1
|
Tuleja A, Bernhard S, Hamvas G, Andreoti TA, Rössler J, Boon L, Vikkula M, Kammer R, Haupt F, Döring Y, Baumgartner I. Clinical phenotype of adolescent and adult patients with extracranial vascular malformation. J Vasc Surg Venous Lymphat Disord 2023; 11:1034-1044.e3. [PMID: 37030445 DOI: 10.1016/j.jvsv.2023.03.012] [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: 10/14/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVE In recent years, genotypic characterization of congenital vascular malformations (CVMs) has gained attention; however, the spectrum of clinical phenotype remains difficult to attribute to a genetic cause and is rarely described in the adult population. The aim of this study is to describe a consecutive series of adolescent and adult patients in a tertiary center, where a multimodal phenotypic approach was used for diagnosis. METHODS We analyzed clinical findings, imaging, and laboratory results at initial presentation, and set a diagnosis according to the International Society for the Study of Vascular Anomalies (ISSVA) classification for all consecutively registered patients older than 14 years of age who were referred to the Center for Vascular Malformations at the University Hospital of Bern between 2008 and 2021. RESULTS A total of 457 patients were included for analysis (mean age, 35 years; females, 56%). Simple CVMs were the most common (n = 361; 79%), followed by CVMs associated with other anomalies (n = 70; 15%), and combined CVMs (n = 26; 6%). Venous malformations (n = 238) were the most common CVMs overall (52%), and the most common simple CVMs (66%). Pain was the most frequently reported symptom in all patients (simple, combined, and vascular malformation with other anomalies). Pain intensity was more pronounced in simple venous and arteriovenous malformations. Clinical problems were related to the type of CVM diagnosed, with bleeding and skin ulceration in arteriovenous malformations, localized intravascular coagulopathy in venous malformations, and infectious complications in lymphatic malformations. Limb length difference occurred more often in patients with CVMs associated with other anomalies as compared with simple or combined CVM (22.9 vs 2.3%; P < .001). Soft tissue overgrowth was seen in one-quarter of all patients independent of the ISSVA group. CONCLUSIONS In our adult and adolescent population with peripheral vascular malformations, simple venous malformations predominated, with pain as the most common clinical symptom. In one-quarter of cases, patients with vascular malformations presented with associated anomalies on tissue growth. The differentiation of clinical presentation with or without accompanying growth abnormalities need to be added to the ISSVA classification. Phenotypic characterization considering vascular and non-vascular features remains the cornerstone of diagnosis in adult as well as pediatric patients.
Collapse
Affiliation(s)
- Aleksandra Tuleja
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Sarah Bernhard
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland
| | - Györgyi Hamvas
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland
| | - Themis-Areti Andreoti
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Inselspital - University Hospital of Bern, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Jochen Rössler
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Inselspital - University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Laurence Boon
- Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Saint Luc University Hospital, Brussels, Belgium
| | - Miikka Vikkula
- Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Saint Luc University Hospital, Brussels, Belgium; Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
| | - Rafael Kammer
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland
| | - Fabian Haupt
- Department of Radiology, Inselspital, Bern University, Hospital, Bern, Switzerland
| | - Yvonne Döring
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland; Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland; Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich (LMU), Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland
| |
Collapse
|
2
|
Gasparella P, Flucher C, Beqo BP, Schmidt B, Spendel S, Arneitz C, Till H, Haxhija EQ, Singer G. Outcome after surgical treatment of venous malformations of the hand in childhood. J Vasc Surg Venous Lymphat Disord 2023; 11:793-800. [PMID: 36906103 DOI: 10.1016/j.jvsv.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE Surgical treatment of venous malformations (VMs) of the hand is challenging. The hand's small functional units, dense innervation, and terminal vasculature can be easily compromised during invasive interventions like surgery or sclerotherapy, leading to an increased risk of functional impairment, cosmetic consequences, and negative psychological effects. METHODS We have conducted a retrospective review of all surgically treated patients diagnosed with VMs of the hand between 2000 and 2019 and evaluated their symptoms, diagnostic investigations, complications, and recurrences. RESULTS Twenty-nine patients (females, n = 15) with a median age of 9.9 years (range, 0.6-18 years) were included. Eleven patients presented with VMs involving at least one of the fingers. In 16 patients, the palm and/or dorsum of the hand was affected. Two children presented with multifocal lesions. All patients presented with swelling. Preoperative imaging was done in 26 patients and consisted of magnetic resonance imaging in nine patients, ultrasound in eight patients, and both modalities in nine patients. Three patients underwent surgical resection of the lesions without any imaging. Indications for surgery were pain and restriction of function (n = 16), and when lesions were preoperatively evaluated as completely resectable (n = 11). In 17 patients, a complete surgical resection of the VMs was performed, whereas in 12 children, an incomplete resection of VM was deemed due to nerve sheath infiltration. At a median follow-up of 135 months (interquartile range, 136.5 months; range, 36-253 months), recurrence occurred in 11 patients (37.9%) after a median time of 22 months (range, 2-36 months). Eight patients (27.6%) were reoperated because of pain, whereas three patients were treated conservatively. The rate of recurrences did not significantly differ between patients presenting with (n = 7 of 12) or without (n = 4 of 17) local nerve infiltration (P = .119). All surgically treated patients who were diagnosed without preoperative imaging developed a relapse. CONCLUSIONS VMs in the region of the hand are difficult to treat, and surgery is associated with a high recurrence rate. Accurate diagnostic imaging and meticulous surgery may contribute to improve the outcome of the patients.
Collapse
Affiliation(s)
- Paolo Gasparella
- Department of Paediatric and Adolescent Surgery, VASCERN VASCA European Reference Centre, Medical University of Graz, Graz, Austria
| | - Christina Flucher
- Department of Paediatric and Adolescent Surgery, VASCERN VASCA European Reference Centre, Medical University of Graz, Graz, Austria
| | - Besiana P Beqo
- Department of Paediatric and Adolescent Surgery, VASCERN VASCA European Reference Centre, Medical University of Graz, Graz, Austria; Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Barbara Schmidt
- Department of Paediatric and Adolescent Surgery, VASCERN VASCA European Reference Centre, Medical University of Graz, Graz, Austria
| | - Stephan Spendel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Christoph Arneitz
- Department of Paediatric and Adolescent Surgery, VASCERN VASCA European Reference Centre, Medical University of Graz, Graz, Austria
| | - Holger Till
- Department of Paediatric and Adolescent Surgery, VASCERN VASCA European Reference Centre, Medical University of Graz, Graz, Austria
| | - Emir Q Haxhija
- Department of Paediatric and Adolescent Surgery, VASCERN VASCA European Reference Centre, Medical University of Graz, Graz, Austria.
