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Osuga K, Yamamoto K, Higashihara H, Juri H, Yamamoto K, Higashiyama A, Matsutani H, Sugimoto A, Toda S, Fujitani T. Endovascular and Percutaneous Embolotherapy for the Body and Extremity Arteriovenous Malformations. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:36-48. [PMID: 37485480 PMCID: PMC10359173 DOI: 10.22575/interventionalradiology.2022-0008] [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: 02/21/2022] [Accepted: 04/24/2022] [Indexed: 07/25/2023]
Abstract
Arteriovenous malformations (AVMs) consist of abnormal communications between the arteries and veins. They can involve any part of the body and extremity and grow in proportion to age and in response to hormonal influence or trauma. When symptoms progress from Schöbinger clinical stage II to III, transcatheter and/or direct puncture embolization are less-invasive and repeatable options for symptom palliation. The goal of embolization is to obliterate the AV shunt, and the choice of lesion access and embolic agents is based on the individual anatomy and flow. Embolization can be technically challenging due to complex vascular anatomy and morbidity risks. Therefore, a multidisciplinary management is essential for the diagnosis and therapeutic intervention of AVMs.
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Affiliation(s)
- Keigo Osuga
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Kazuhiro Yamamoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Hiroki Higashihara
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan
| | - Hiroshi Juri
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Kiyohito Yamamoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Akira Higashiyama
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Hiroki Matsutani
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Asami Sugimoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Sou Toda
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Tomohiro Fujitani
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
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Jia H, Chen Y, Yang X, Lee Y, Zou Y, Zhou J, Jin Y, Hua C, Lin X. Treatment of Challenging Extracranial Arteriovenous Malformations: A Single-Center Experience and Literature Review. Ann Plast Surg 2023; 90:S177-S182. [PMID: 36752531 DOI: 10.1097/sap.0000000000003375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ABSTRACT Extracranial arteriovenous malformation (AVM) is a high-flow congenital vascular malformation, where direct communication between the arteries and veins impedes perfusion of capillary beds and causes disfigurement of the affected tissue. Surgery and endovascular therapy are currently the main treatment for extracranial AVMs. Nevertheless, management of complex cases is sometimes challenging because of severe complications such as refractory ulceration, life-threatening bleeding, and even cardiac insufficiency. Here, we reviewed the development and potential treatment for extracranial AVMs and shared our single-center experiences of diagnosis and treatment of this challenging disease.
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Affiliation(s)
- Hechen Jia
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Lee SY, Kang DH, Kim YS, Lee J, Lee SJ, Huh S, Kim JY, Chung HY. Efficacy and safety of transarterial bleomycin sclerotherapy of early-stage facial arteriovenous malformation: Single-center multidisciplinary team experience. J Plast Reconstr Aesthet Surg 2023; 77:379-387. [PMID: 36623374 DOI: 10.1016/j.bjps.2022.12.002] [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: 04/05/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND To evaluate the efficacy and safety of transarterial bleomycin sclerotherapy of early-stage facial arteriovenous malformation (AVM). METHODS A retrospective review was performed of patients who underwent bleomycin sclerotherapy for early-stage AVM (Schobinger stage I or II) in a single-referral vascular anomalies center. Bleomycin was slowly infused transarterially with flow control techniques to prolong the effects of bleomycin. Procedure details, AVM characteristics, and previous treatments were reviewed. Initial therapeutic outcomes were determined by 5 categories using both radiological and clinical findings in a 6-month follow-up. Further follow-up outcomes were reviewed to evaluate the long-term efficacy and safety of the treatment. Procedure-related complications were also analyzed. RESULTS Nineteen patients (mean age 22.4 ± 14.0 years, 14 females) with 31 sessions of sclerotherapies were enrolled. All AVMs were Cho-Do classification type III (type IIIa [n = 13], type IIIb [n = 2], and type IIIa+b [n = 4]). Patients received a mean of 1.6 (range, 1-4) sessions of treatment. The mean cumulative bleomycin dose was 23,600 IU ± 14,500 (range, 8000 - 60,000 IU). The results showed that 14 patients (74%) were responsive to transarterial bleomycin sclerotherapy, including complete response (n = 3), marked improvement (n = 1), and partial improvement (n = 10). The remaining 5 (26%) showed no response. During a mean follow-up of 32.6 months, 5 (26%) showed slight progression compared with 6-month outcomes and 14 (74%) were stable. There were only 2 minor complications [hyperpigmentation (n = 1) and cellulitis (n = 1)]. CONCLUSIONS Transarterial bleomycin sclerotherapy using flow control techniques can be a safe and feasible alternative treatment option for facial early-stage AVM.
