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Ishikawa K, Maeda T, Funayama E, Murao N, Miura T, Sasaki Y, Seo D, Mitamura S, Oide S, Yamamoto Y, Sasaki S. Fluoroscopy- and Endoscopy-Guided Transoral Sclerotherapy Using Foamed Polidocanol for Oropharyngolaryngeal Venous Malformations in a Hybrid Operation Room: A Case Series. J Clin Med 2024; 13:2369. [PMID: 38673643 PMCID: PMC11050875 DOI: 10.3390/jcm13082369] [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: 02/19/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Treatment of oropharyngolaryngeal venous malformations (VMs) remains challenging. This study evaluated the effectiveness and safety of fluoroscopy- and endoscopy-guided transoral sclerotherapy for oropharyngolaryngeal VMs in a hybrid operation room (OR). Methods: Patients with oropharyngolaryngeal VMs who underwent transoral sclerotherapy in a hybrid OR were enrolled. Results: Fourteen patients (six females, eight males; median age of 26 years; range, 4-71 years) were analyzed. The symptoms observed were breathing difficulties (n = 3), snoring (n = 2), sleep apnea (n = 1), and swallowing difficulties (n = 1). Lesions were extensive in the face and neck (n = 9) and limited in the oropharyngolarynx (n = 5). A permanent tracheostomy was performed on two patients, while a temporary tracheostomy was performed on five patients. The treated regions were the soft palate (n = 8), pharynx (n = 7), base of the tongue (n = 4), and epiglottis (n = 1). The median number of sclerotherapy sessions was 2.5 (range, 1-9). The median follow-up duration was 81 months (range, 6-141). Treatment outcomes were graded as excellent (n = 2), good (n = 7), or fair (n = 5). The post-treatment complication was bleeding (n = 1), resulting in an urgent tracheostomy. Conclusions: Fluoroscopy- and endoscopy-guided transoral sclerotherapy in a hybrid OR can be effective and safe for oropharyngolaryngeal VMs.
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Affiliation(s)
- Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
- Center for Vascular Anomalies, Department of Plastic and Reconstructive Surgery, Tonan Hospital, Sapporo 060-0004, Japan
| | - Taku Maeda
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
| | - Emi Funayama
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
| | - Naoki Murao
- Center for Vascular Anomalies, Department of Plastic and Reconstructive Surgery, Tonan Hospital, Sapporo 060-0004, Japan
| | - Takahiro Miura
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
| | - Yuki Sasaki
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
- Center for Vascular Anomalies, Department of Plastic and Reconstructive Surgery, Tonan Hospital, Sapporo 060-0004, Japan
| | - Dongkyung Seo
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
- Center for Vascular Anomalies, Department of Plastic and Reconstructive Surgery, Tonan Hospital, Sapporo 060-0004, Japan
| | - Shintaro Mitamura
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
- Center for Vascular Anomalies, Department of Plastic and Reconstructive Surgery, Tonan Hospital, Sapporo 060-0004, Japan
| | - Shunichi Oide
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
- Center for Vascular Anomalies, Department of Plastic and Reconstructive Surgery, Tonan Hospital, Sapporo 060-0004, Japan
| | - Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
| | - Satoru Sasaki
- Center for Vascular Anomalies, Department of Plastic and Reconstructive Surgery, Tonan Hospital, Sapporo 060-0004, Japan
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Liu JW, Ni B, Gao XX, He B, Nie QQ, Fan XQ, Ye ZD, Wen JY, Liu P. Comparison of bleomycin polidocanol foam vs electrochemotherapy combined with polidocanol foam for treatment of venous malformations. J Vasc Surg Venous Lymphat Disord 2024; 12:101697. [PMID: 37890588 DOI: 10.1016/j.jvsv.2023.101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/08/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE This study aims to investigate the difference in safety and efficacy between two treatments for venous malformations (VMs), electrochemotherapy combined with polidocanol foam (ECP) and bleomycin polidocanol foam (BPF), providing alternative therapies for VMs. METHODS We conducted a retrospective review of 152 patients with VMs treated with ECP and BPF. Pre- and post-treatment magnetic resonance images (MRIs) were collected, and clinical follow-up assessments were performed. Imaging results were used to calculate lesion volume changes. Clinical outcomes included changes in pain and improvements in perceived swelling. Patients were followed up at 1 week and 6 months after surgery. All emerging complications were documented in detail. RESULTS Of the 152 patients, 87 (57.2%) received BPF treatment, and 65 (42.8%) received ECP treatment. The