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Chikada M, Chiba K, Nawata K, Tomita M, Nakamura R, Kinebuchi S, Kita S, Komagamine M, Kogo M, Nishimaki H, Miyairi T. Longterm Followup of a Pediatric Patient with Congenital Abdominal Aortic Aneurysm with Coarctation. Ann Vasc Dis 2022; 15:341-343. [PMID: 36644269 PMCID: PMC9816021 DOI: 10.3400/avd.cr.22-00067] [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: 06/08/2022] [Accepted: 08/27/2022] [Indexed: 11/05/2022] Open
Abstract
Congenital abdominal aortic aneurysm (AAA) with coarctation has been considered an extremely rare condition. In this study, we present a 3-year-old boy, who was diagnosed by chance with congenital AAA at first operation. We replaced the AAA+coarctation with a 6-mm polytetrafluoroethylene (PTFE) graft. Histological examination of the aortic wall revealed no particular abnormalities. Collateral vessels were noted to develop over 14 years of followup. Good blood flow to both lower limbs and no intermittent claudication were observed. After growth, at the age 17, he underwent extra-anatomical bypass using a 12-mm PTFE graft. This is the first report of successful treatment of congenital AAA+coarctation with longterm followup.
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Affiliation(s)
- Masahide Chikada
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,Corresponding author: Masahide Chikada, MD. Department of Cardiovascular Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan Tel: +81-44-977-8111, Fax: +81-44-976-5792, E-mail:
| | - Kiyoshi Chiba
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kan Nawata
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masahiro Tomita
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Ryuji Nakamura
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Satoshi Kinebuchi
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shota Kita
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masahide Komagamine
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Misa Kogo
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hiroshi Nishimaki
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Takeshi Miyairi
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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2
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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.
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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
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3
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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.
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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
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4
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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.
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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
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5
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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.
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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.
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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
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7
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Asghar F, Aqeel R, Farooque U, Haq A, Taimur M. Presentation and Management of Klippel-Trenaunay Syndrome: A Review of Available Data. Cureus 2020; 12:e8023. [PMID: 32528762 PMCID: PMC7282379 DOI: 10.7759/cureus.8023] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Klippel-Trenaunay Syndrome (KTS) is a rare and sporadic congenital disorder, characterized by the classical triad of port-wine stains, varicosities along with bone and soft tissue hypertrophy. Symptoms of Klippel-Trenaunay Syndrome include pain, swelling, lymphedema, bleeding, superficial thrombophlebitis, and deep vein thrombosis. The etiology remains indistinct and has been attributed to both genetic and environmental factors. In most cases, a thorough history and clinical examination is enough for the diagnosis of Klippel Trenaunay Syndrome. However, when certain complications are present, noninvasive imaging techniques are used for the diagnosis and evaluation of the disease in patients. Due to the diversity of presentation, a multidisciplinary approach is essential for the proper management of such patients. At present, there is no cure for the disease; rather, symptomatic treatment is employed in order to improve the patients' quality of life. In this review, we provide a brief overview of the clinicopathological profile and management of Klippel-Trenaunay Syndrome.
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Affiliation(s)
- Fahham Asghar
- Neurology, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Ramsha Aqeel
- Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Umar Farooque
- Neurology, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| | | | - Muhammad Taimur
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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8
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Upadhyaya VD, Bhatnagar A, Kumar B, Neyaz Z, Kishore JS, Sthapak E. Is multiple session of intralesional bleomycin mandatory for complete resolution of macrocystic lymphatic malformation? Indian J Plast Surg 2019; 51:60-65. [PMID: 29928081 PMCID: PMC5992947 DOI: 10.4103/ijps.ijps_154_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Intralesional bleomycin scelro-therapy has become a favored line of treatment for macrocystic lymphatic malformations. However the need for multiple sessions is a drawback associated with this treatment modality. Our aim is to document whether multiple session of intra- lesional sclero-therapy is necessary for complete resolution of cystic lymphatic malformation. Method Intralesional bleomycin under Ultrasound guidance was used for macrocystic lymphangioma at concentration of 3mg/ml but not exceeding the total dose (1mg/kg) body weight for single session or cumulative dose of 5mg/kg. In all cases intralesional sclerosant (ILS) was installed under proper aseptic precaution in operation theatre in general anesthesia or sedation depending on the site or size of lesion and age of the patient. Age of patients at the time of enrolment in study ranged from 3 months to 18 years. Clinical examination was the main stay of diagnosis which was supplemented by USG and/or computed tomography. Compression of the lesion site was done for few hours wherever it was possible after the ILS session. Result A total of 21 patients included in our study. The age ranged from 3 months to 18 years. Male to female ratio was 8:13. The most common site of involvement was neck and axilla followed by anterior chest wall and nape of the neck. Complete resolution after single session was observed in 90.5% cases where as surgery was required in 9.5% case. Major complication was observed in one patient, who had intralesional bleeding which was managed conservatively. Transient pain and fever was observed in 23.8% of cases. Only two patient required surgical intervention where one had persistent subcutaneous fibrotic nodule and other one did not respond to ILS. Conclusion Intralesional bleomycin is an effective treatment for macrocystic lesion, and complete resolution may be achieved by single session of ILS if proper principle are followed.