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Affiliation(s)
- Sang Yub Lee
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Dong Hun Kang
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea; Department of Neurosurgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Yong Sun Kim
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Jongmin Lee
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Seok Jong Lee
- Department of Dermatology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Seung Huh
- Department of Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Ho Yun Chung
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea.
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Ye JP, Gao Y, Lu LW, Ye YJ. Effectiveness and safety of ultrasound-guided intramuscular lauromacrogol injection combined with hysteroscopy in cervical pregnancy treatment: A case report. World J Clin Cases 2022; 10:6128-6135. [PMID: 35949833 PMCID: PMC9254199 DOI: 10.12998/wjcc.v10.i18.6128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/07/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cervical pregnancy is increasing in morbidity, and a definite diagnosis in early stages is challenging due to its specific onset site. Surgery is the mainstay of treatment for cervical pregnancy, but it may result in the loss of natural fertility. Therefore, it is a great challenge to pursue a safe and effective treatment for cervical pregnancy.
CASE SUMMARY We report the case of a cervical pregnancy successfully treated by ultrasound-guided cervical-intramuscular lauromacrogol injection combined with hysteroscopy. A 23-year-old woman with minor irregular vaginal bleeding was admitted to our department with suspected ectopic pregnancy. Transvaginal ultrasound revealed a gestational sac (approximately 22 mm x 13 mm) situated in the cervical canal with a yolk sac and blood flow signals. No cardiac activity was detected. Serum beta progesterone was 17.06 ng/mL, and serum beta human chorionic gonadotropin (β-HCG) was 5077.0 IU/L. The patient was diagnosed with cervical pregnancy. She was treated by ultrasound-guided cervical-intramuscular injections of lauromacrogol (3 mL) in combination with aborting under hysteroscopic visualization. A gradual decrease in β-HCG levels and normal ultrasound findings were observed. Postoperative pathologic examination showed the presence of villi and changes in the endometrium in the secretory phase. The patient was discharged on day 6, and her β-HCG level was 0.67 mIU/mL after 1 wk. There was no statistical difference between baseline and 1-week postoperative data in terms of serum indices including liver function, renal function, and routine blood analysis after treatment. The patient subsequently became pregnant 2 mo later and no abnormalities were detected on routine screening during pregnancy.
CONCLUSION Ultrasound-guided cervical-intramuscular lauromacrogol injection combined with hysteroscopy may be effective and safe in the treatment of cervical pregnancy.
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Affiliation(s)
- Jian-Pei Ye
- Department of Ultrasonography, Lishui Hospital of Traditional Chinese Medicine, Lishui 323000, Zhejiang Province, China
| | - Yang Gao
- Department of Gynaecology, Lishui Hospital of Traditional Chinese Medicine, Lishui 323000, Zhejiang Province, China
| | - Li-Wei Lu
- Department of Gynaecology, Lishui Hospital of Traditional Chinese Medicine, Lishui 323000, Zhejiang Province, China
| | - Yong-Ju Ye
- Department of Gynaecology, Lishui Hospital of Traditional Chinese Medicine, Lishui 323000, Zhejiang Province, China
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Wu Z, Ma Y. Takotsubo syndrome caused by sclerotherapy for varicose vein: A case report. Asian J Surg 2022; 45:1889-1890. [PMID: 35440384 DOI: 10.1016/j.asjsur.2022.03.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/31/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Zhoupeng Wu
- Department of Vascular Surgery, West China Hospital, 37 GuoXue Alley, Chengdu, 610041, Sichuan Province, China
| | - Yukui Ma
- Department of Vascular Surgery, West China Hospital, 37 GuoXue Alley, Chengdu, 610041, Sichuan Province, China.
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Lingual Arteriovenous Malformation With Bleeding Treated With Polidocanol Foam Sclerotherapy Using Intestinal Forceps to Control Blood Flow. J Craniofac Surg 2021; 33:e292-e293. [PMID: 34510063 DOI: 10.1097/scs.0000000000008149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Arteriovenous malformation (AVM) sometimes causes hemorrhage that can be fatal. We report a case of AVM of the tongue with bleeding that was treated by semi-emergent sclerotherapy with polidocanol. A 33-year-old woman presented with Schobinger stage III AVM of the tongue. Sclerotherapy with 3% polidocanol foam was performed under general anesthesia using curved intestinal forceps to clamp the root of the tongue for control of blood flow. Postoperatively, there was no further bleeding from the lesion. Three subsequent sclerotherapy sessions with polidocanol were performed, and there was a marked reduction in the size of the lesion. The lesion has remained well controlled in the year since the last sclerotherapy session.