| | - Georg Singer
- Department of Paediatric and Adolescent Surgery, VASCERN VASCA European Reference Centre, Medical University of Graz, Graz, Austria
| |
Collapse
|
3
|
GUK YM, CHERNUKHA LM, ZYMA AM, VYDERKO RV, CHEVERDA AI, KINCHA-POLISHCUK TA, SKURATOV OY. Orthopedic manifestations in patients with arteriovenous malformations of the lower limbs. ACTA PHLEBOLOGICA 2023. [DOI: 10.23736/s1593-232x.22.00543-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
|
4
|
Portugal MFC, Tachibana A, Rocha MA, Naves ÉA, Amaral LTW, Camilo LP, Hallage B, Wolosker N, Teivelis MP. Radiological Profile of 18,430 Vascular Anomalies: Incidence and Demographic Distribution in an Adult Population. Ann Vasc Surg 2023:S0890-5096(23)00103-6. [PMID: 36805426 DOI: 10.1016/j.avsg.2023.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Most studies on focusing on the prevalence of vascular anomalies are either aimed to determine the individual occurrence of a specific type among known bearers of abnormalities or propose an estimation of prevalence for the general population by extrapolating from the paediatric population. In this scenario, we intended to assess the profile of vascular anomalies in a group of patients subjected to imaging studies, throughout a long period of time, to evaluate the frequency of abnormal findings in a consecutive, nonselected population. METHODS This is a retrospective review of 996,569 computed tomography and magnetic resonance studies between 2009 and 2019. Findings were grouped as vascular tumours (hemangiomas; vascular tumours), cavernomas, and vascular malformations. Positive findings were evaluated with regard to patients' demographic characteristics and anatomic distribution and the subset of vascular malformations was also evaluated with regard to size, classification in accordance to flow pattern, and Hamburg Classification. RESULTS Eighteen thousand four hundred thirty positive examinations were evaluated (mean age, 55.82 ± 15.43 years; 8,188 men). Vascular anomalies were present in 18.49 per 1,000 examinations (17.41 hemangiomas; 0.69 cavernomas and 0.39 vascular malformations per 1,000 examinations). Hemangiomas and cavernomas were homogeneous in anatomic location between sexes throughout the age groups. Complex malformations were heterogeneous in anatomic distribution between the sexes in each age group, with intracranial findings decreasing for female patients in older groups. CONCLUSIONS Vascular anomalies were found in 18.49 per 1,000 examinations. Hemangiomas and cavernomas were homogenously distributed, whereas complex malformations displayed a heterogeneous anatomic distribution pattern between sexes in each age group.
Collapse
Affiliation(s)
| | | | | | - Érica A Naves
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Luana Perrone Camilo
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Albert Eistein, São Paulo, Brazil
| | - Bianca Hallage
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Albert Eistein, São Paulo, Brazil
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Albert Eistein, São Paulo, Brazil; Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, Brazil
| | - Marcelo Passos Teivelis
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Albert Eistein, São Paulo, Brazil
| |
Collapse
|
5
|
Lee A, Patel NA. Systematic review of pediatric postcricoid cushion and postcricoid lesions. Int J Pediatr Otorhinolaryngol 2022; 162:111293. [PMID: 36044795 DOI: 10.1016/j.ijporl.2022.111293] [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: 11/29/2021] [Revised: 08/12/2022] [Accepted: 08/20/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVES It is thought that many infants have a prominent venous plexus of the postcricoid area. In the past this entity had occasionally been reported as a postcricoid hemangioma or even a postcricoid mass. The term postcricoid cushion is now gaining acceptance to describe the prominent venous plexus of the posterior cricoid area. Although it rarely causes symptoms, it should be considered when patients present with symptoms of obstruction. Differentiating between normal variant postcricoid prominent venous plexuses, hemangiomas, and vascular malformations can be difficult and cannot be confirmed without immunohistochemistry. The objective of this systematic review is to describe current practices, clinical symptoms, management and outcomes of pediatric postcricoid lesions including postcricoid cushion. METHODS A systemic review of the literature was done using the PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analyses) guidelines to investigate postcricoid lesions. The following terms: Postcricoid, Postcricoid lesions, Postcricoid mass, Posterior cricoid, Pressure-dependent postcricoid mass, postcricoid prolapse, postcricoid hemangiomas, postcricoid vascular malformations, and postcricoid cushion were searched in PubMed and Google Scholar. Articles that were within the inclusion criteria were reviewed. Demographics, past medical and birth histories, clinical symptoms, evaluations, biopsy results, treatments, and outcomes were included. For the purposes of this review, postcricoid cushions, pressure-dependent postcricoid mass, and postcricoid prolapse will be group under normal variant postcricoid cushion. RESULTS 15 articles with 42 distinct cases were included in this systemic review. 21/42 of the patients were female, the age ranged from 2 days to 18 years, the median age was 6.5 months, and 39/42 of patients were under the age of 2 years. 17/42 patients were diagnosed "hemangiomas" in the papers with only 1 case confirming the diagnosis of hemangioma with immunohistochemistry. 7/42 were diagnosed vascular malformations with 3 cases confirming the diagnosis of with immunohistochemistry. 17/42 of cases were normal variant postcricoid cushions. Most commonly, patients had a history of laryngomalacia (14/33) followed by no other medical history (9/33). The most common clinical symptoms were stridor, dysphonia, or weak cry in 30/42, dysphagia in 20/42, sleep disordered breathing in 9/42, and regurgitation or aspiration in 9/42.8/38 of patients diagnosed with postcricoid cushion did not have visualization of the lesion until a Valsalva maneuver was performed. The most common management for "hemangiomas" was observation (8/17), for "vascular malformations" was laser therapy (3/7), and for normal variant postcricoid cushions was observation (8/17). The most common outcome was complete resolution (14/30) followed by improvement of symptoms (9/30), and residual complications (4/30) The median time to follow-up was 12 months. CONCLUSION Due to the relatively new "discovery" of the normal variant postcricoid cushion, including postcricoid cushion, pressure-dependent postcricoid mass, and postcricoid prolapse, the majority of the literature are case reports. Although it is theorized that many children under the age of 2 have a prominent venous plexus, in some cases it could cause symptoms of obstruction. Because immunohistochemistry is rarely done and reported in the literature, many case reports may have misdiagnosed the postcricoid lesions. Also, in many cases visualizing the normal variant postcricoid cushion requires that the patients have increased intrathoracic pressure; therefore, if no postcricoid prominence is seen initially or when the patient is under general anesthesia and a postcricoid lesion is suspected, the patient should receive a Valsalva maneuver or be placed in Trendelenburg position. Most cases of normal variant postcricoid cushions can be managed with observation. Due to the rarity and novelty of the discovery, more research needs to be done on the management of symptomatic postcricoid lesions and differentiating between normal variants and pathological vascular lesions.
Collapse
Affiliation(s)
- Alice Lee
- City University of New York (CUNY) School of Medicine, New York, USA
| | - Neha A Patel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Otolaryngology-Head and Neck Surgery, Hempstead, NY, USA; Cohen Children's Medical Center, Division of Pediatric Otolaryngology, New Hyde Park, NY, USA.
| |
Collapse
|
6
|
CLOVES Syndrome. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02692-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
7
|
Shalhub S, Hysa L, Byers PH, Meissner MH, Ferreira M. True radial artery aneurysm in a patient with somatic mosaicism for a mutation in platelet-derived growth factor receptor β gene. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:567-571. [PMID: 34504985 PMCID: PMC8411016 DOI: 10.1016/j.jvscit.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/11/2021] [Indexed: 11/24/2022]
Abstract
We have presented the case of a right radial artery aneurysm (RAA) in a 27-year-old man with cerebral and coronary artery aneurysms and features of Parkes-Weber syndrome (port-wine stains and right upper extremity arteriovenous malformation and overgrowth). The RAA was repaired with an interposition great saphenous vein bypass graft. Analysis of the intracranial artery aneurysm and affected skin demonstrated a somatic mutation in the platelet-derived growth factor receptor-β gene. Mosaicism was present in the RAA but not in the great saphenous vein. Somatic mosaicism should be considered as a possible etiology for peripheral aneurysms in patients for whom standard genetic test results are unrevealing.
