography. No major complications occurred. CONCLUSION Intraarterial transcatheter administration of polidocanol alone or in combination with other agents is a safe and effective alternative treatment for peripheral AVMs.
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Affiliation(s)
- Onur Ergun
- Department of Radiology, Sincan State Hospital, Ankara, Turkey,
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Ethanolamine oleate sclerotherapy combined with transarterial embolization using n-butyl cyanoacrylate for extracranial arteriovenous malformations. Cardiovasc Intervent Radiol 2013; 37:371-80. [PMID: 23737022 DOI: 10.1007/s00270-013-0653-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study was designed to assess the safety and effectiveness of ethanolamine oleate (EO) sclerotherapy combined with transarterial embolization using a liquid adhesive agent (n-butyl cyanoacrylate, NBCA) for treatment of extracranial arteriovenous malformations (AVMs). METHODS Twenty-four patients with symptomatic AVMs in the head and neck (n = 15), extremity (n = 5), and trunk (n = 4) with a mean age of 44 years (range, 18-78) treated with EO sclerotherapy were retrospectively assessed. AVMs were classified according to the angiographic morphology of the nidus. There were 7 type II (arteriolovenous fistulae), 6 type IIIa (arteriolovenulous fistulae with nondilated fistula), and 11 type IIIb (arteriolovenulous fistulae with dilated fistula). Transarterial embolization using NBCA was performed to reduce arterial flow before sclerotherapy. EO mixed with contrast material was delivered by percutaneous direct puncture or by catheterization into the draining vein under balloon occlusion. RESULTS Three (13%) of 24 patients were cured, 17 (71%) had partial remission, and 4 (16%) no remission. Treatment was considered effective (cure and partial remission) in 20 patients (83%). Four patients (16%) experienced transient minor complications, including self-healing skin ulcer (n = 3) and localized deep venous thrombosis (n = 1). There were no major complications. CONCLUSIONS EO sclerotherapy combined with transarterial embolization using NBCA is safe and effective for treating extracranial AVMs with an acceptable risk of minor complications.
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Rosen RJ, Nassiri N, Drury JE. Interventional Management of High-Flow Vascular Malformations. Tech Vasc Interv Radiol 2013; 16:22-38. [DOI: 10.1053/j.tvir.2013.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ishikawa K, Sasaki S, Furukawa H, Nagao M, Iwasaki D, Saito N, Yamamoto Y. Preliminary experience with intraoperative near-infrared fluorescence imaging in percutaneous sclerotherapy of soft-tissue venous malformations. Dermatol Surg 2013; 39:907-12. [PMID: 23433041 DOI: 10.1111/dsu.12152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND It has recently been demonstrated that near-infrared (NIR) fluorescence imaging can be used to visualize the blood vasculature. Although sclerotherapy has been successfully used in treating venous malformations, the spread of sclerosant is difficult to monitor during sclerotherapy. OBJECTIVE To evaluate the safety and efficacy of NIR fluorescence imaging in percutaneous sclerotherapy of soft-tissue venous malformations. METHODS AND MATERIALS The use of NIR fluorescence imaging after administration of indocyanine green (ICG) was evaluated in duplex-guided sclerotherapy performed on 15 patients with venous malformations. The lower extremities were involved in seven, the upper extremities in four, and the face in four. RESULTS In 13 of the 15 procedures, spotty fluorescence images were obtained, and in eight procedures, linear fluorescence images were obtained. In two patients with intramuscular venous malformations in the lower extremities, no fluorescence images were obtained. Observational depth seemed to be <1 cm below the skin surface with an ICG concentration of 0.01 mg/mL. No complications associated with ICG were observed. Adjacent tissue ulceration occurred in one patient. CONCLUSION NIR fluorescence imaging with ICG can be a useful additional monitor for percutaneous sclerotherapy of venous malformations, especially in the face and hands, enabling noninvasive assessment of real-time spread of sclerosant.
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Affiliation(s)
- Kosuke Ishikawa
- Center for Vascular Anomalies, KKR Sapporo Medical Center Tonan Hospital, Sapporo, Japan
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Predictive Factors for Response of Peripheral Arteriovenous Malformations to Embolization Therapy: Analysis of Clinical Data and Imaging Findings. J Vasc Interv Radiol 2012; 23:1478-86. [DOI: 10.1016/j.jvir.2012.08.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 07/24/2012] [Accepted: 08/09/2012] [Indexed: 11/21/2022] Open
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Pekkola J, Lappalainen K, Vuola P, Klockars T, Salminen P, Pitkäranta A. Head and neck arteriovenous malformations: results of ethanol sclerotherapy. AJNR Am J Neuroradiol 2012; 34:198-204. [PMID: 22766677 DOI: 10.3174/ajnr.a3180] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Peripheral AVM is a locally aggressive disease with a high tendency to recur; its treatment is complex, especially in the anatomically delicate head and neck area. Here, we report results of ethanol sclerotherapy for head and neck AVM and discuss its potential use for peripheral AVM. MATERIALS AND METHODS We retrospectively assessed degree of AVM eradication, complications, and clinical or imaging signs of recurrence for 19 patients treated with ethanol sclerotherapy for head and neck AVM (1 intraosseous, 18 soft-tissue AVMs). RESULTS Of the 19 patients, 11 had complete eradication of arteriovenous shunting at DSA, with 1 recurrence (mean follow-up 15 months), and for 7 patients, treatment is ongoing. During 59 treatment sessions, 12 patients experienced 14 complications, 1 leading to permanent functional damage. CONCLUSIONS Ethanol sclerotherapy has potential for complete eradication of head and neck AVM with low recurrence within the first year after completion of treatment. Complete eradication may require several treatment sessions during which complications should be minimized with careful techniques.
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Affiliation(s)
- J Pekkola
- Department of Radiology, University of Helsinki and HUS Radiology, Helsinki, Finland.
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Lojo Rocamonde I, Moro Mayor A, Barreiro Veiguela J. Malformaciones vasculares periféricas. Diagnóstico y tratamiento. ANGIOLOGIA 2012. [DOI: 10.1016/j.angio.2012.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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