most common location of VMs was the lower extremities (92/152; 60.2%), and the most common symptom was pain (108/152; 71.1%). Forty-three patients had previously undergone therapy in the BPF group (43/87; 49.4%), whereas 30 patients had received prior treatment in the ECP group (30/65; 46.2%). The study found that the percentage of lesion volume reduction in the BPF group was not significantly different from that in the ECP group (75.00% ± 17.85% vs 74.69% ± 8.48%; P = .899). ECP was more effective when the initial lesion volume was greater than 30 mL (67.66% ± 12.34% vs 73.47% ± 8.00%; P = .048). Patients treated with BPF had significantly less posttreatment pain than those treated with ECP, in different baseline lesion size. In the overall sample, pain relief was significantly higher in the BPF group than in the ECP group (4.21 ± 1.19 vs 3.57 ± 0.76; P = .002). However, there was no difference in pain relief between the two groups for the treatment of initially large VMs (4.20 ± 0.94 vs 3.70 ± 0.87; P = .113). The ECP group was significantly more likely to develop hyperpigmentation (5/87; 5.75% vs 11/65; 16.92%; P = .026) and swelling (9/87; 10.34% vs 16/65; 24.62%; P = .019) 1 week after surgery than the BPF group. CONCLUSIONS Our study demonstrates that both BPF and ECP are effective treatments for VMs, with BPF being a safer option. ECP is a better choice for patients with the initial lesion volume greater than 30 mL, but it is more likely to lead to early swelling and hyperpigmentation.
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Affiliation(s)
- Jing-Wen Liu
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China; Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Bin Ni
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China; Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xi-Xi Gao
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Bin He
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Qiang-Qiang Nie
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xue-Qiang Fan
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhi-Dong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jian-Yan Wen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
| | - Peng Liu
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China; Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
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He B, Yang B, Nie QQ, Zhang JB, Chen J, Liu P, Fan XQ, Ye ZD. Comparison of polidocanol foam versus bleomycin polidocanol foam for treatment of venous malformations. J Vasc Surg Venous Lymphat Disord 2023; 11:143-148. [PMID: 35940448 DOI: 10.1016/j.jvsv.2022.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/17/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this research was to retrospectively investigate the difference of safety and efficacy between polidocanol foam and bleomycin polidocanol foam (BPF) in the treatment of venous malformations (VMs), and provide clinical evidence for the application of BPF for VMs. METHODS Patients with VMs treated with polidocanol foam and BPF were included between July 2018 and July 2020. The VM tissue involvements and symptoms were collected. The treatment outcomes were evaluated by the clinical improvement of symptoms and the degree of devascularization on ultrasound examination or magnetic resonance imaging. Patients were followed up for 1, 3, and 6 months after the sclerotherapy. Immediate and delayed complications were closely followed and recorded. RESULTS A total of 51 patients were included, including 34 females and 17 males with a mean age of 26.8 years (range, 5-65 years). The most commonly involved sites were lower extremities (31/60 [51.7%]) and the most common symptom was pain (33/51 [64.7%]). Fifty-four sclerotherapies were performed with a mean of 1.06 ± 0.24 sessions (range, 1-2 sessions) per patient. The reduction percentage of lesion volume in the BPF group was significantly higher than the polidocanol foam group (79.4 ± 1.6% vs 55.7 ± 6.1%; P < .001). Patient satisfaction scores in the BPF group were significantly higher than the polidocanol foam group (7.2 ± 1.1 vs 5.7 ± 0.8; P < .001). No major complication was observed in either group. Cardiovascular and Interventional Radiological Society of Europe (CIRSE) grade 1 complications occurred in 5 of 21 patients in the BPF group and 7 of 30 patients in the polidocanol foam group, CIRSE grade 2 complications occurred in 5 of 21 patients in the BPF group and 4 of 30 patients in the polidocanol foam group; there were no significant differences between the two groups. CONCLUSIONS BPF is a safe and effective sclerosant for VMs, showing better efficacy and similar safety as commonly used mild sclerosants. It could be a promising agent to treat VMs or other slow-flow vascular malformations.