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Affiliation(s)
| | - Ankur Bhatnagar
- Department of Plastic Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Basant Kumar
- Department of Pediatric Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Zafar Neyaz
- Department of Radio Diagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - J S Kishore
- Department of Pediatric Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Eti Sthapak
- Department of Anatomy, RML, PGIMER, Lucknow, Uttar Pradesh, India
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9
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Gould DJ, Mehrara BJ, Neligan P, Cheng MH, Patel KM. Lymph node transplantation for the treatment of lymphedema. J Surg Oncol 2018; 118:736-742. [PMID: 30129675 DOI: 10.1002/jso.25180] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 11/05/2022]
Abstract
Lymphedema is a complex disease process with deranged lymphatic transport, fluid accumulation and secondary lipedema and fibrosis. This is a challenging disease to treat with a surgical focus on debulking and physiologic strategies. One strategy is the use of vascularized lymph node transplant (VLNT) to improve physiologic lymph clearance. In this article, VLNT is discussed in detail, including mechanisms, combined strategies, and outcomes.
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Affiliation(s)
- Daniel J Gould
- Division of Plastic and Reconstructive Surgery, University of Southern California, California
| | - Babak J Mehrara
- Department of Surgery, Plastic and Reconstructive Surgery, Service, Memorial Sloan-Kettering Cancer Center, New York
| | - Peter Neligan
- Department of Plastic Surgery, University of Washington Medical Center, Washington
| | - Ming-Huei Cheng
- Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Chang Gung Memorial Hospital, Taiwan
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, University of Southern California, California
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10
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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.
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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
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11
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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%.
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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.
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12
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The Efficiency of Sclerotherapy in the Treatment of Vascular Malformations: A Retrospective Study of 63 Patients. PLASTIC SURGERY INTERNATIONAL 2017; 2016:2809152. [PMID: 28074157 PMCID: PMC5198189 DOI: 10.1155/2016/2809152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 11/23/2016] [Indexed: 01/23/2023]
Abstract
Background and Aims. Vascular malformations are a vast group of congenital malformations that are present at birth. These malformations can cause pain, pressure, and cosmetic annoyance as well as downturn growth and development in a child in the case of high flow. Sclerotherapy has become an important tool in the treatment of vascular malformations. However, little is known about the success rate of sclerotherapy. Material and Methods. In this study, the efficiency of sclerotherapy in the treatment of vascular anomalies was investigated retrospectively in 63 patients treated in Turku University Hospital between 2003 and 2013. Results. Out of the 63 patients investigated, 83% (53) had venous malformations (VMs) and 9% (5) were defined as having arteriovenous malformations (AVMs). Patients with a VM were operated on, in 14% (8) out of all VM cases. Hence 86% (45) of patients with a VM received adequate help to their symptoms solely from sclerotherapy. The duration of treatment for the 14% of the VM patients that needed a surgical procedure was prolonged by 7–9 months, that is, by 41%. Conclusions. Sclerotherapy is an effective method in the treatment of VMs with a satisfactory clinical response in patients symptoms in 84% of cases.
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13
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Behravesh S, Yakes W, Gupta N, Naidu S, Chong BW, Khademhosseini A, Oklu R. Venous malformations: clinical diagnosis and treatment. Cardiovasc Diagn Ther 2016; 6:557-569. [PMID: 28123976 DOI: 10.21037/cdt.2016.11.10] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Venous malformation (VM) is the most common type of congenital vascular malformation (CVM). They are present at birth and are often symptomatic, causing morbidity and pain. VMs can be challenging to diagnose and are often confused with hemangioma in terminology as well as with imaging. An accurate clinical history and cross-sectional imaging are critical for diagnosis and for devising management. This manuscript will review imaging approaches to diagnosing VMs and current treatment strategies.
