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Truong AY, Iaconetti E, Clapp A, Brackett S, Fallon EM, Garzon MC, Tulin-Silver S, Wu JK. Utilization of Healthcare Resources by Vascular Anomaly Patients: An Assessment of Healthcare Burden by Lesion Complexity. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5348. [PMID: 37850202 PMCID: PMC10578775 DOI: 10.1097/gox.0000000000005348] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/06/2023] [Indexed: 10/19/2023]
Abstract
Background Vascular anomalies (VAs) are heterogeneous lesions. Symptoms vary widely by lesion type and complexity. VA patients often require life-long interdisciplinary care; however, there is a paucity of data on the healthcare utilization of VA patients, and their burden on the healthcare system remains largely unquantified. We hypothesize that healthcare utilization by complex lymphatic malformation (LM) and venous malformation (VM) patients will be significantly higher compared with simple LM and VM patients. Methods A retrospective, longitudinal study was performed of LM/VM patients seen through multidisciplinary VA clinics between January 1, 2019 and December 31, 2020. Data were collected from each patient's first presentation through December 31, 2021 and included number of office visits, imaging studies, specialists involved, procedures, hospitalization data, and approximate costs, normalized to per year utilization. Patients were divided into "simple" and "complex" LMs/VMs. Involvement of the airway, more than one anatomic area, and/or complex lymphatic anomalies were defined as "complex." Results In total, 28 simple and 29 complex LM patients and 51 simple and 18 complex VM patients were identified. Complex LM and VM patients had significantly higher numbers of imaging studies, specialists involved, procedures and hospitalizations, and costs incurred. Complex LM patients also had significantly higher per year office visits. Conclusions VA care is chronic and costly, especially for complex LM/VM patients. LM/VM complexity was a predictor for increased inpatient and outpatient healthcare utilization and higher costs. Better awareness of the healthcare utilization trends of LM/VM patients will allow for improved counseling for these patients regarding prognosis and expectations.
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Affiliation(s)
- Albert Y. Truong
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, N.Y
| | - Emma Iaconetti
- Columbia University Vagelos College of Physicians and Surgeons, New York, N.Y
| | - Averill Clapp
- Columbia University Vagelos College of Physicians and Surgeons, New York, N.Y
| | - Shannon Brackett
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, N.Y
| | - Erica M. Fallon
- Division of Pediatric Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, N.Y
| | - Maria C. Garzon
- Departments of Dermatology and Pediatrics, Division of Pediatric Dermatology, Columbia University Irving Medical Center, New York, N.Y
| | - Sheryl Tulin-Silver
- Department of Radiology, Columbia University Irving Medical Center, New York, N.Y
| | - June K. Wu
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, N.Y
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Cohen-Cutler S, Blatt J, Bayliff S, Iacobas I, Hammill A, Sisk BA. Vascular Anomalies Care in the United States: A Cross-Sectional National Survey. J Pediatr 2023; 261:113579. [PMID: 37353145 DOI: 10.1016/j.jpeds.2023.113579] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To characterize the current distribution, composition, and practice patterns of multidisciplinary vascular anomalies (VAs) teams in the US. STUDY DESIGN This is a cross-sectional survey of children's hospitals in the US offering VAs care. We approached 142 children's hospitals that provided care for VAs via email. The survey evaluated VA clinic location, medical staffing, research participation, and treatments offered. The survey was administered between October 2021 and July 2022. RESULTS Participants from 95 eligible hospitals responded to the survey (response rate = 67%). Large areas of the Midwest and Northwest US had no available multidisciplinary VA teams or clinics. Most respondents worked at academic centers (89%), with 66% at a freestanding children's hospital, and 56% reported having a multidisciplinary clinic. Most common physician participants in clinic included hematology-oncology (91%), interventional radiology (87%), dermatology (85%), plastic surgery (81%), and otolaryngology (74%). Only 38% of programs included medical geneticists. Smaller hospitals had fewer medical and ancillary staff and offered fewer therapeutic options. Research was available at most larger institutions (69%) but less commonly at smaller hospitals (34%). CONCLUSIONS Major portions of the US lack multidisciplinary VA care. Furthermore, VA programs vary in composition and geneticists are absent from the majority of programs. These findings should inform efforts to address disparate access and develop standards of care for multidisciplinary VA care in the US.