Collapse
Affiliation(s)
- Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Lisa Hysa
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Peter H Byers
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Wash.,Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, Wash
| | - Mark H Meissner
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Manuel Ferreira
- Department of Neurosurgery, University of Washington School of Medicine, Seattle, Wash
| |
Collapse
|
8
|
Seneviratne M, Longue C, Harrington N, Bristow P. Arteriovenous Malformation of the Tongue Resulting in Recurrent Severe Hemorrhage in a Young Dog. J Am Anim Hosp Assoc 2021; 56:336. [PMID: 33113561 DOI: 10.5326/jaaha-ms-7080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/11/2022]
Abstract
An 8 mo old male entire beagle was presented to the emergency and critical care service following several severe bleeding episodes from the oral cavity. Oral examination revealed a purple, spongy, pulsatile lesion on the rostral two-thirds of the tongue. Computed tomography angiography revealed a severely distended right linguofacial vein with numerous, tortuous branching vessels within the tongue, consistent with an arteriovenous (AV) malformation. A cervical surgical approach was performed, and the right lingual artery was isolated and catheterized. A direct arteriogram confirmed this was the main feeder artery to the lesion, and it was ligated. Although the bleeding episodes initially resolved, a moderate bleeding episode occurred 6 days postoperatively, and a partial glossectomy was performed. Histopathology was consistent with an AV malformation. The dog had a good recovery from surgery and remains free of clinical signs 13 mo later. Following extensive review of the veterinary literature, this is the only reported case of a lingual AV malformation in the dog. Partial glossectomy resulted in resolution of the clinical signs and was well tolerated. Although rare, AV malformations should be considered as a differential diagnosis for spontaneous oropharyngeal bleeding.
Collapse
Affiliation(s)
- Maheeka Seneviratne
- From the Department of Clinical Sciences and Services (M.S., P.B.) and Department of Pathology and Pathogen Biology (C.L., N.H.), Royal Veterinary College, Hatfield, United Kingdom
| | - Camille Longue
- From the Department of Clinical Sciences and Services (M.S., P.B.) and Department of Pathology and Pathogen Biology (C.L., N.H.), Royal Veterinary College, Hatfield, United Kingdom
| | - Norelene Harrington
- From the Department of Clinical Sciences and Services (M.S., P.B.) and Department of Pathology and Pathogen Biology (C.L., N.H.), Royal Veterinary College, Hatfield, United Kingdom
| | - Poppy Bristow
- From the Department of Clinical Sciences and Services (M.S., P.B.) and Department of Pathology and Pathogen Biology (C.L., N.H.), Royal Veterinary College, Hatfield, United Kingdom
| |
Collapse
|
9
|
Le-Nguyen A, Joharifard S, Côté G, Borsuk D, Ghali R, Lallier M. Neonatal Microsurgical Repair of a Congenital Abdominal Aortic Aneurysm with a Cadaveric Graft. European J Pediatr Surg Rep 2021; 9:e23-e27. [PMID: 33680709 PMCID: PMC7929720 DOI: 10.1055/s-0041-1723019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/18/2020] [Indexed: 10/28/2022] Open
Abstract
Congenital abdominal aortic aneurysms (AAA) are an extremely rare entity. We present the case of a female fetus diagnosed with an AAA on routine prenatal ultrasound. A postnatal computed tomography angiogram revealed an infrarenal AAA with a narrow proximal neck. Surgery was performed on day of life 14 using a cadaveric femoral artery graft. The proximal anastomosis was performed under the microscope given the severity of the aortic stenosis and the proximity of the renal arteries. The patient's postoperative course was uneventful and she is developing normally 1 year after surgery. The graft remains permeable, albeit with evidence of proximal and distal stenosis and graft calcification on imaging.
Collapse
Affiliation(s)
- Annie Le-Nguyen
- Department of Surgery, Division of General Surgery, Saint Justine Hospital, Montreal, Quebec, Canada
| | - Shahrzad Joharifard
- Department of Surgery, Division of Pediatric Surgery, Saint Justine Hospital, Montreal, Quebec, Canada
| | - Geneviève Côté
- Department of Anesthesiology, Saint Justine Hospital, Montreal, Quebec, Canada
| | - Daniel Borsuk
- Department of Surgery, Division of Plastic Surgery, Saint Justine Hospital, Montreal, Quebec, Canada
| | - Rafik Ghali
- Department of Surgery, Division of Vascular Surgery, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Michel Lallier
- Department of Surgery, Division of Pediatric Surgery, Saint Justine Hospital, Montreal, Quebec, Canada
| |
Collapse
|
10
|
Efficacy and Clinical Outcomes of Bleomycin in the Treatment of Lymphangiomas: A Multicenter Experience. Dermatol Surg 2021; 47:948-952. [PMID: 33625132 DOI: 10.1097/dss.0000000000002976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bleomycin sclerotherapy became a popular nonsurgical option for the management of lymphangiomas. However, its efficacy has not been thoroughly evaluated. The purpose of this study was to assess the clinical outcomes and the effectiveness of bleomycin injection for the treatment of lymphangioma. METHODS This retrospective study was conducted in 4 centers and included 47 infants and children. All patients had bleomycin sclerotherapy between November 2005 and September 2020. Men presented 53.2% of the study sample (n = 25), and the most common site was the head and neck (n = 29, 61.7%). RESULTS Two injections were required in 11 patients (23.4%), and 7 patients (14.9%) required 3 or more injections. Excellent response was achieved in 63.8% (n = 30), 14 patients (29.8%) had a good response, and 4 had a poor response (8.5%). There was no difference in the response according to the site of the lesion (p = .75). The most frequent complication was recurrence (n = 11, 23.4%), and swelling occurred in 5 patients (10.6%). No patient had facial or phrenic nerve palsy or hoarseness. Two patients had persistent pain, and 2 had an infection (4.3%). CONCLUSION Intralesional bleomycin injection could be an effective therapy for lymphangiomas. The procedure has a low complication profile, and long-term study is recommended to evaluate the systemic and late bleomycin injection complications.
Collapse
|
11
|
Fresa M, El Ezzi O, DE Buys Roessingh A, Qanadli SD, Ney B, Mazzolai L. Ultrasound-guided percutaneous endovenous laser treatment combined with sclerotherapy for the treatment of large intramuscular venous malformations. INT ANGIOL 2020; 40:1-8. [PMID: 33236869 DOI: 10.23736/s0392-9590.20.04549-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Among vascular anomalies, congenital venous malformations (VMs) are the most common lesions. Treatment of VMs is sometimes difficult or cumbersome, depending on their size and tissue involvement. Surgery may lead to invasive and mutilating excisions, often allowing only partial removal, with an increased risk of recurrence. Sclerotherapy is a mainstream technique, resulting in endothelium destruction, fibrosis and subsequent shrinkage of the vascular lesion, also with a risk of recurrence. However, this technique may not be efficient in cases of large and infiltrating VMs. Endovenous thermal ablation has been found to be more effective than sclerotherapy for transmural vascular destruction and has therefore been employed in the treatment of VMs. METHODS In this study we described a combined technique for the treatment of large intramuscular VMs in seven consecutive patients, associating endovenous laser ablation with sclerotherapy. The aim was to assess feasibility and safety of the procedure. RESULTS We reported a high immediate technical success, clinical and radiological improvement, with no complications. CONCLUSIONS The preliminary results presented herein show, that combining EVLA and sclerotherapy for the treatment of voluminous persistent intramuscular VM is safe and technically feasible. The combination of a wide direct intimal thermal damage with chemical sclerotherapy is the force of this approach. The small number of cases and the medium term follow up represent though a limitation.