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Affiliation(s)
- Sasan Behravesh
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Wayne Yakes
- Vascular Malformation Center, Englewood, CO 80113, USA
| | - Nikhil Gupta
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Sailendra Naidu
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Brian W Chong
- Department of Radiology and Neurological Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Ali Khademhosseini
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA;; Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
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14
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Nassiri N, Thomas J, Cirillo-Penn NC. Evaluation and management of peripheral venous and lymphatic malformations. J Vasc Surg Venous Lymphat Disord 2016; 4:257-65. [DOI: 10.1016/j.jvsv.2015.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/02/2015] [Indexed: 12/18/2022]
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15
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Primary Aneurysm of the Medial Marginal Vein of the Foot. Case Rep Vasc Med 2015; 2015:374691. [PMID: 26576318 PMCID: PMC4631882 DOI: 10.1155/2015/374691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/12/2015] [Indexed: 11/25/2022] Open
Abstract
The primary superficial venous aneurysms of the foot are very rare. A 34-year-old female patient developed a dorsal foot mass during the second trimester of pregnancy with no history of previous trauma, puncture, or infection. One year later, she was referred to the surgical department for excision of “foot hygroma.” Based on the clinical findings, the venous aneurysm was suspected and duplex ultrasound confirmed the diagnosis of the aneurysm of the medial marginal vein of the foot. Excision of aneurysm with bipolar ligation of marginal vein was performed under local anesthesia. The postoperative evolution was uneventful. The authors hope that the presented case report will increase the awareness of general practitioners, dermatologists, and surgeons regarding the superficial venous aneurysms of lower limbs.
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Eivazi B, Werner JA. Extracranial vascular malformations (hemangiomas and vascular malformations) in children and adolescents - diagnosis, clinic, and therapy. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc02. [PMID: 25587362 PMCID: PMC4273163 DOI: 10.3205/cto000105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The field of extracranial vascular anomalies is considered as special focus of pediatric otolaryngology and it has shown a rapid development during the last years. The reason for this interest is finally also due to the global acceptance of the classification introduced by the ISSVA (International Society for the Study of Vascular Anomalies). Hemangiomas are the most frequently observed vascular tumors. Today the systemic propranolol therapy is mostly used for therapy of hemangiomas requiring treatment. Increasingly, the topical application of beta blocker is discussed while the benefit in the head and neck seems to be limited. Vascular malformations are classified according to the morphology of the affected part of the vascular system in arterial, venous, arterio-venous, lymphatic, capillary, and combined vascular malformations. Conventional surgery, sclerosing therapy, and laser treatment are invasive options for the treatment of lymphatic malformations. The options for the treatment of venous malformations could be significantly improved during the last years. In this context, the use of Nd:YAG laser, the conservative treatment of the localized disseminated intravascular coagulation with low-molecular weight heparin, the re-discovery of bleomycin as effective sclerosing agent, and the improvement of alcohol-based embolization agents must be mentioned. Today the treatment with dye laser is the preferred therapy for capillary malformations and it is superior to other therapeutic options as for example photodynamic therapy. Arterio-venous malformations as representatives for high-flow lesions are the high-risk lesions. Frequently they are compared to malignant head and neck tumors, in particular when a curative treatment can no longer be assured because of diffuse or multifocal extent and when the disease shows a progressive course. The combined treatment of embolization and surgical resection and if necessary consecutive defect reconstruction have turned out to be appropriate for arterio-venous malformations. Incurable findings are still a major challenge. Despite the introduction of antiangiogenetic drugs in oncology, the medicamentous therapeutic approach could not be established for arterio-venous malformations up to now.
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Affiliation(s)
- Behfar Eivazi
- Department of Otolaryngology, Head & Neck Surgery, Philipps University of Marburg, Angioma Center Marburg, Germany
| | - Jochen A Werner
- Department of Otolaryngology, Head & Neck Surgery, Philipps University of Marburg, Angioma Center Marburg, Germany
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Nosher JL, Murillo PG, Liszewski M, Gendel V, Gribbin CE. Vascular anomalies: A pictorial review of nomenclature, diagnosis and treatment. World J Radiol 2014; 6:677-692. [PMID: 25276311 PMCID: PMC4176785 DOI: 10.4329/wjr.v6.i9.677] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Vascular anomalies, including vascular malformations and tumors, are frequently straightforward to detect; however, accurate diagnosis and appropriate treatment are often challenging. Misdiagnosis of these lesions can lead clinicians in the wrong direction when treating these patients, which can have unfavorable results. This review presents an overview of the classification systems that have been developed for the diagnosis of vascular lesions with a focus on the imaging characteristics. Pictorial examples of each lesion on physical examination, as well as non-invasive and minimally invasive imaging are presented. An overview of the endovascular treatment of these lesions is also given. In some cases, vascular anomalies may be associated with an underlying syndrome and several of the most commonly encountered syndromes are discussed. Understanding of the classification systems, familiarity with the treatment options and knowledge of the associated syndromes are essential for all physicians working with this patient population. The approach to the described entities necessitates an organized multi-disciplinary team effort, with diagnostic imaging playing an increasingly important role in the proper diagnosis and a combined interventional radiologic and surgical treatment method showing promising results.
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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.
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Lee BB. Commentary on 'Ultrasound-guided intralesional diode laser treatment of congenital extratruncular venous malformations: mid-term results'. Eur J Vasc Endovasc Surg 2014; 47:565. [PMID: 24679361 DOI: 10.1016/j.ejvs.2014.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 02/26/2014] [Indexed: 11/19/2022]
Affiliation(s)
- B B Lee
- Center for the Lymphedema and Vascular Malformations, George Washington University, Washington, DC, USA.