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Affiliation(s)
- Bin He
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Bo Yang
- Department of Vascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiang-Qiang Nie
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jian-Bin Zhang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jie Chen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Peng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xue-Qiang Fan
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhi-Dong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
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England RW, Motaghi M, Kohler B, Hemmingson TE, Wu AW, Weiss CR. Development and Preliminary Validation of the Patient-Reported Outcome Measure for Vascular Malformation Questionnaire: A Prospective Cohort Study. J Vasc Interv Radiol 2021; 32:683-690.e4. [PMID: 33678569 DOI: 10.1016/j.jvir.2021.01.263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/18/2020] [Accepted: 01/13/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To develop and validate the Patient-Reported Outcome Measure for Vascular Malformation (PROVAM) questionnaire to assess the health-related quality of life in patients with vascular malformations. MATERIALS AND METHODS We developed and validated PROVAM using a mixed methods design during a prospective clinical trial at a vascular anomalies clinic. From July 2019 to February 2020, 108 consecutive patients completed 130 questionnaires. The 30-item instrument assessed the domains of pain, emotional/social well-being, functional impact, and treatment satisfaction. Two additional items assessed ease of understanding and relevance. The primary outcomes of instrument reliability and validity were evaluated across several indices. The secondary outcome of responsiveness evaluated total score changes for patients who completed questionnaires both before and after treatment. RESULTS Instrument reliability, as measured by Cronbach alpha, was ≥0.79 for pain, emotional/social well-being, and functional impact domains. Primary domain structure was confirmed by factor analysis (P <. 001) and convergent construct validity for all but 1 Likert scale item. In the subgroup analysis of 13 participants who completed PROVAM before and after treatment, instrument responsiveness, as measured by the total score, showed a significant decrease (median, -10 points; interquartile range [IQR], -3 to -16; P = .04). Participants found the questions easy to understand (median, 5 points; IQR, 4-5 on a 5-point scale) and relevant (median score, 4; IQR, 3-5). CONCLUSIONS Preliminary data support the reliability and validity of PROVAM in measuring the health-related quality of life in patients with vascular malformations.
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Affiliation(s)
- Ryan W England
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Mina Motaghi
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Beatriz Kohler
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Thomas E Hemmingson
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Albert W Wu
- Center for Health Services and Outcomes Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clifford R Weiss
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, The Johns Hopkins Hospital, Baltimore, Maryland.
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Araslanova R, O TMJ, Waner M. Endoscopic Multimodal Approach to the Treatment of Airway Venous Malformations. Laryngoscope 2021; 131:E521-E524. [PMID: 32533772 DOI: 10.1002/lary.28730] [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: 11/30/2019] [Revised: 04/03/2020] [Accepted: 04/17/2020] [Indexed: 11/11/2022]
Abstract
View Video S1
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Affiliation(s)
- Rakhna Araslanova
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, New York
- Vascular Birthmark Institute of New York, Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, New York, New York
| | - Teresa Min-Jung O
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, New York
- Vascular Birthmark Institute of New York, Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, New York, New York
| | - Milton Waner
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, New York
- Vascular Birthmark Institute of New York, Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, New York, New York
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Cronan J, Gill AE, Shah JH, Hawkins CM. The Role of Interventional Radiologists in the Treatment of Congenital Lymphatic Malformations. Semin Intervent Radiol 2020; 37:285-294. [PMID: 32773954 DOI: 10.1055/s-0040-1713446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Lymphatic malformations are low-flow vascular malformations that are typically apparent in the pediatric population and can cause significant functional limitations and effects on quality of life. While surgical resection has historically been the mainstay of therapy, percutaneous sclerotherapy has garnered increasing popularity due to its efficacy and low complication rates. The role of interventional radiology in the multidisciplinary management of these often complex malformations requires thorough understanding of the disease process. This article will review the pathophysiology, clinical presentation, imaging workup, and management options of lymphatic malformations. Special attention will be devoted to available sclerosants, the mammalian target of rapamycin inhibitor sirolimus, and complex lymphatic anomalies.