Collapse
Affiliation(s)
- Marco Fresa
- Department of Angiology, Center for Malformation and Rare Vascular Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland -
| | - Oumama El Ezzi
- Department of Pediatric Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | - Salah D Qanadli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Barbara Ney
- Department of Angiology, Center for Malformation and Rare Vascular Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Lucia Mazzolai
- Department of Angiology, Center for Malformation and Rare Vascular Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| |
Collapse
|
12
|
Chen KS, Montaser A, Ashour R, Orbach DB. Intracranial venous malformations: Incidence and characterization in a large pediatric cohort. Interv Neuroradiol 2020; 27:6-15. [PMID: 32689840 DOI: 10.1177/1591019920943752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Significant advances have been reported recently in the genetic and mechanistic characterization of extracranial venous malformations. However, intracranial purely venous malformations (icVM) analogous to those outside the CNS have not been systematically described. PURPOSE We sought to ascertain whether such an entity as icVM could in fact be identified, distinct from previously described CNS venous anomalies and analogous to extracranial venous malformations. METHODS Our prospectively collected pediatric cerebrovascular database was reviewed to identify patients with icVM; 1458 consecutive angiograms and/or angiographic interventions performed on 706 children at our institution from October, 2006 through May, 2019 were evaluated, in addition to outside imaging studies on 192 additional patients sent to our Vascular Anomalies Center for cerebrovascular review during the same time period. Thus, the cohort consisted of 898 children. RESULTS Nineteen of 898 patients (2.1%) were found to harbor icVM, including 9 (47.3%) with sinus pericranii, 15 (78.9%) with associated large, complex extracranial venous malformations, and 3 (15.7%) with neurocognitive delay. There was no intracranial hemorrhage or venous hypertension seen in the cohort. Asymptomatic venous thrombosis in the superior sagittal sinus was seen in three patients. CONCLUSION Venous malformations, both extracranial and icVM, share many characteristics that are distinct from developmental venous anomalies. icVM were not associated with venous hypertension. The underlying genetic mutations involved in the development of icVM, germ-line or somatic, remain to be elucidated, but may very well involve shared mechanisms and pathways with extracranial venous malformations.
Collapse
Affiliation(s)
- Karen S Chen
- Neurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alaa Montaser
- Neurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Neurological Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ramsey Ashour
- Department of Neurosurgery, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Darren B Orbach
- Neurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Neurological Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
13
|
The Sclerotherapy-An Efficacious Approach in the Management of Vascular Lesions and Pyogenic Granuloma: Case Series with Literature Review. Indian J Otolaryngol Head Neck Surg 2020; 73:167-173. [PMID: 34150591 DOI: 10.1007/s12070-020-01960-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022] Open
Abstract
Sclerotherapy is a targeted elimination of small vessels, varicose veins, and vascular anomalies by the injection of a sclerosant. Sclerotherapy aims to damage the vessel wall and transform it into fibrous tissue. The present study was conducted to evaluate the efficacy of a sclerosing agent 3% polidocanol in the treatment of vascular lesions and pyogenic granuloma. The solution was injected intralesionally at multiple sites and was repeated after an interval of 2 weeks. The treatment effect was determined by clinical examination. Sclerotherapy with 3% polidocanol is effective in the treatment of vascular lesions and pyogenic granuloma. This treatment modality offers an alternative to conventional methods such as surgical excision, laser therapy, cryotherapy, steroid therapy, etc., in cases where conservative treatment is preferable. The advantage is that it causes minimal discomfort, negligible blood loss, less cumbersome, and above all is economical. There is no requirement of local anesthesia or postoperative dressings or any specific care. The patient can resume his daily activities immediately.
Collapse
|
14
|
Bagga B, Goyal A, Das A, Bhalla AS, Kandasamy D, Singhal M, Kairo A. Clinicoradiologic predictors of sclerotherapy response in low-flow vascular malformations. J Vasc Surg Venous Lymphat Disord 2020; 9:209-219.e2. [PMID: 32653406 DOI: 10.1016/j.jvsv.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/19/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the clinical effectiveness of sclerotherapy agents in low-flow vascular malformations (LFVM) and identify clinical/imaging features to predict response. METHODS A retrospective analysis of hospital records of symptomatic LFVM patients who underwent phlebosclerotherapy from January 2015 to April 2018 was done. Patients were subdivided into venous malformations (VM) and lymphatic malformations (LM). Out of 246 cases, 223 patients (132 males, 91 females; age range, 2-52 years) had VM and 23 (13 males, 10 females; age range, 3 months to 45 years) had LM. The clinical response was graded as excellent (>60%), good (30%-60%), and poor (<30%). More than 30% was considered as acceptable response. The χ2 test was performed for correlation between clinical response and clinical, sonographic, magnetic resonance imaging, phlebographic parameters followed by multilinear regression. RESULTS Cavitary (43%) and spongy (37.7%) were the most common phlebographic patterns seen among VM and a cavitary pattern (87%) was most frequent in LM. Sodium tetradecyl sulphate and bleomycin were most commonly used sclerosants in VM and LM, respectively. The mean number of sessions was 4.35 (range, 1-23) in VM and 2.64 (range, 2-7) in LM. Among VM, 114 patients (51.1%) had excellent response to treatment (>60%) and 75.8% patients had an acceptable response (>30%). All patients with LM had an acceptable response (excellent response in 86.9%). Clinical disfigurement, discoloration, diffuse involvement, dysplastic venous morphology on phlebogram, and late and indirect draining vein correlated with poor response to sclerotherapy in VM (P = .003, P = .036, P = .007, P = .008, P = .003, and P = .035, respectively). Cystic components on ultrasound examination and direct draining vein were seen more often in excellent responders (P = .004 and P = .007) in addition to absence of disfigurement, discoloration, and diffuse involvement (P = .032, P = .003, and P = .002). Mod els comprising clinical disfigurement, dysplastic veins, and late draining vein had the greatest predictive value for poor response (R2 = 0.256). Also, the best model for predicting excellent response comprised presence of direct draining vein and absence of skin discoloration (R2 = 0.109). Eleven instances of minor complications occurred among a total of 1032 sessions, seven with sodium tetradecyl sulphate and four with polidocanol. CONCLUSIONS Acceptable response to sclerotherapy was achieved in majority of LFVM with extremely low complication rates. Clinicoradiologic features, especially phlebographic findings, correlated with response to sclerotherapy.
Collapse
Affiliation(s)
- Barun Bagga
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
| | - Abanti Das
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | | | - Maneesh Singhal
- Department of Plastic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kairo
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
15
|
Ghareeb A, Kakaje A, Ghareeb A, Nahas MA. An enormous arteriovenous malformation presenting in a child in sacro-gluteal region and managed successfully by recurrent embolisation and surgery. Int J Surg Case Rep 2020; 71:244-249. [PMID: 32492638 PMCID: PMC7264987 DOI: 10.1016/j.ijscr.2020.05.010] [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] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/09/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022] Open
Abstract
A massive arterio-venous malformation (AVM) on the buttock of a young girl. Recurrent embolisation and surgery made total resection possible. This is the first report from the Middle East of such a case in a child. This AVM was sucessfully managed by repeated embolization and resection. Management should not be postponed from financial disadvantge.
Background Arteriovenous malformations (AVMs) are rare congenital lesions that affect multiple regions. AVMs often affect the brain and the buttock is the least common. They are usually congenital, but discovered later in life as they are asymptomatic, small and resemble a benign lesion. However, they can abruptly grow and become symptomatic and life-threatening as they can bleed and get infected. Presentation of case An eight-year-old girl presented with ulcerated and bleeding AVM at the sacro gluteal region. However, due to financial difficulty, it grew to reach an enormous size of (15*15*2 cm) in the buttock. It was later managed by multiple embolisation followed by total surgical resection. Discussion This case reflects the first case of enormous AVM in the sacro-gluteal region in a child in the Middle East as they rarely reach such huge sizes. Total resection was possible by repeat embolisation and surgery. Conclusion Embolisation can render even huge AVM operable. AVMs should be treated as early as possible as they continue to grow and drastically decrease the quality of life of the patient.