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Ultrasound-guided intralesional diode laser treatment of congenital extratruncular venous malformations: mid-term results. Eur J Vasc Endovasc Surg 2014; 47:558-64. [PMID: 24656873 DOI: 10.1016/j.ejvs.2014.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 02/14/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE/BACKGROUND Over the short term, endovenous laser ablation (EVLA) has been found to be safe and effective for endovenous ablation in extratruncular venous malformations (EVMs). We report our experiences in percutaneous ultrasound (US)-guided treatment of congenital EVMs with respect to effectiveness and safety over the mid-term. METHODS This was a retrospective analysis of a collected database of consecutive US-guided intralesional diode laser treatments of congenital EVMs (2007-2013). A consecutive series of 164 patients (86 women/girls [53%] and 78 men/boys [46%], aged 1.5-68.0 years [mean age 20.78 years]) were treated using EVLA for congenital EVMs at our institution. All of the patients were symptomatic. The primary outcomes for assessing safety were mortality and morbidity, including laser-related adverse events, thrombotic events, and important nerve or vessel injuries, and so on. Effectiveness was assessed according to reduction of the mass, the absence of pain, and technical success. RESULTS One hundred and ninety procedures were undertaken in 164 patients, achieving a 100% immediate technical success rate. Most complications were minor and improved quickly, except in one patient, who suffered a peroneal nerve injury. Spot skin burn injuries occurred in one procedure (0.53%). Paresthesia in the treated area was noted after 15 procedures (7.89%). For complaints related to swelling, cosmetic outcomes, and pain, the clinical success rates were 65.71%, 68.97% and 97.74%, respectively. After a mean follow-up of 23.91 months, no patient suffering from pain, hemorrhage, or limited range of motion had returned with recurrent symptoms after initial successful treatment (resolved). Recurrence rates in patients with heavy sensation, swelling, and deformity were 6.89% (two of 29), 7.41% (two of 27), and 11.11% (one of nine), respectively. One hundred and twelve (59.00%) treated lesion areas were classified as "excellent", 59 lesions (31.00%) were "good", and 19 lesions (10.00%) were "fair" using duplex US imaging at the final follow-up visit. CONCLUSIONS EVLA is a minimally invasive treatment with the advantages of safety, effectiveness, and simplicity in ameliorating symptoms associated with EVMs in appropriately selected patients.
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Pilecki S, Gierach M, Gierach J, Swiętaszczyk C, Junik R, Lasek W. Congenital vascular malformations in scintigraphic evaluation. Pol J Radiol 2014; 79:27-32. [PMID: 24567769 PMCID: PMC3927420 DOI: 10.12659/pjr.889874] [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: 10/08/2013] [Accepted: 12/05/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Congenital vascular malformations are tumour-like, non-neoplastic lesions caused by disorders of vascular tissue morphogenesis. They are characterised by a normal cell replacement cycle throughout all growth phases and do not undergo spontaneous involution. Here we present a scintigraphic image of familial congenital vascular malformations in two sisters. MATERIAL/METHODS A 17-years-old young woman with a history of multiple hospitalisations for foci of vascular anomalies appearing progressively in the upper and lower right limbs, chest wall and spleen. A Parkes Weber syndrome was diagnosed based on the clinical picture. Due to the occurrence of new foci of malformations, a whole-body scintigraphic examination was performed. A 12-years-old girl reported a lump in the right lower limb present for approximately 2 years, which was clinically identified as a vascular lesion in the area of calcaneus and talus. Phleboscintigraphy visualized normal radiomarker outflow from the feet via the deep venous system, also observed in the superficial venous system once the tourniquets were released. In static and whole-body examinations vascular malformations were visualised in the area of the medial cuneiform, navicular and talus bones of the left foot, as well as in the projection of right calcaneus and above the right talocrural joint. CONCLUSIONS People with undiagnosed disorders related to the presence of vascular malformations should undergo periodic follow-up to identify lesions that may be the cause of potentially serious complications and to assess the results of treatment. Presented scintigraphic methods may be used for both diagnosing and monitoring of disease progression.