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Affiliation(s)
- Sally Cohen-Cutler
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA; Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Julie Blatt
- Division of Pediatric Hematology Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Sherry Bayliff
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Kentucky Chandler Medical Center, Lexington, KY
| | - Ionela Iacobas
- Department of Pediatrics, Texas Children's Vascular Anomalies Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Adrienne Hammill
- Division of Hematology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, Cancer and Blood Diseases Institute, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Bryan A Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St. Louis, MO
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3
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Ryu JY, Chang YJ, Lee JS, Choi KY, Yang JD, Lee SJ, Lee J, Huh S, Kim JY, Chung HY. A nationwide cohort study on incidence and mortality associated with extracranial vascular malformations. Sci Rep 2023; 13:13950. [PMID: 37626114 PMCID: PMC10457363 DOI: 10.1038/s41598-023-41278-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/24/2023] [Indexed: 08/27/2023] Open
Abstract
Extracranial vascular malformations are abnormal formations of blood vessels located outside the brain (extracranial) that develop during fetal development. They are caused by errors in the formation of blood vessels in the embryo and can affect various parts of the body, such as the head, neck, face, and other regions. Some malformations may be asymptomatic and only require monitoring, while others may cause significant health issues or cosmetic concerns and may need medical intervention. There are very few studies have investigated the nationwide incidence and quantitative mortality of vascular malformations in terms of their subtypes. Thus, this study aimed to determine the nationwide incidence and mortality associated with vascular malformations. This nationwide population-based study evaluated 70,517 patients with vascular malformations from 2008 to 2021. We evaluated the incidence and mortality associated with each subtype of vascular malformation. Furthermore, Cox regression analysis was used to evaluate the association between vascular malformation and mortality. The annual incidence (per 100,000 population) of overall vascular, venous, capillary, arteriovenous, and lymphatic malformations was 9.85, 1.48, 2.31, 0.24, and 5.82 cases, respectively. Patients with vascular malformations, except those with venous malformations, had higher mortality than the matched controls. Moreover, among the vascular malformation subgroups, the adjusted hazard ratio of mortality was the highest for arteriovenous malformations. This study revealed that the overall annual incidence of vascular malformations was 9.85 cases per 100,000 population in Korea from 2008 to 2021. The mortality of the matched general population was lower than that of patients with vascular malformations, except for those with venous malformations. Additionally, the adjusted hazard ratio for mortality associated with arteriovenous malformations was the highest among the vascular malformation subgroups.
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Affiliation(s)
- Jeong Yeop Ryu
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosanro, Jung-gu, Daegu, 41405, Republic of Korea
| | - Yong June Chang
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosanro, Jung-gu, Daegu, 41405, Republic of Korea
| | - Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosanro, Jung-gu, Daegu, 41405, Republic of Korea
| | - Kang Young Choi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosanro, Jung-gu, Daegu, 41405, Republic of Korea
| | - Jung Dug Yang
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosanro, Jung-gu, Daegu, 41405, Republic of Korea
| | - Seok-Jong Lee
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jongmin Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Huh
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ho Yun Chung
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosanro, Jung-gu, Daegu, 41405, Republic of Korea.
- Cell and Matrix Research Institute, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
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4
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Gariépy-Assal L, Dubois J, Zwicker K, Pincivy A, Powell J, Zhang Y, Breakey V, Price V, Brandão LR, Carcao M, Kleiber N. Defining vascular anomaly phenotypes in children based on a systematic literature search: A critical step in developing a single severity score for interventional clinical trials. Pediatr Blood Cancer 2022; 69:e29869. [PMID: 35731233 DOI: 10.1002/pbc.29869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/18/2022] [Accepted: 06/16/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Genetically targeted drugs in vascular anomalies (VA) are used despite the absence of a validated severity score. The aim of this study was to evaluate the feasibility of grouping phenotypic VA clinical characteristics into a single severity score. METHODS A systematic literature review including children treated with sirolimus accompanied by a detailed description of phenotype and management was conducted. Demographic data and clinical features were extracted to define distinct categories of phenotypes. RESULTS Children with VA display two main phenotypes regardless of VA subtype, which may overlap. A systemic phenotype results from direct invasion and compression of vital structures generally leading to hospitalization and aggressive management in infancy. A functional phenotype is associated with chronic pain and disability manifesting mainly during early adolescence and managed in the outpatient setting. CONCLUSION The two distinct phenotypes described could be the basis for developing a unified scoring system for VA severity assessment.