Collapse
Affiliation(s)
- Amjad Ghareeb
- Damascus University, Faculty of Medicine, Damascus, Syria.
| | - Ameer Kakaje
- Damascus University, Faculty of Medicine, Damascus, Syria.
| | - Ayham Ghareeb
- Damascus University, Faculty of Medicine, Damascus, Syria
| | - Mohamad Ali Nahas
- Chief of Vascular and Endovascular Surgery Department, Al Assad University Hospital, Damascus, Syria
| |
Collapse
|
16
|
Wang SK, Drucker NA, Gupta AK, Marshalleck FE, Dalsing MC. Diagnosis and management of the venous malformations of Klippel-Trénaunay syndrome. J Vasc Surg Venous Lymphat Disord 2018. [PMID: 28624001 DOI: 10.1016/j.jvsv.2016.10.084] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE A dearth of information exists in the literature regarding current practice in the management of Klippel-Trénaunay syndrome (KTS), a rare condition. We review and describe the etiology, diagnosis, and treatment of KTS. METHODS Relevant data were synthesized from a Medline review using a combination of the keyterms "Klippel" and "Trénaunay." The majority of hits described singular case reports and were subsequently excluded. The remaining papers were then reviewed and included on the basis of the quality of evidence and the authors' discretion. CONCLUSIONS KTS is characterized by a clinical triad of extremity varicosities, cutaneous vascular malformations, and hypertrophy of soft tissues and long bones. The diagnosis is clinically supplemented with magnetic resonance imaging and computed tomography. Although this syndrome is associated with significant comorbidities, such as pain, edema, ulcerations, and pruritus, it is rarely the cause of death. The backbone of treatment is nonoperative in nature but should be supplemented with minimally invasive, endovascular, and rarely open surgical procedures for refractory cases.
Collapse
Affiliation(s)
- S Keisin Wang
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind; Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Natalie A Drucker
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Alok K Gupta
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind; Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | | | - Michael C Dalsing
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind; Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind.
| |
Collapse
|
17
|
Settembre N, D'oria M, Dekerle L, Saba C, Bouziane Z, Malikov S. Free Omental Flap for Tissue Defect Coverage after Resection of Complicated Venous Malformation in the Area of the Knee. Ann Vasc Surg 2018; 51:327.e9-327.e13. [PMID: 29772322 DOI: 10.1016/j.avsg.2018.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 11/28/2022]
Abstract
Venous malformations are the most common slow-flow vascular malformations; they are not prone to volume decrease over time, and invasive treatment is usually required. There are 2 main techniques to address the definitive therapy of these lesions, sclerotherapy and surgical excision, each with its own advantages and disadvantages. We report the case of a 56-year-old man who came to our attention with persistent pain after multiple unsuccessful attempts to treat a large venous malformation located in the area of the right knee. After radical excision of the painful lesion, we covered the resulting major tissue loss (20 cm × 15 cm) with a free omental flap. The arterial and venous anastomoses were on the region above the knee pedicles. The postoperative course was uneventful. A secondary skin grafting was performed. The patient is doing well at 1-year follow-up. The omental flap may be a bailout solution for tissue loss coverage in the knee area when the use of the common fascia-cutaneous or muscular flaps is not possible.
Collapse
Affiliation(s)
- Nicla Settembre
- Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, Nancy, France; INSERM 1116, University of Lorraine, Nancy, France.
| | - Mario D'oria
- Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, Nancy, France
| | - Lucie Dekerle
- Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, Nancy, France
| | - Charbel Saba
- Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, Nancy, France
| | - Zakariyae Bouziane
- Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, Nancy, France
| | - Serguei Malikov
- Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, Nancy, France; INSERM 1116, University of Lorraine, Nancy, France
| |
Collapse
|
18
|
Laroche JP, Blaise S, Becker F, Laaeng Massoni C, Nou-Howaldt M, Pichot O, Desmurs-Clavel H, Jeancolas J, Jurus C, Sarlon-Bartoli G, Soulier-Sotto V, Thiel H, Sevestre-Pietri MA, Maloizel-Delaunay J, Mestre-Godin S. [Quality standards for ultrasonographic assessment of peripheral vascular malformations and vascular tumors. Report of the french society for vascular medicine. 2018 Update]. JOURNAL DE MEDECINE VASCULAIRE 2018; 43:36-51. [PMID: 29425539 DOI: 10.1016/j.jdmv.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/02/2017] [Indexed: 06/08/2023]
Abstract
UNLABELLED The quality standards of the French Society of Vascular Medicine for the ultrasonographic assessment of vascular malformations are based on the two following requirements: (1) technical know-how: mastering the use of ultrasound devices and the method of examination; (2) medical know-how: ability to adapt the methods and scope of the examination to its clinical indication and purpose, and to rationally analyze and interpret its results. AIMS OF THE QUALITY STANDARDS To describe an optimal method of examination in relation to the clinical question and hypothesis. To homogenize practice, methods, glossary, and reporting. To provide good practice reference points, and promote a quality process. ITEMS OF THE QUALITY STANDARDS The 3 levels of examination; their clinical indications and goals. The reference standard examination (level 2), its variants according to clinical needs. The minimal content of the examination report; the letter to the referring physician (synthesis, conclusion and proposal for further investigation and/or therapeutic management). Commented glossary (anatomy, hemodynamics, semiology). Technical bases. Setting and use of ultrasound devices. Here, we discuss ultrasonography methods of using of ultrasonography for the assessment of peripheral vascular malformations and tumors (limbs, face, trunk).
Collapse
MESH Headings
- Adult
- Blood Coagulation Disorders/blood
- Blood Coagulation Disorders/etiology
- Blood Flow Velocity
- Clinical Competence
- Disease Progression
- Eye Neoplasms/diagnostic imaging
- Female
- Fibrin Fibrinogen Degradation Products/analysis
- Fibrinogen/analysis
- Hemangioma/diagnostic imaging
- Hemodynamics
- Humans
- Infant
- Lymphangioma, Cystic/diagnostic imaging
- Male
- Quality Assurance, Health Care
- Ultrasonography, Doppler, Color/instrumentation
- Ultrasonography, Doppler, Color/methods
- Ultrasonography, Doppler, Duplex/instrumentation
- Ultrasonography, Doppler, Duplex/methods
- Ultrasonography, Doppler, Duplex/standards
- Vascular Malformations/blood
- Vascular Malformations/classification
- Vascular Malformations/complications
- Vascular Malformations/diagnostic imaging
- Vascular Neoplasms/diagnostic imaging
Collapse
Affiliation(s)
- J P Laroche
- Médecine vasculaire, médecine interne B, hôpital Saint-Eloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - S Blaise
- Département de médecine vasculaire, CHU Grenoble Alpes, 38000 Grenoble, France.