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Affiliation(s)
- Stanisław Pilecki
- Laboratory of Nuclear Medicine, Regional Specialist Hospital in Grudziądz, Grudziądz, Poland ; Laboratory of Nuclear Medicine, Department of Endocrinology and Diabetology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Marcin Gierach
- Laboratory of Nuclear Medicine, Department of Endocrinology and Diabetology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Joanna Gierach
- Laboratory of Nuclear Medicine, Department of Endocrinology and Diabetology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Cyprian Swiętaszczyk
- Laboratory of Nuclear Medicine, Regional Specialist Hospital in Grudziądz, Grudziądz, Poland
| | - Roman Junik
- Laboratory of Nuclear Medicine, Department of Endocrinology and Diabetology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Władysław Lasek
- Department and Institute of Imaging Diagnostics, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
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Eivazi B, Werner JA. [Venous and arteriovenous malformations in the head and neck region. Therapeutic options and challenges]. HNO 2013; 62:19-24. [PMID: 24343057 DOI: 10.1007/s00106-013-2805-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Venous malformations are the prototype low-flow malformations in the head and neck region. Arteriovenous malformations (AVM) represent the main high-flow malformations. In recent years it has been possible to significantly optimize the therapeutic options for venous malformations. In addition to conventional surgery, laser treatment and sclerotherapy have become established techniques and the importance of embolization with new alcohol-based materials is increasing. AVM are progressive and destructive diseases. Therapy of choice is usually a combined treatment comprising embolization and surgical removal of the arteriovenous nidus. This curative approach is usually possible if diagnosis is made at an early stage. Incomplete embolization or sole ligation of the arterial supply causes progression. There is a clear need for improved therapeutic methods and pharmacotherapeutic approaches.
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Affiliation(s)
- B Eivazi
- Marburger Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Angiomzentrum Marburg, Universitätsmedizin Marburg, UKGM GmbH, Baldingerstr., 35043, Marburg, Deutschland,
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Williams KJ, Al-Sakkal MN, Alsafi A, Davies AH. Massive localised lymphoedema: a rare vascular malformation. BMJ Case Rep 2013; 2013:bcr2013010060. [PMID: 23761611 PMCID: PMC3702917 DOI: 10.1136/bcr-2013-010060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lymphatic malformations are a subset of congenital vascular malformations, and are caused by a defect in lymphatic development during embryogenesis. When lymphatic mesoderm development is prematurely arrested, it retains it proliferative potential. Stimulus in the future can cause the lesion to proliferate locally without coordination or regulation, resulting in the rare condition known as massive localised lymphoedema (MLL). We present a case report of MLL, a rare and ill-defined soft tissue mass reported in the morbidly obese, with reference to the existing literature.
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Affiliation(s)
- K J Williams
- Academic Section of Vascular Surgery, Imperial College London, London, UK.
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Abstract
OBJECTIVES To analyze all the arguments against chronic cerebrospinal venous insufficiency (CCSVI) as a medical entity, and its association with multiple sclerosis (MS) and to revise all the findings suggesting a possible connection between these two entities. METHODS We revised the methodology and results of all fourteen published studies on prevalence of CCSVI in MS patients. Furthermore, we take into consideration other work dealing with possible causes and explanations of venous, as well as vascular dysfunctions linked with MS. RESULTS Studies of prevalence show a great variability in prevalence of CCSVI in MS patients. However, a recent meta-analysis assessed an over 13 times increased prevalence in MS. Global hypoperfusion of the brain, and reduced cerebral spinal fluid dynamics in MS was shown to be related to CCSVI. Post-mortem studies show a higher prevalence of intraluminal defects in the main extracranial vein in MS patients in respect to controls. DISCUSSION Taking into account the current epidemiological data, the autoptic findings, and the relationship between CCSVI and both hypoperfusion and cerebrospinal fluid flow, CCSVI can be inserted in the list of multiple factors involved in MS pathogenesis. Our careful data analysis may conclude that great variability in prevalence of CCSVI in MS patients can be a result of different methodologies used in venous ultrasound assessment. Finally, it has been proven that CCSVI share the three main risk factors with MS. On the other hand, smoking is the most important risk factor for endothelial cell damage, vitamin D has a protective role and Epstein-Barr virus passes the blood-brain barrier by invading the endothelial cells, therefore, epidemiologically, linking the imbalance of these three factors to MS through autoimmunity.
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Lee BB, Laredo J, Neville R. Current status of lymphatic reconstructive surgery for chronic lymphedema: it is still an uphill battle! Int J Angiol 2012; 20:73-80. [PMID: 22654468 DOI: 10.1055/s-0031-1279685] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The goal of reconstructive lymphatic surgery is to restore normal lymphatic function to "cure" permanently the lymphedematous limb in patients with lymphedema. In reality, reconstructive surgery remains an adjunctive treatment at best, with its current indication being refractory lymphedema in patients treated with complex decongestive therapy (CDT) alone. The role of reconstructive lymphatic surgery remains controversial and is far from being accepted as standard independent therapy because of multiple reasons. However, reconstructive surgery appears to be most effective in controlling the progression of lymphedema during the early stages when the paralyzed lymph vessels are still able to function and recover. Our experience in reconstructive surgery has shown that improved long-term results are dependent on prolonged patient compliance with maintenance CDT and the prevention and treatment of infection. To better understand the role of reconstructive surgery in the management of chronic lymphedema, well-constructed clinical trials based on well-organized multicenter studies with similar protocols are mandated. For the future, it remains the only possible treatment method capable of providing a cure.