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7
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Arteriovenous Malformation of the Upper Eyelid: A Case Report. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3609. [PMID: 34123685 PMCID: PMC8191694 DOI: 10.1097/gox.0000000000003609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Abstract
Arteriovenous malformations (AVMs) are rare lesions formed by direct connection of arteries and veins bypassing capillary beds. AVM locations can vary; however, extracranial AVMs remain the least common. The vast majority of these malformations are congenital and can be triggered by hormonal changes. A 49-year-old woman presented with a progressive right-sided upper eyelid swelling over the past 12 years. The patient had mechanical ptosis and mild impairment of the right visual field. The swelling was compressible with a thrill, and bruits were heard. The patient was diagnosed with AVM using cerebral angiography. Preoperative endovascular embolization was not possible; however, surgical excision was successfully done with no complications. AVMs and fistulas are high-flow vascular lesions that usually occur during childhood and progress with time. Only a few cases of face and eyelid AVMs have been reported in the literature. Diagnosis of these anomalies is mostly made based on clinical presentation and radiographic imaging such as angiography. Treatment options remain controversial, and management should be individualized for each patient. Endovascular embolization followed by surgical excision is advisable in many cases. Due to its rare entity, information regarding the best management options for AVMs is limited. Reducing the risk of bleeding and achieving total resection is the goal of treatment. Long-term follow-up is required in these patients because recurrent cases of AVMs have been reported.
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Albuquerque TVC, Stamoulis DNJ, Monsignore LM, de Castro-Afonso LH, Nakiri GS, Rezende MT, Trivelato FP, Vanzin JR, Ulhoa AC, G Abud D. The use of dual-lumen balloon for embolization of peripheral arteriovenous malformations. Diagn Interv Radiol 2021; 27:225-231. [PMID: 33517257 DOI: 10.5152/dir.2021.19628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE We aimed to evaluate the safety and feasibility of the embolization of peripheral arteriovenous malformation (AVM) with non-adhesive liquid agents (NALA) injected by dual-lumen balloons (DLB). METHODS We conducted a multicenter retrospective study between January 2017 and June 2019, including patients with peripheral AVM embolized with NALA by DLB. Fourteen patients were included. The AVM classification, technical and clinical success were evaluated, as were nidus size, liquid agent used, volume and time of injection in DLB, complications, follow-up and need of surgical intervention. RESULTS The mean age of the patients was 37±22.5 years (range, 6-82 years). The mean nidus size was 5.2±2.4 cm (range, 3.0-12.0 cm). By Schobinger classification, 11 AVMs were classified in stage 3 and 3 AVMs were classified in stage 2. By Cho's classification, 2 AVMs were in stage II, 4 AVMs were in stage I, 4 AVMs were in stage IIIa and 4 AVMs were in stage IIIb. Onyx was used in 11 patients (78.6%), while Squid, PHIL, and both Onyx and Squid were used in one patient each (7.1%). Seven patients (50%) required one session of embolization, 4 patients (28.6%) required two, 2 patients (14.3%) required three and 1 patient (7.1%) required four sessions. Complete nidus exclusion was achieved in 11 patients (78.6%), optimal clinical response in 12 patients (85.7%). Four patients (28.6%) exhibited minor complications, all controlled. No major complications were seen. Four patients underwent surgical intervention (28.6%). CONCLUSION The embolization of peripheral AVM with NALA in DLB appears to be safe and feasible, achieving high rates of technical and clinical success.
