Ehlers-Danlos syndromes: state of the art on clinical practice guidelines

Objective

To report the effort of the European Reference Network for Rare and Complex CONnective tissue and musculoskeletal diseases NETwork working group on Ehlers-Danlos syndromes (EDS) and related disorders to assess current available clinical practice guidelines (CPGs) specifically addressed to EDS, in order to identify potential clinician and patient unmet needs.

Methods

Systematic literature search in PUBMED and EMBASE based on controlled terms (MeSH and Emtree) and keywords of the disease and publication type (CPGs). All the published articles were revised in order to identify existing CPGs on diagnosis, monitoring and treatment of EDS.

Results

Literature revision detected the absence of papers reporting good quality CPGs to optimise EDS patient care. The current evidence-based literature regarding clinical guidelines for the EDS was limited in size and quality, and there is insufficient research exploring the clinical features and interventions, and clinical decision-making are currently based on theoretical and limited research evidences.

Conclusions

Many clinician and patient unmet needs have been identified.

Embolisation of bleeding pelvic lesions from benign origin--long-term results

Long-term outcome and survival after emergency embolisation of life-threatening bleeding caused by non-malignant small pelvic lesions were analysed and related to the techniques and embolisation materials used. Emergency transcatheter embolisation was performed in 11 patients, heavily bleeding from uterine arteriovenous malformations (4 patients), pelvic fractures (4 patients), Endoxan induced cystitis (1 patient), haemorrhoids (1 patient) and polyposis recti (1 patient) using GAW-coils. Ethibloc and Gelfoam strips as embolisation materials, alone or in combination. Follow-up was obtained up to 7.5 years with analysis of survival. Only in one patient, with terminal hepatic insufficiency and severe disturbance of coagulation, recurrent bleeding occurred 1 month after embolisation. Two other patients died during follow-up for other reasons (cardiac insufficiency at 17 months, ileus at 52 months). Complications in relation to the embolisation therapy did not occur. In conclusion, percutaneous transcatheter embolisation is a safe and effective procedure in severe hemorrhage resulting from non-malignant lesions of the pelvis.