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Affiliation(s)
- Julie Cronan
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Anne E Gill
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.,Division of Pediatric Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jay H Shah
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.,Division of Pediatric Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - C Matthew Hawkins
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.,Division of Pediatric Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Marín-Manzano E, Mendieta-Azcona C, Riera-del-Moral L, López-Gutiérrez JC. Effectiveness and safety of 1470-nm diode laser fulguration in the management of diffuse venous malformations. J Vasc Surg Venous Lymphat Disord 2020; 8:423-434. [DOI: 10.1016/j.jvsv.2019.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/04/2019] [Indexed: 01/29/2023]
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Zhang H, Xu MP, Dong ZQ, Liu SH, Yang AJ. Does using outpatient room air for bleomycin foam preparation increase the risk of infection? Phlebology 2020; 35:583-588. [PMID: 32312165 DOI: 10.1177/0268355520919267] [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: 11/16/2022]
Abstract
OBJECTIVE To evaluate whether the risk of infections is increased with the use of air from outpatient rooms to prepare bleomycin foam. METHODS Settling plates were adopted to collect bacteria from outpatient room air, operating theatre air, human serum albumin, bleomycin solution and bleomycin foam prepared with both outpatient room and operating theatre air. The plates were placed in an incubator at 37°C for 48 h, and the number of bacterial colonies was recorded using colony-forming units. The results were analysed by the t-test. A retrospective study was then performed to evaluate the outpatient safety of bleomycin foam. RESULTS The number of colony-forming units in the bleomycin foam produced using both operating and outpatient room air was very low, with no statistic difference. No infection cases were reported in clinical evaluation. CONCLUSION Using the air from outpatient treatment rooms for bleomycin foam preparation does not increase the risk of infections.
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Affiliation(s)
- Hao Zhang
- Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University, Jinan, China.,Institute of Stomatology, Shandong University, Jinan, China.,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University, Jinan, China
| | - Ming Pei Xu
- Institute of Stomatology, Shandong University, Jinan, China.,Department of Plastic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zuo Qing Dong
- Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University, Jinan, China.,Institute of Stomatology, Shandong University, Jinan, China
| | - Shao Hua Liu
- Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University, Jinan, China.,Institute of Stomatology, Shandong University, Jinan, China
| | - Ai Jun Yang
- Library of Shandong University, Jinan, China
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Yang X, Chen H, Gu H, Jin Y, Hu L, Hua C, Wang Y, Sun Y, Yu W, Lin X. Interim results of bleomycin-polidocanol foam sclerotherapy as a highly efficient technique for venous malformations. J Vasc Surg Venous Lymphat Disord 2020; 8:1066-1073. [PMID: 32284311 DOI: 10.1016/j.jvsv.2019.11.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/03/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study was to retrospectively review the clinical and radiographic outcomes of patients with venous malformations (VMs) treated with bleomycin-polidocanol foam (BPF) sclerotherapy. METHODS The Institutional Review Board waived ethical approval for this retrospective review in which 55 patients (31 female and 24 male patients; mean age, 18.8 years; range, 2-60 years) were treated with BPF sclerotherapy. The stability (half-life) of BPF compared with polidocanol foam was studied. Standard sclerotherapy techniques were used. A total of 111 sclerotherapy sessions were performed, with a mean of 2.0 treatments per patient (range, 1-6). An average of 10 mL of BPF was used per procedure, with the total amount ranging from 2.5 to 30 mL. Symptoms before and after treatment, follow-up time, complications, and volume reduction on magnetic resonance imaging were recorded. RESULTS The median half-lives of the BPF and polidocanol foam were 238.25 ± 3.86 seconds and 194.33 ± 3.5 seconds, respectively. A t-test indicated significant differences between the groups (P < .01). The mean follow-up was 14 months (range, 6-24 months). All 55 patients (100%) reported improvement in symptoms. The total excellent and good response rate was 94.6%. An excellent response was achieved in 32 cases (58.2% [32/55]), a good response in 20 cases (36.4% [20/55]), and a poor response in 3 cases (5.4% [3/55]). Postprocedural magnetic resonance imaging demonstrated volume reduction of treated lesions in 54 of 55 patients (98%), with a mean lesion volume reduction of 84.6%. Postprocedure complications were minor in 13 of 111 procedures (12%) that were performed on 10 of 55 patients (18.2%), and no major complications occurred. CONCLUSIONS BPF sclerotherapy of VMs is safe and effective. BPF sclerotherapy can be a promising first-line treatment of VMs.