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Affiliation(s)
- Tales V C Albuquerque
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Dimitrius Nikolaos Jaconi Stamoulis
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Lucas M Monsignore
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Luis Henrique de Castro-Afonso
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Guilherme Seizem Nakiri
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Marco Tulio Rezende
- Division of Interventional Neuroradiology, Felício Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Felipe Padovani Trivelato
- Division of Interventional Neuroradiology, Felício Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - José Ricardo Vanzin
- Division of Interventional Neuroradiology, Clinics Hospital, Passo Fundo, Rio Grande do Sul, Brazil
| | - Alexandre Cordeiro Ulhoa
- Division of Interventional Neuroradiology, Felício Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Daniel G Abud
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Pandelaki J, Prasetyono TOH, Sidipratomo P, Ramandika H. Torrential bleeding of arteriovenous malformation in hand post-ethanol sclerotherapy: A case report. Radiol Case Rep 2020; 15:1496-1501. [PMID: 32670448 PMCID: PMC7339009 DOI: 10.1016/j.radcr.2020.06.017] [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: 06/01/2020] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 11/24/2022] Open
Abstract
Embolization or sclerotherapy is considered as the first-line therapy for the management of arteriovenous malformations (AVM) and can be performed directly targeting the nidus. Ethanol is an effective embolic agent; however, some complications may arise. This paper illustrates a case of torrential bleeding following ethanol sclerotherapy in a patient with progressive hand arteriovenous malformations with a poor prognosis and was suggested to be amputated. Direct pressure, tourniquet appliance, and split-thickness skin graft procedure were performed to stop the bleeding successfully. No recurrence of bleeding was reported; and complete alleviation of pain was achieved.
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Affiliation(s)
- Jacub Pandelaki
- Division of Interventional Radiology, Department of Radiology, Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia
| | | | - Prijo Sidipratomo
- Division of Interventional Radiology, Department of Radiology, Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia
| | - Heltara Ramandika
- Division of Interventional Radiology, Department of Radiology, Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia
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10
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Sclerotherapy Induced Takotsubo Syndrome. Case Rep Cardiol 2020; 2020:5626078. [PMID: 32082640 PMCID: PMC6983283 DOI: 10.1155/2020/5626078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/02/2019] [Accepted: 01/04/2020] [Indexed: 11/25/2022] Open
Abstract
A 66-year-old female was brought to the emergency department for acute-onset left-sided chest pain. Prior to arrival, she was at an outpatient appointment with a vascular surgeon for elective sclerotherapy treatment of her lower extremity varicose veins. After receiving an IV injection of polidocanol, she developed severe chest pain with left arm and jaw numbness for the first time in her life. Upon arrival to the ED, the patient reported that her symptoms had resolved. Electrocardiogram (ECG) on presentation was significant for T-wave inversions in leads V1-V3. An initial set of cardiac enzymes showed a troponin I level of 0.62 ng/mL, which subsequently increased to 2.26 ng/mL. Her echocardiogram was significant for mild left ventricular systolic dysfunction with apical hypokinesis (ejection fraction 50%). A repeat ECG showed new T-wave inversions compared to that from the time of admission. The patient eventually agreed to cardiac catheterization, which revealed patent vessels without coronary artery disease, supporting our diagnosis of Takotsubo syndrome and what is the first reported case of likely polidocanol-induced Takotsubo syndrome in the United States.
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11
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Fernández-Alvarez V, Suárez C, de Bree R, Nixon IJ, Mäkitie AA, Rinaldo A, Downer J, Ferlito A. Management of extracranial arteriovenous malformations of the head and neck. Auris Nasus Larynx 2019; 47:181-190. [PMID: 31862283 DOI: 10.1016/j.anl.2019.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/09/2019] [Accepted: 12/02/2019] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to review the outcomes of the different therapies for extracranial head and neck arteriovenous malformations (AVMs). AVMs are high-flow congenital vascular anomalies. They are composed of a complex system of vessels directly connecting feeding arteries to draining veins forming a nidus. They may be potentially life-threatening due to progressive symptoms and infiltrative disease. Extracranial AVMs most commonly affect the head and neck area (47.4%) followed by the extremities (28.5%). AVMs are best characterized as being either focal or diffuse. Focal AVMs have good outcomes following adequate treatment. Diffuse lesions have multiple feeding vessel, which results in high rates of recurrence despite treatment. The management of AVMs includes conventional surgery and endovascular techniques. A combination of embolization and surgical resection has become the treatment of choice over the last years. The main goal of both forms of treatment being the complete blockage or resection of the nidus. Transcatheter embolization of vessels has evolved over the years and new embolic agents have emerged. The types of materials available for embolization are classified into mechanical devices, liquid agents and particulates. Efficacy, rate of recurrence and most common complications were evaluated. AVMs recurrence after embolization or resection is reported in up to 80% of cases. Incomplete resection and embolization can induce aggressive growth of the remaining nidus and the risk of progression is up to 50% within the first 5 years and recurrences can occur up to 10 years later. Although ethanol seems to be associated with the highest degree of cure and permanent occlusion, the overall complication rate reported was 48%. Other materials, such as cyanoacrylate, have obtained modest rates of complete remission, while the reported rates of complete regression of AVMs with Fibrin glue and Polyvinyl alcohol are above 50%. At present, there are no unified agreement on the ideal embolic agent. Therefore, a multidisciplinary approach is recommended to support decision making about the best therapeutic approach and to achieve optimal outcome. A long-term post-treatment follow-up is recommended to recognize early recurrence.