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Affiliation(s)
- B B Lee
- Division of Vascular Surgery, Department of Surgery, George Washington University School of Medicine, Washington, D.C
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Roh YN, Do YS, Park KB, Park HS, Kim YW, Lee BB, Pyon JK, Lim SY, Mun GH, Kim DI. The Results of Surgical Treatment for Patients With Venous Malformations. Ann Vasc Surg 2012; 26:665-73. [DOI: 10.1016/j.avsg.2011.12.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 08/15/2011] [Accepted: 12/06/2011] [Indexed: 11/30/2022]
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[Congenital vascular malformations (Hauert disease)]. DER ORTHOPADE 2012; 41:493-502; quiz 503-4. [PMID: 22699760 DOI: 10.1007/s00132-012-1932-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Patients with congenital vascular malformations often suffer from arthralgia, especially of the lower limbs. This orthopaedic disease pattern is defined as destructive, angiodysplatic arthritis or Hauert disease and leads to very early destruction of the joints. By presenting diagnostic and therapeutic algorithms, Hauert disease is emphasized as a possible differential diagnosis in order to minimize the risk of an incorrect diagnosis which might lead to under-, over-, or even incorrect treatment. A minimally invasive transathroscopic therapy in the early stages can lead to significant improvement of symptoms and prevention of progressive joint destruction.
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Yun WS, Kim DI, Rho YN, Do YS, Park KB, Kim KH, Park HS, Kim YW, Park UJ, Kim N, Woo SY. Natural course of venous malformation after conservative treatment. Surg Today 2012; 42:950-5. [PMID: 22535018 DOI: 10.1007/s00595-012-0185-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 08/15/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the clinical course of patients with venous malformation (VM) treated conservatively. METHODS We reviewed retrospectively the database of our Congenital Vascular Malformation clinic and interviewed 207 patients with VM, who had been managed only conservatively. The questionnaires asked about changes in size (no change, increase in proportion to growth, increase greater than in proportion to growth, decrease) and changes in symptoms (markedly worse, moderately worse, no change, moderately improved, markedly much improved). Progression of VMs was defined as an increase greater than in proportion to growth or worsening symptoms. RESULTS Fifty patients (24 %) reported an increase in size greater than in proportion to growth and 25 patients (12 %) reported symptoms worsening from their initial symptoms. Overall, sixty-six (32 %) of the patients reported evidence of progression of their VM. A binary logistic regression model identified VM combined with capillary malformation (CM) or lymphatic malformation (LM) as an independent predictor of VM progression (OR 2.67, 95 % CI 1.29-5.53). CONCLUSIONS Based on responses to the questionnaire, the size and symptoms of VM progressed in 32 % of patients over the course of their life. VMs combined with CM or LM were the only independent predictor of progression of a VM after conservative management.
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Affiliation(s)
- Woo-Sung Yun
- Congenital Vascular Malformation Clinic, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea
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Murdaca G, Cagnati P, Gulli R, Spanò F, Puppo F, Campisi C, Boccardo F. Current views on diagnostic approach and treatment of lymphedema. Am J Med 2012; 125:134-40. [PMID: 22269614 DOI: 10.1016/j.amjmed.2011.06.032] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 10/14/2022]
Abstract
Lymphedema is a chronic, progressive, and often debilitating condition. Primary lymphedema is a lymphatic malformation developing during the later stage of lymphangiogenesis. Secondary lymphedema is the result of obstruction or disruption of the lymphatic system, which can occur as a consequence of tumors, surgery, trauma, infection, inflammation, and radiation therapy. In this review, we report an update upon the diagnostic approach and the medical and surgical therapy for both primary and secondary lymphedema.
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Abstract
AVFs differ in their characteristics, natural history, and response to interventions. These differences need to be considered when planning treatment. Endovascular treatments have emerged as a mainstay of treatment of all types of AVMs. They can be used as definitive therapy for acquired arteriovenous malformation, in remote or high-risk locations, and in elderly or otherwise debilitated patients. Endovascular control is often helpful in open repair of acquired AVF. Endovascular techniques are essential in the management of congenital AVF and are the first line of interventional therapy. In these cases, repeated interventions are the rule, and careful imaging and planning is the key to success.