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Affiliation(s)
- Xi Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunbo Jin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Hu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Hua
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yungying Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenxin Yu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Abstract
BACKGROUND Foam sclerotherapy is an effective treatment strategy for vascular malformations, and its sclerosing power depends on foam stability. Twenty quick passages have been widely used as an indicator of the most stable state of sclerosants, but the universality of their effectiveness has not been proven yet. OBJECTIVE We aimed to identify simple and objective indicators of the most stable state of commonly used sclerosants and provide practitioners with suggestions to judge when foam producing is completed in sclerotherapy. MATERIALS AND METHODS The universality of the effectiveness of 20 passages was tested by producing bleomycin foam with different passages. Further study was performed by testing modified bleomycin, polidocanol, and sodium tetradecylsulfate foam. RESULTS The bleomycin foam became denser as passages were added, and the sound of each passage became almost silent after 40 passages. The almost silent sound can be an indicator of foam stability for most sclerosants. It has a different application range compared with 20 quick passages. CONCLUSION We suggest that practitioners choose a different indicator depending on the foam used.
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Ryu JY, Eo PS, Lee JS, Lee JW, Lee SJ, Lee JM, Lee SY, Huh S, Kim JY, Chung HY. Surgical approach for venous malformation in the head and neck. Arch Craniofac Surg 2019; 20:304-309. [PMID: 31658794 PMCID: PMC6822077 DOI: 10.7181/acfs.2019.00416] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 10/14/2019] [Indexed: 12/14/2022] Open
Abstract
Background Treatment for venous malformations of the head and neck includes sclerotherapy, surgical resection, or a combination of both. Surgical resection can remove or reduce the volume of vascular lesions; however, surgery can cause postoperative scarring and potential surgical complications. This study sought to determine the effectiveness of surgery for the treatment of venous malformations of the head and neck. Methods A retrospective review of the medical records of patients who received surgeries for venous malformations of the head and neck from January 2011 to July 2019 was performed. Using clinical photographs, preoperative and postoperative Doppler ultrasonography, outpatient clinic records, and operation records, the postoperative result and complications were evaluated for each case. Results Among patients who visited our vascular anomalies clinic, 43 patients (ratio of male to female= 24:19) received surgeries for venous malformations of the head and neck. Twenty-nine patients had undergone surgery only, five patients received sclerotherapy after surgery, and nine patients received surgery after preoperative sclerotherapy. In postoperative evaluations, the result was excellent in 24 patients, good in 18 patients, and poor in one patient. Four patients experienced a recurrence of lesions with lagophthalmos, drooping of the corner of the mouth, partial wound necrosis, and scar widening found in one patient each. Conclusion Because the head and neck region is the most exposed area in the body, more active implementation of surgical treatments with or without sclerotherapy is essential to reduce the functional and cosmetic impairments associated with venous malformations.
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Affiliation(s)
- Jeong Yeop Ryu
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Pil Seon Eo
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jeong Woo Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seok Jong Lee
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong Min Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Yub Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Huh
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Yun Chung
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Abstract
BACKGROUND Bleomycin foam is an effective sclerotherapy method for venous malformations. The preparation method is rather complicated, and the volume and stability of the foam are limited. OBJECTIVE To modify the currently used method for preparing bleomycin foam, to simplify the preparation procedure, and to produce foam with greater volume and increased stability. MATERIALS AND METHODS Experiment 1: 6.0 IU of bleomycin powder was dissolved in different human serum albumin (HSA):saline solution (SS) ratios of 0.5:1.5, 0.75:1.25, 1:1, 1.25:0.75, 1.5:0.5, 1.75:0.25, and 2:0 in volume; then, an air:liquid ratio of 2:1 was used to create foam using the Tessari method. Experiment 2: 6.0 IU of bleomycin was dissolved directly in 2.0 mL of HSA; then, air:liquid ratios of 1:1, 2:1, 3:1, and 4:1 were used to create foam using the Tessari method. The optimum proportions of HSA:SS and air:liquid were screened by comparing the foam half-life (FHL). RESULTS Experiment 1: the optimum proportion of HSA:SS was 2:0, and the FHL was 7.5 minutes. Experiment 2: the optimum proportion of air:liquid was 3:1, and the FHL was 9.0 minutes. CONCLUSION The modified method is simpler and could produce more stable bleomycin foam with greater volume.