| | - F Becker
- Service d'angiologie et d'hémostase, hôpitaux universitaires de Genève, hôpital Cantonal, 1205 Genève, Suisse
| | | | - M Nou-Howaldt
- Médecine vasculaire, médecine interne B, hôpital Saint-Eloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - O Pichot
- Département de médecine vasculaire, CHU Grenoble Alpes, 38000 Grenoble, France
| | - H Desmurs-Clavel
- Hospices civils de Lyon, service de médecine interne, hôpital Édouard-Herriot, 5, rue d'Arsonval, 69437 Lyon, France
| | - J Jeancolas
- Médecine vasculaire, CHU Caen, avenue de la Côte de Nacre, 14033 Caen, France
| | - C Jurus
- Médecine vasculaire, clinique du Tonkin, 26, rue du Tonkin, 69100 Villeurbanne, France
| | - G Sarlon-Bartoli
- Médecine vasculaire, CHU La Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - V Soulier-Sotto
- Médecine vasculaire, médecine interne B, hôpital Saint-Eloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - H Thiel
- Médecine vasculaire, CHU Clermont-Ferrand, hôpital Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France
| | - M A Sevestre-Pietri
- Médecine vasculaire, Site Sud, CHU d'Amiens-Picardie, 80054 Amiens cedex 1, France
| | - J Maloizel-Delaunay
- Médecine vasculaire, CHU Rangueil, 1, avenue du Professeur Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - S Mestre-Godin
- Département de médecine vasculaire, CHU Grenoble Alpes, 38000 Grenoble, France
| |
Collapse
|
19
|
Affiliation(s)
- Jung Ho Lee
- Department of Plastic and Reconstructive Surgery, The Catholic University of Korea Bucheon St. Mary's Hospital, Seoul, Korea
| | - David W. Chang
- Section of Plastic and Reconstructive Surgery, Department of Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| |
Collapse
|
20
|
Ghanem AA, el Hadidi YN. Management of a Life Threatening Bleeding Following Extraction of Deciduous Second Molar Related to a Capillary Haemangioma. Craniomaxillofac Trauma Reconstr 2017; 10:166-170. [PMID: 28523092 PMCID: PMC5435487 DOI: 10.1055/s-0037-1598102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/27/2016] [Indexed: 01/01/2023] Open
Abstract
Various forms of vascular lesion affect the head and neck region. The head and neck vascular lesions are classified into neoplasms and malformations. Neoplasm presents either as hemangioma or lymphangioma; neoplasm usually presents in young age compared with vascular malformation. A 9-year-old female patient presented to the outpatient clinic referred from the department of pedodontics after extraction of a right mandibular second deciduous molar. Extraction was done by dental GP in outpatient clinic. Massive bleeding followed the extraction. Bleeding was controlled by electrocoagulation of bleeding site and systemic and local application of antifibrinolytic agent. An intravenous line was placed to provide fluid replacement. Injection of intravenous cyklokapron was given to stabilize the blood clot. Selective embolization was performed 24 hours prior to surgical resection of lesion and the lesion was removed under general anesthesia followed by peripheral ostectomy of bone to remove any feeders. Different protocols are used to control life-threatening bleeding. Primary local measures such as Gelfoam packing, Tranexamic or Aminocaproic topical application, Surgicel application, Electrocautery, Bone wax, Ligation of External Carotid or Common Carotid Artery, or Selective Embolization of feeder vessel may be used to control the bleeding. Interventional radiographic blockage of feeder vessel currently shows high success rate in the management of life-threatening bleeding compared with previous techniques.
Collapse
Affiliation(s)
- Amr Amin Ghanem
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Yasser Nabil el Hadidi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| |
Collapse
|
21
|
Mayer C, Hattingen E, Schild H, Bootz F, Schröck A. [Interventional radiology in the head and neck region]. HNO 2017; 65:482-489. [PMID: 28451716 DOI: 10.1007/s00106-017-0354-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In interventional neuroradiology, endovascular embolization represents an important and helpful tool in the treatment of multiple head and neck diseases. These interventional procedures may be performed with curative intent, to reduce the surgical risk within a multimodal treatment concept, or to improve or at least maintain a good quality of life within a palliative therapy concept. In addition to a good understanding of disease pathology, knowledge of vascular anatomy, including collateral vessels and dangerous extracranial-intracranial anastomoses, is essential for successful treatment, as is implementation of an established technique using appropriate material. Indications for endovascular embolization are i. otherwise unmanageable bleeding (caused by e. g., trauma, vascular malformation, or tumor), ii. reduction of perioperative bleeding by preoperative embolization in case of a hypervascularized tumor, iii. selective induction of tumor necrosis by palliative embolization to enhance local tumor control. Major complications such as stroke, loss of vision, and cranial nerve palsy are mostly due to a lack of preinterventional evaluation. Regarding neurological deficits, interventions within the supply region of the external carotid artery have a complication rate below 1%.
Collapse
Affiliation(s)
- C Mayer
- Klinik für Radiologie, Universität Bonn, Bonn, Deutschland
| | - E Hattingen
- Klinik für Radiologie, Universität Bonn, Bonn, Deutschland
| | - H Schild
- Klinik für Radiologie, Universität Bonn, Bonn, Deutschland
| | - F Bootz
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde/Chirurgie, Universität Bonn, Sigmund-Freud Straße 25, 53127, Bonn, Deutschland
| | - A Schröck
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde/Chirurgie, Universität Bonn, Sigmund-Freud Straße 25, 53127, Bonn, Deutschland.
| |
Collapse
|
22
|
Malgor RD, Gloviczki P, Fahrni J, Kalra M, Duncan AA, Oderich GS, Vrtiska T, Driscoll D. Surgical treatment of varicose veins and venous malformations in Klippel–Trenaunay syndrome. Phlebology 2015; 31:209-15. [DOI: 10.1177/0268355515577322] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Klippel–Trenaunay syndrome (KTS) is a mixed mesenchymal malformation characterised by varicose veins, venous and capillary malformations, and hypertrophy of soft tissue and bone. The purpose of this study was to evaluate the surgical outcomes in KTS patients to provide standards for comparison with endovenous therapy. Methods The clinical data of consecutive patient with KTS who underwent open venous surgical treatment between January 1987 and December 2008 were reviewed. Demographics, clinical presentation, operative data, and clinical outcomes were recorded. Follow-up information was obtained from the medical records, mailed questionnaires and phone calls. Descriptive statistics, the Kaplan–Meier method and Log-rank statistics were used where appropriate. Results Twenty-seven females and 22 males, (mean age 26.5 years, range 7.7–55.8) were included in this study. All had varicose veins, 36 (73%) had limb hypertrophy, and 33 (67%) had capillary malformations, with two of three clinical features present in all. The most frequent symptom was pain (N = 43, 88%). Forty-nine patients underwent operations on 53 limbs. Stripping of the GSV, small and accessory saphenous and lateral embryonic veins was performed in 17 (32%), 10 (19%), 9 (17%), and 15 (28%) limbs, respectively. Two patients developed deep vein thrombosis, one had pulmonary embolism (PE), and one patient had peroneal nerve palsy. Freedom from disabling pain at 1, 3 and 5 years was 95%, 77% and 59%, respectively, and freedom from secondary procedures was 78% at 3 years, and 74% at 5 years. At the last follow-up visit, the venous clinical severity score had decreased from 9.48 ± 3.27 to 6.07 ± 3.20 (P < 0.001). Conclusions In selected symptomatic patients with KT syndrome, open surgical treatment is safe and durable. Three-fourths of the patients remain free of disabling pain at five years, but secondary procedures are required in one-fourth of the patients. These data can serve as standards for comparison of endovenous therapy for KT syndrome.
Collapse
Affiliation(s)
- Rafael D Malgor
- Division of Vascular and Endovascular Surgery, The University of Oklahoma College of Medicine, Tulsa, Oklahoma, USA
| | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jennifer Fahrni
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Audra A Duncan
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Terri Vrtiska
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - David Driscoll
- Vascular Malformation Clinic, Gonda Vascular Center, Mayo Clinic, Rochester, USA
| |
Collapse
|
23
|
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.