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Affiliation(s)
- Jennifer A Sexton
- Georgetown University School of Medicine, Georgetown/Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010-3017, USA
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Lu X, Ye K, Shi H, Li W, Huang Y, Huang X, Lu M, Jiang M. Percutaneous endovenous treatment of congenital extratruncular venous malformations with an ultrasound-guided and 810-nm diode laser. J Vasc Surg 2011; 54:139-45. [DOI: 10.1016/j.jvs.2010.11.105] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 10/21/2010] [Accepted: 11/13/2010] [Indexed: 10/18/2022]
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Suzuki J, Miyata T, Hoshina K, Okamoto H, Kimura H, Shigematsu K. Surgical treatment of patients with congenital vascular malformation-associated aneurysms. Eur J Vasc Endovasc Surg 2011; 42:517-22. [PMID: 21550267 DOI: 10.1016/j.ejvs.2011.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 04/06/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Aneurysms associated with congenital vascular malformation (CVM) comprise critical complication. We review our experience with extracranial CVM-associated aneurysms and attempt to clarify their clinical features. PATIENTS AND METHODS The prevalence, site, size and morphology of the accompanying aneurysms of 48 consecutive CVM patients, who were managed at our hospital from 1999 to 2008, were evaluated. After diagnosis or treatment, the patients were followed up, and the recurrence of aneurysms and patient survival were assessed. RESULTS CVM-associated aneurysms were found in 14 patients (29%). CVMs were classified according to the Hamburg classification. The patients were classified into groups as follows: four (31%), in the 'predominantly arteriovenous (AV) shunting defect type'; eight (47%), 'combined vascular defects + predominantly AV shunting defects type'; and two (11%), 'combined vascular defects type'. All aneurysms except one situated at the CVM were saccular, whereas nine were fusiform aneurysms; all the ruptured aneurysms and seven out of the nine enlarging aneurysms were saccular. Surgical treatment was performed 8 times in six patients. During the postoperative follow-up period, recurrence and an aneurysm rupture were encountered in one patient each. CONCLUSION Aneurysm is not a rare complication of CVM. It is important to treat CVM before the emergency presents. In addition to the treatment for malformation, regular screening for and proper management of the aneurysms in CVM patients are indispensable.
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Affiliation(s)
- J Suzuki
- Division of Vascular Surgery, Department of Surgery, Graduate school of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Hu X, Chen D, Jiang C, Jin Y, Chen H, Ma G, Lin X. Retrospective analysis of facial paralysis caused by ethanol sclerotherapy for facial venous malformation. Head Neck 2010; 33:1616-21. [PMID: 21990226 DOI: 10.1002/hed.21652] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/23/2010] [Accepted: 09/22/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Absolute ethanol sclerotherapy provides a reliable treatment for facial venous malformation, although facial nerve injury may occur after sclerotherapy. This study is a retrospective review of facial nerve dysfunction after sclerotherapy. METHODS A total of 91 patients with facial venous malformations accepted 288 ethanol sclerotherapy sessions. The facial nerve dysfunctions caused by the therapy were evaluated and analyzed. RESULTS There were 9 instances of facial nerve injury. For 18 sessions of sclerotherapy in the temporal region, 5.6% of patients experienced injury to the temporal branch; for 12 sessions in the zygomatic region, 41.7% of patients experienced injury to the zygomatic branch. After patients were treated with medication, 8 of 9 instances of nerve injury recovered. CONCLUSIONS The zygomatic and temporal branches of the facial nerve were the most vulnerable to injury after ethanol sclerotherapy. Surgeons are thus called on to pay more attention when performing ethanol sclerotherapy in those areas.
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Affiliation(s)
- XiaoJie Hu
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Liu NF, Lu Q, Yan ZX. Lymphatic malformation is a common component of Klippel-Trenaunay syndrome. J Vasc Surg 2010; 52:1557-63. [DOI: 10.1016/j.jvs.2010.06.166] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 06/22/2010] [Accepted: 06/23/2010] [Indexed: 01/19/2023]
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Pandya R, Tummala V. Giant infantile pulmonary hemangioma. Pediatr Radiol 2010; 40 Suppl 1:S63-7. [PMID: 20461368 DOI: 10.1007/s00247-010-1669-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 02/28/2010] [Accepted: 03/23/2010] [Indexed: 11/29/2022]
Abstract
We present a very unusual case of giant infantile pulmonary hemangioma presenting as a large solitary pulmonary mass. This was successfully managed with surgical resection. Histological examination revealed that the mass was positive for GLUT-1 receptor, a marker for infantile hemangioma. To our knowledge only a few cases of pulmonary hemangioma have been described previously in the literature. Pulmonary hemangiomas are very rare lesions, most of them presenting as a pulmonary mass. This case emphasizes the fact that this rare lesion should be considered in the differential of an enhancing pulmonary mass in an infant.
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Affiliation(s)
- Rajul Pandya
- Department of Radiology, Hurley Medical Center One Hurley Plaza, Flint, MI 48503, USA.
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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.