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Effect of foam and liquid bleomycin in the management of venous malformations in head and neck region: A comparative study. J Plast Reconstr Aesthet Surg 2019; 73:90-97. [PMID: 31201109 DOI: 10.1016/j.bjps.2019.05.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 04/15/2019] [Accepted: 05/16/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many treatment options for venous malformations (VMs) have been documented in the literature, but injection sclerotherapy has been considered a current mainstay for their treatment. We conducted this study to determine the efficacy and durability of injection of different forms of bleomycin sclerotherapy in the treatment of VMs in the cervico-facial region. PATIENTS AND METHODS Thirty patients with clinically diagnosed VMs of the head and neck region, confirmed by magnetic resonance imaging, had been injected with the bleomycin sclerosing material. They were divided into 2 groups according to the form of bleomycin injected: in Group A, the foam form was injected, and in Group B, the liquid form was injected. Data of patients' demographics, anatomical sites, type and volume of the VMs, number of injection sessions and the average dose of injected agents were documented and statistically compared between the 2 groups. RESULTS MRI showed a decline of more than 90% from the initial size of the lesions in 66.7% of the cases and considerable decline (60-90%) in 33.3% of the cases. In Group A, the number of sessions and the amount of sclerosant material injected were lower than those in Group B. The cumulative dose in the equal-sized lesions was lower in the foam form than in the liquid form. CONCLUSION We recommend using bleomycin in its foam form on a greater number of patients with larger VMs and in different sites, as the results are more promising in this form than in the liquid form.
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Gregory S, Burrows PE, Ellinas H, Stadler M, Chun RH. Combined Nd:YAG laser and bleomycin sclerotherapy under the same anesthesia for cervicofacial venous malformations: A safe and effective treatment option. Int J Pediatr Otorhinolaryngol 2018; 108:30-34. [PMID: 29605361 DOI: 10.1016/j.ijporl.2018.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/03/2018] [Accepted: 02/03/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Extensive cervicofacial venous malformations (VM) pose significant challenges to a patient's quality of life (altered breathing, dysphagia, dysarthria). Treatment options include: 1) Surgical debulking; 2) Sclerotherapy; 3) laser therapy; or 4) Combined modalities. Recent studies have demonstrated the importance of multimodality and multidisciplinary management of these patients. However, no studies have described combined single anesthetic laser and sclerotherapy treatment. We sought to demonstrate the safety and efficacy of combined Nd:YAG laser and sclerotherapy under the same anesthetic administration. METHODS Retrospective review of 8 patients (Age 6 mo -74 yrs, x͂ 31) with extensive cervicofacial VM with significant airway involvement. Patients were treated with combined suspension laryngoscopy with Nd:YAG laser of airway VM followed by image guided direct puncture sclerotherapy using bleomycin in the airway VM and sodium tetradecyl sulfate (STS) foam in the cervicofacial VM during the same anesthetic encounter. RESULTS All 8 patients had extensive cervicofacial VMs that were symptomatic with snoring or orthopnea. Four of the patients had previously been treated at outside institutions with residual disease or significant complications. All patients remained intubated post procedure (Avg. 1.07 days) and tolerated extubation without re-intubation or any major complications. The average length of hospital stay was 3.2 days, of which 1.9 days were spent in the ICU. Patients reported symptomatic improvement or had decreased VM disease on MRI follow up. CONCLUSION Combined Nd:YAG laser therapy and sclerotherapy allows treatment of both superficial and deep components of VMs in a safe and efficient manner. In addition, suspension laryngoscopy provides improved visualization and access for the interventional radiologist in difficult to reach areas for sclerotherapy.
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Affiliation(s)
- Stacie Gregory
- Department of Surgery, Division of Otolaryngology, Southern Illinois University School of Medicine, Springfield, IL, United States.
| | - Patricia E Burrows
- Department of Vascular and Interventional Radiology, MCW, Milwaukee, WI, United States.
| | | | - Michael Stadler
- Department of Otolaryngology, Medical College of Wisconsin (MCW), Milwaukee, WI, United States.
| | - Robert H Chun
- Department of Otolaryngology, Medical College of Wisconsin (MCW), Milwaukee, WI, United States.
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