Collapse
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.
| |
Collapse
|
24
|
Olímpio HDO, Bustorff-Silva J, Oliveira Filho AGD, Araujo KCD. Cross-sectional study comparing different therapeutic modalities for cystic lymphangiomas in children. Clinics (Sao Paulo) 2014; 69:505-8. [PMID: 25141107 PMCID: PMC4129551 DOI: 10.6061/clinics/2014(08)01] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 12/20/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Here, we describe our experience with different therapeutic modalities used to treat cystic lymphangiomas in children in our hospital, including single therapy with OK-432, bleomycin and surgery, and a combination of the three modalities. METHODS We performed a retrospective, cross-sectional study including patients treated from 1998 to 2011. The effects on macrocystic lymphangiomas and adverse reactions were evaluated. Twenty-nine children with cystic lymphangiomas without any previous treatment were included. Under general anesthesia, patients given sclerosing agents underwent puncture of the lesion (guided by ultrasound when necessary) and complete aspiration of the intralesional liquid. The patients were evaluated with ultrasound and clinical examinations for a maximum follow-up time of 4 years. RESULTS The proportions of patients considered cured after the first therapeutic approach were 44% in the surgery group, 29% in the bleomycin group and 31% in the OK-432 group. These proportions were not significantly different. Sequential treatment increased the rates of curative results to 71%, 74% and 44%, respectively, after the final treatment, which in our case was approximately 1.5 applications per patient. CONCLUSION The results of this study indicate that most patients with cystic lymphangiomas do not show complete resolution after the initial therapy, regardless of whether the therapy is surgical or involves the use of sclerosing agents. To achieve complete resolution of the lesions, either multiple operations or a combination of surgery and sclerotherapy must be used and should be tailored to the characteristics of each patient.
Collapse
|
25
|
Bai N, Chen YZ, Fu YJ, Wu P, Zhang WN. A clinical study of pingyangmycin sclerotherapy for venous malformation: an evaluation of 281 consecutive patients. J Clin Pharm Ther 2014; 39:521-6. [PMID: 24924412 DOI: 10.1111/jcpt.12183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 05/12/2014] [Indexed: 02/01/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE In China, lidocaine together with 2 mg/mL of pingyangmycin (PYM, also known as bleomycin A5) is recommended for the treatment of venous malformations (VMs). The purpose of this study was to investigate whether lidocaine has a synergistic effect with PYM in improving the therapeutic outcomes of patients with VMs. Additionally, this study aimed to evaluate the outcomes of sclerotherapy for VMs using an intralesional injection of a low concentration of PYM (0·5 mg/mL). METHODS A total of 281 patients with VMs were treated with 0·5 or 2 mg/mL of PYM with or without lidocaine and dexamethasone (DEX). All of the patients received a direct intralesional injection at a rate of 1 mL/min, and the volume of the solution varied from 1·5 to 6·0 mL per injection. RESULTS AND DISCUSSION No significant differences were observed in the clinical outcomes between the PYM and PYM + lidocaine treatment groups (P > 0·05). The clinical outcomes were similar between the groups that were treated with 0·5 and 2 mg/mL of PYM, but the swelling and pain in the patients who were treated with 0·5 mg/mL of PYM were less severe compared with the patients who were treated with 2 mg/mL of PYM. A total of 29 patients with VM lesions on the glans penis were treated with 0·5 mg/mL of PYM + 0·5% lidocaine. Of these patients, 26 were cured, whereas three experienced a marked improvement. WHAT IS NEW AND CONCLUSION Lidocaine does not have a synergistic effect with PYM in improving the therapeutic outcomes of patients with VMs. Sclerotherapy with a low concentration of PYM (0·5 mg/mL) combined with lidocaine and DEX is a safe and effective therapy for small superficial VMs of critical organs, such as the lips and the glans penis.
Collapse
Affiliation(s)
- N Bai
- Department of Plastic Surgery, Linyi People's Hospital, Linyi, Shandong province, China
| | | | | | | | | |
Collapse
|
26
|
Lee BB. Commentary on preliminary experience with intraoperative near-infrared fluorescence imaging in percutaneous sclerotherapy of soft-tissue venous malformations. Dermatol Surg 2013; 39:913-4. [PMID: 23738958 DOI: 10.1111/dsu.12077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Byung-Boong Lee
- Center for the Lymphedema and Vascular Malformations, George Washington University, Washington, DC, USA.
| |
Collapse
|
27
|
Affiliation(s)
- BB Lee
- Division of Vascular Surgery, Department of Surgery, George Washington University, Washington, DC, USA
| | - J Laredo
- Division of Vascular Surgery, Department of Surgery, George Washington University, Washington, DC, USA
| |
Collapse
|
28
|
Yuan SM, Hong ZJ, Jiang HQ, Wang J, Hu XB. Intralesional copper wire retention and pingyangmycin injection: an effective combinational therapy for complex venous malformation in soft tissue. Phlebology 2013; 29:179-85. [PMID: 23508003 DOI: 10.1177/0268355513477086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Complex venous malformations (VMs) may extensively involve the soft tissue. The treatment remains a challenge till now. Here we introduce a combinational therapy of copper wires and pingyangmycin (bleomycin A5,PYM). METHODS Copper wires were retained in VMs by repeated penetration with a straight needle. Subsequently, PYM solution was injected into the lesion. Eight to 10 days later, copper wires were removed. The dressing was changed every day until the puncture pores healed. Magnetic resonance imaging scanning was performed to observe the change of VMs. RESULTS From January 2001 to December 2011, 56 patients were treated. During the follow-up period, most of the VMs shrunk obviously. The symptoms were relieved or disappeared. The complications included local pain, temporary paraesthesia and moderate fever, which disappeared quickly after the removal of copper wires. CONCLUSIONS This combinational therapy is a safe and effective approach for the complex VMs in soft tissue.
Collapse
Affiliation(s)
- S-M Yuan
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | | | | | | | | |
Collapse
|
29
|
Lee BB. Venous malformation and haemangioma: differential diagnosis, diagnosis, natural history and consequences. Phlebology 2013; 28 Suppl 1:176-87. [DOI: 10.1177/0268355513475960] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Venous malformation (VM) is the most common form of congenital vascular malformation (CVM). VM presents at birth as an inborn vascular defect and never disappears/regresses spontaneously through the rest of life; it will continue to grow slowly at a rate that is proportional to the growth rate of the body. Haemangioma is not a vascular malformation but one of the vascular tumours originating from the endothelial cells; it develops after birth mostly in the infantile/neonatal period with a distinctive growth cycle: a proliferation phase of early rapid growth followed by an involutional phase of slow regression. Although the vascular malformation and vascular tumour belong to the ‘vascular anomaly’ together, both conditions are fundamentally different not only in their anatomical, histological and pathophysiological findings but also in their clinical courses. Therefore, an appropriate differential diagnosis of the VM is mandated not only from other kinds of CVMs but also from ‘genuine’ haemangioma. Appropriate diagnosis and assessment of VMs can be made based on clinical presentation and a proper combination of basic non-invasive studies in general but the presence of a mixed lesion involving other types of CVM lesions and the type of VM lesion, extratruncular and truncular, will dictate the need for further work-up with additional non- to less-invasive study or angiography. Otherwise, angiography is usually reserved for therapeutic planning and treatment.
Collapse
Affiliation(s)
- B B Lee
- Center for the Lymphedema and Vascular Malformations, George Washington University, Washington, DC, USA
| |
Collapse
|
30
|
Abstract
Venous malformations are the result of an arrested development of the venous system during the embryogenesis. In the treatment of venous malformations the standard of care is a multidisciplinary approach including the use of traditional surgical therapy if applicable and endovascular treatment. Endovascular techniques include embolization therapy for instance with coils but also sclerotherapy with liquid or foamed sclerosants. The aim of this paper is to give an overview of foam sclerotherapy in venous malformations. Sclerotherapy of venous malformations has been performed in superficial and intramuscular malformations. In many cases ethanol has been used for the treatment. Since more than 10 years, less aggressive sclerosants like polidocanol and sodiumtetradecyl sulphate have been used to treat venous malformations. These substances can be used without anaesthesia and the rate of side-effects is much lower. Yamaki and Cabrera are the first who used foam sclerotherapy for the treatment of symptomatic venous malformations. Compared with liquid sclerotherapy foam sclerotherapy has the advantage of a better and longer lasting contact of the sclerosing agent with the vessel wall which leads to a more effective treatment and to a reduction of concentrations needed. In a recent European Guideline on Sclerotherapy foam sclerotherapy is recommended over liquid therapy for the treatment of venous malformations. Foam sclerotherapy is an effective treatment option for low flow extratruncular and truncular venous malformations. Foam is significantly more effective than liquid sclerotherapy and side-effects with polidocanol or sodiumtetradecyl sulphate foam are less compared with sclerotherapy with ethanol. With foam sclerotherapy a significant reduction of pain and volume of the venous malformations can be reached.