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Affiliation(s)
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Iain J Nixon
- Departments of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh, UK
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Programme in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | | | - Jonathan Downer
- Department of Clinical Neurosciences, Edinburgh University, UK
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Italy
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12
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Parsi K, Roberts S, Kang M, Benson S, Baker L, Berman I, Bester LJ, Connor DE, Dinnen P, Grace J, Stirling A, Ibrahim N, Lekich C, Lim A, Matar L, Nadkarni S, Paraskevas P, Rogan C, Thibault PK, Thibault S, van Rij A, Yang A. Cyanoacrylate closure for peripheral veins: Consensus document of the Australasian College of Phlebology. Phlebology 2019; 35:153-175. [PMID: 31368408 DOI: 10.1177/0268355519864755] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Cyanoacrylates are fast-acting adhesives used in procedural medicine including closure of superficial wounds, embolization of truncal vessels pre-operatively, vascular anomalies, visceral false aneurysms, endoleaks, gastrointestinal varices and gastrointestinal bleeding. More recently, catheter-directed cyanoacrylate adhesive closure was introduced as an alternative to endovenous thermal ablation (ETA) to occlude superficial veins of the lower limbs. Objectives To formulate policies for the safe and effective delivery of cyanoacrylate adhesive closure procedures in Australasia, based on current experience and evidence. Methods A panel of phlebologists including vascular surgeons, interventional radiologists, dermatologists and research scientists systematically reviewed the available data on cyanoacrylate products used in medicine and shared personal experience with the procedure. The reviewed material included bibliographic and biomedical data, material safety data sheets and data requested and received from manufacturers. Results and recommendations: Cyanoacrylate adhesive closure appears to be an effective treatment for saphenous reflux with occlusion rates at 36 months of 90–95%. We recommend a maximum dose of 10 mL of cyanoacrylate per treatment session. Serious complications are rare, but significant. Hypersensitivity to acrylates is reported in 2.4% of the population and is an important absolute contraindication to cyanoacrylate adhesive closure. 1 Post-procedural inflammatory reactions, including hypersensitivity-type phlebitis, occur in 10–20% of patients. 2 In the long term, cyanoacrylate adhesive closure results in foreign-body granuloma formation within 2–12 months of the procedure. We recommend against the use of cyanoacrylate adhesive closure in patients with uncontrolled inflammatory, autoimmune or granulomatous disorders (e.g. sarcoidosis). Caution should be exercised in patients with significant active systemic disease or infection and alternative therapies such as thermal ablation and foam sclerotherapy should be considered. Conclusions Cyanoacrylate adhesive closure appears to be an effective endovenous procedure, with short-term closure rates comparable to ETA and therefore greater efficacy than traditional surgery for treating superficial veins of the lower limbs. Ongoing data collection is required to establish the long-term safety.
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Affiliation(s)
- Kurosh Parsi
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | | | - Mina Kang
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | | | - Luke Baker
- Department of Medical Imaging, Westmead Hospital, Sydney, Australia
| | | | | | - David E Connor
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | - Paul Dinnen
- Gold Coast Vascular Centre, Gold Coast, Australia
| | | | | | - Nabeel Ibrahim
- Sydney Centre for Venous Disease, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia
| | | | - Adrian Lim
- Department of Dermatology, The Royal North Shore Hospital, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | | | | | | | - Christopher Rogan
- Macquarie University Hospital, Sydney, Australia.,Department of Medical Imaging, Sydney Adventist Hospital, Sydney, Australia.,Department of Medical Imaging, Royal Prince Alfred Hospital, Sydney, Australia
| | - Paul K Thibault
- Central Vein and Cosmetic Medical Centre, Newcastle, Australia
| | - Simon Thibault
- Central Vein and Cosmetic Medical Centre, Newcastle, Australia
| | - Andre van Rij
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Anes Yang
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
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