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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
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39
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Regarding “A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency”. J Vasc Surg 2010; 52:533. [DOI: 10.1016/j.jvs.2010.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 03/02/2010] [Accepted: 03/03/2010] [Indexed: 11/24/2022]
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Lee BB, Villavicencio JL. Primary lymphoedema and lymphatic malformation: are they the two sides of the same coin? Eur J Vasc Endovasc Surg 2010; 39:646-53. [PMID: 20176496 DOI: 10.1016/j.ejvs.2010.01.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 01/25/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To clear the confusion regarding the relationship between the 'primary lymphoedema' and (truncular) lymphatic malformation (LM); the latter is one of congenital vascular malformations. MATERIALS & METHODS A literature review was carried out on the primary lymphoedema either existing as an independent LM lesion or as a component of the Klippel-Trenaunay syndrome. RESULTS The review was able to provide a contemporary guide/conclusion on the definition and classification, clinical evaluation and clinical management regarding conservative (physical) therapy, reconstructive surgical therapy and ablative/excisional surgical therapy, for the primary lymphoedema as an LM. CONCLUSIONS Primary lymphoedema can be considered as 'congenital' since its majority represents a clinical manifestation of the truncular type of LM arising during the later stages of lymphangiogenesis. Such embryological staging information of the LM is critical for proper management of the primary lymphoedema when it exists with other congenital vascular malformations (Klippel-Trenaunay syndrome). 2. Basic non-invasive to minimally invasive tests will provide an adequate diagnosis and lead to the correct multidisciplinary, specifically targeted and sequenced treatment strategy. 3. The mainstay of current management of the primary lymphoedema/truncular LM is complex decongestive therapy; and the reconstructive as well as ablative surgical therapy remain adjunctive therapies at best.
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Affiliation(s)
- B B Lee
- Division of Vascular Surgery, Georgetown University School of Medicine, Washington, DC 20007, USA.
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41
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Zamboni P, Galeotti R, Menegatti E, Malagoni AM, Gianesini S, Bartolomei I, Mascoli F, Salvi F. A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency. J Vasc Surg 2009; 50:1348-58.e1-3. [PMID: 19958985 DOI: 10.1016/j.jvs.2009.07.096] [Citation(s) in RCA: 215] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 07/17/2009] [Accepted: 07/23/2009] [Indexed: 10/20/2022]
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Maftei N, Howard A, Brown LC, Gunning MP, Standfield NJ. The surgical management of 73 vascular malformations and preoperative predictive factors of major haemorrhage--a single centre experience. Eur J Vasc Endovasc Surg 2009; 38:488-97. [PMID: 19660969 DOI: 10.1016/j.ejvs.2009.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 06/20/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES In our series of patients with congenital vascular malformations (CVMs) we investigate the preoperative factors for predicting major haemorrhage at surgery and propose an algorithm for their surgical management. DESIGN This is a partly prospective case series of patients with severe symptoms/complications due to CVMs. MATERIALS AND METHODS Data were collected on 73 consecutive procedures in 41 patients with CVMs from 1992 to 2006 at a large university hospital and the association of following factors with blood loss during the procedure were investigated: type of procedure, possibility of proximal tourniquet use, lesion flow characteristics, previous history of major haemorrhage with CVM surgery, platelet counts and length of hospital stay. RESULTS Significantly higher blood loss was associated with debulking surgery (p=0.006) and with previous history of major haemorrhage during CVM surgery, (p=0.041). Blood loss was higher in lesions where proximal tourniquet application was not possible (p=0.093). High-flow lesions were not strongly associated with major blood loss (p=0.288). Major blood loss (>2l) occurred in 16 (20.8%) procedures performed on 11 (26.2%) patients, but this did not prolong hospital stay. CONCLUSION Surgery can potentially improve morbidity/mortality in patients with life/limb-threatening complications or severe symptoms due to CVMs, providing they are managed in multidisciplinary specialised centres.
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Affiliation(s)
- N Maftei
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, Department of Vascular Surgery, London, UK.
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Malikov S, Delarue A, Fais PO, Keshelava G. Anatomical repair of a congenital aneurysm of the distal abdominal aorta in a newborn. J Vasc Surg 2009; 50:1181-4. [PMID: 19595534 DOI: 10.1016/j.jvs.2009.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Revised: 05/11/2009] [Accepted: 05/12/2009] [Indexed: 10/20/2022]
Abstract
Congenital (primary) neonatal abdominal aortic aneurysm (AAA) is an extremely rare truncular arterial abnormality among numerous congenital vascular malformations. Only seven cases have been reported as congenital origin in newborns. This report presents the case of a male infant in whom a 33-mm congenital AAA was diagnosed prenatally and was successfully treated 10 days after birth without exogenous graft material or aneurysmorrhaphy. Follow-up study at 39 months demonstrated excellent clinical, ultrasound scan, and computed tomography scan findings. Anatomic reconstruction with native vessels is the preferred surgical technique to ensure the child's potential for harmonious growth.
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Affiliation(s)
- Sergueï Malikov
- Department of Vascular Surgery, School of Medicine, Mediterranean University, La Timone Hospital, Marseille Cedex, France.
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