Collapse
Affiliation(s)
- E Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| | - F Pannier
- Department of Dermatology, University of Cologne, Cologne, Germany
| |
Collapse
|
31
|
Lee BB, Laredo J. Classification of congenital vascular malformations: the last challenge for congenital vascular malformations. Phlebology 2012; 27:267-9. [DOI: 10.1258/phleb.2012.012e04] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- B B Lee
- George Washington University, Washington, DC, USA
| | - J Laredo
- George Washington University, Washington, DC, USA
| |
Collapse
|
32
|
Roehm CE, Chelius DC, Larrier D, Hicks MJ, Albright JT, Valdez TA. Postcricoid vascular lesions. Laryngoscope 2011; 121:397-403. [DOI: 10.1002/lary.21243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 06/01/2010] [Accepted: 06/04/2010] [Indexed: 11/10/2022]
|
33
|
Boettcher MC, Eivazi B, Roessler M, Bette M, Cai C, Wiegand S, Güldner C, Werner JA, Mandic R. Involvement of LYVE-1-positive endothelial cells in the formation of non-lymphatic vascular malformations. Histopathology 2010; 57:764-8. [PMID: 21083607 DOI: 10.1111/j.1365-2559.2010.03690.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
34
|
Gloviczki P. Union of forces. Phlebology 2010; 25:217-8. [DOI: 10.1258/phleb.2010.010e04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- P Gloviczki
- The Joe M. and Ruth Roberts Professor of Surgery, Division of Vascular and Endovascular Surgery and Director, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
35
|
Abstract
The aim of this review was to discuss the current knowledge on aetiopathogenesis, diagnosis and therapeutic management of venous malformations (VMs). VMs are slow-flow vascular anomalies. They are simple, sporadic or familial (cutaneomucosal VMs or glomuvenous malformations), combined (e.g. capillaro-venous and capillaro-lymphaticovenous malformations) or syndromic (Klippel-Trenaunay, blue rubber bleb naevus and Maffucci). Genetic studies have identified causes of familial forms and of 40% of sporadic VMs. Another diagnostic advancement is the identification of elevated D-dimer level as the first biomarker of VMs within vascular anomalies. Those associated with pain are often responsive to low-molecular-weight heparin, which should also be used to avoid disseminated intravascular coagulopathy secondary to intervention, especially if fibrinogen level is low. Finally, development of a modified sclerosing agent, ethylcellulose-ethanol, has improved therapy. It is efficient and safe, and widens indications for sclerotherapy to sensitive and dangerous areas such as hands, feet and periocular area.
Collapse
Affiliation(s)
- Anne Dompmartin
- Université de Caen Basse Normandie, CHU Caen, Department of Dermatology, Caen (France)
| | - Miikka Vikkula
- Université catholique de Louvain, de Duve Institute, Laboratory of Human Molecular Genetics, B-1200 Brussels, Belgium
| | - Laurence M Boon
- Université catholique de Louvain, de Duve Institute, Laboratory of Human Molecular Genetics, B-1200 Brussels, Belgium
- Université catholique de Louvain, Cliniques universitaires St Luc, Center for Vascular Anomalies, Division of Plastic Surgery, B-1200 Brussels, Belgium
| |
Collapse
|
36
|
LEE BB. Not All Venous Malformations Needed Therapy Because They Are Not Arteriovenous Malformations. Dermatol Surg 2010; 36:347. [DOI: 10.1111/j.1524-4725.2009.01441.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
Abstract
Arterio-venous malformation (AVM) is a congenital vascular malformation that is neither a venous malformation nor a haemangioma. An AVM is a potentially life-threatening and limb-threatening lesion, especially the 'fistulous' truncular form due to its unique embryological and haemodynamic characteristics. AVM treatment requires an early aggressive approach, one that is careful and based on a thorough assessment of the risks and benefits associated with the treatment plan. A successful treatment strategy requires an accurate assessment of the AVM taking into account the extent, severity and progression of the lesion. This is critical in order to minimize the morbidity associated with the currently available therapies. A multidisiciplinary approach that integrates endovascular and surgical therapy can substantially improve the treatment results seen in patients with AVMs. Preliminary treatment of a fistulous AVM with coil embolization is essential in order to minimize associated morbidity and to alter the lesion haemodynamics from a high-flow lesion to a low-flow lesion that is more amenable to subsequent, definitive management with ethanol or NBCA glue embolo/sclerotherapy.
Collapse
Affiliation(s)
- B B Lee
- Georgetown University School of Medicine, washington, DC, USA.
| | | | | |
Collapse
|
38
|
Wiegand S, Eivazi B, Karger R, Al Kadah B, Sesterhenn AM, Werner JA. Surgery in patients with vascular malformations of the head and neck: value of coagulation disorders. Phlebology 2009; 24:38-42. [DOI: 10.1258/phleb.2008.008019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives The surgical treatment of congenital vascular malformations always bears the risk of severe bleeding. The aim of this study was to investigate the prevalence of haemostatic abnormalities in patients with congenital vascular malformations of the head and neck which could additionally complicate the complex surgery of vascular malformations. Methods Thirteen patients with congenital vascular malformations of the head and neck, who underwent scheduled surgery, were reviewed regarding their haemostatic tests, including prothrombin time, activated partial thromboplastin time, fibrinogen level, platelet count, platelet function analyzer-epinephrine (PFA-Epi) and -adenosine diphosphate (ADP) (PFA-100®), von Willebrand factor (vWF) and D-dimers. Results In six of 13 patients an impaired primary haemostasis was detected by prolonged PFA-Epi and one of these patients also had a slightly prolonged PFA-ADP. Additionally, two of the patients showed mild coagulation factor deficiency. One patient had a mild vWF deficiency that was not detected by PFA-100®. Conclusion Prior to surgery of congenital vascular malformations of the head and neck, a detailed coagulation analysis is needed in order to identify those patients at increased risk of bleeding. This proceeding is supported by the fact that a relevant portion of the patients with congenital vascular malformations of the head and neck show an impaired primary haemostasis.
Collapse
Affiliation(s)
- S Wiegand
- Department of Otolaryngology, Head and Neck Surgery, Philipps-University of Marburg, Marburg, Germany
| | - B Eivazi
- Department of Otolaryngology, Head and Neck Surgery, Philipps-University of Marburg, Marburg, Germany
| | - R Karger
- Institute of Transfusion Medicine and Hemostaseology, Philipps-University of Marburg, Marburg, Germany
| | - B Al Kadah
- Department of Otolaryngology, Head and Neck Surgery, Philipps-University of Marburg, Marburg, Germany
| | - A M Sesterhenn
- Department of Otolaryngology, Head and Neck Surgery, Philipps-University of Marburg, Marburg, Germany
| | - J A Werner
- Department of Otolaryngology, Head and Neck Surgery, Philipps-University of Marburg, Marburg, Germany
| |
Collapse
|