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Affiliation(s)
- Laurence Gariépy-Assal
- Pediatric Residency Program, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Josée Dubois
- Department of Radiology, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Canada.,Vascular Anomalies Canada, Anomalies Vasculaires, Montréal, Quebec, Canada.,Research Center, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Kelley Zwicker
- Vascular Anomalies Canada, Anomalies Vasculaires, Montréal, Quebec, Canada.,Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Alix Pincivy
- Library, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Julie Powell
- Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Canada.,Vascular Anomalies Canada, Anomalies Vasculaires, Montréal, Quebec, Canada.,Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Yang Zhang
- Canadian Economic Analysis Department, Bank of Canada, Ottawa, Ontario, Canada
| | - Vicky Breakey
- Vascular Anomalies Canada, Anomalies Vasculaires, Montréal, Quebec, Canada.,Division of Pediatric Hematology/Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Victoria Price
- Vascular Anomalies Canada, Anomalies Vasculaires, Montréal, Quebec, Canada.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leonardo R Brandão
- Vascular Anomalies Canada, Anomalies Vasculaires, Montréal, Quebec, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Haematology/Oncology, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manuel Carcao
- Vascular Anomalies Canada, Anomalies Vasculaires, Montréal, Quebec, Canada.,Division of Haematology/Oncology, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Niina Kleiber
- Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Canada.,Vascular Anomalies Canada, Anomalies Vasculaires, Montréal, Quebec, Canada.,Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Research Center, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Department of Pharmacology and Physiology, Université de Montréal, Montréal, Quebec, Canada
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5
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Arteriovenous Malformations. Dermatol Clin 2022; 40:445-448. [DOI: 10.1016/j.det.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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6
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Dodds M, Tollefson M, Castelo-Soccio L, Garzon MC, Hogeling M, Hook K, Boull C, Maguiness S. Treatment of superficial vascular anomalies with topical sirolimus: A multicenter case series. Pediatr Dermatol 2020; 37:272-277. [PMID: 31957126 DOI: 10.1111/pde.14104] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Systemic sirolimus (rapamycin) has recently been found effective in treating complex vascular anomalies by reducing the size and associated complications. Many vascular anomalies have a cutaneous component, and thus, we sought to determine whether topical administration of sirolimus may be an effective therapy, as data on the use of topical sirolimus are limited. OBJECTIVE We reviewed the efficacy and tolerability of topical formulations of sirolimus in the treatment of various simple and combined vascular malformations and tumors. METHODS Eighteen patients with any vascular anomaly treated exclusively with topical sirolimus were retrospectively reviewed. RESULTS Eleven patients had combined venous lymphatic malformations, three had tufted angiomas, two had a lymphatic malformation, one had a venous malformation, and one had a verrucous venous malformation. All (100%) patients reported some degree of improvement and 50% of patients reported marked improvement in one or more symptoms, most commonly blebs and lymphatic drainage, and bleeding. LIMITATIONS The retrospective nature, small number of patients, and differences in topical preparations limit the broad application of the results. CONCLUSION Topical sirolimus appears to be a safe and useful non-invasive therapy that is well-tolerated in the treatment of the cutaneous portion of a variety of vascular anomalies.
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Affiliation(s)
- Melissa Dodds
- Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Megha Tollefson
- Division of Pediatric Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Leslie Castelo-Soccio
- Division of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maria C Garzon
- Division of Pediatric Dermatology, Columbia University Irving Medical Center, Columbia, New York
| | - Marcia Hogeling
- Division of Pediatric Dermatology, University of California Los Angeles, Los Angeles, California
| | - Kristen Hook
- Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Christina Boull
- Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Sheilagh Maguiness
- Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota
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7
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Muir M, Patel R, Gadgil N, Pan I, Lam S. Postoperative 30-day outcomes after craniotomy for supratentorial AVM resection in children. J Clin Neurosci 2019; 70:108-112. [DOI: 10.1016/j.jocn.2019.08.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/06/2019] [Indexed: 11/28/2022]
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8
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Ye Z, Ai X, Zheng J, Hu X, You C, Andrew M F, Fang F. Extravasation of contrast (Spot Sign) predicts in-hospital mortality in ruptured arteriovenous malformation. Br J Neurosurg 2017; 33:149-155. [PMID: 28988494 DOI: 10.1080/02688697.2017.1384792] [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: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE The spot sign is a highly specific and sensitive predictor of hematoma expansion in following primary intracerebral hemorrhage (ICH). Rare cases of the spot sign have been documented in patients with intracranial hemorrhage secondary to arteriovenous malformation (AVM). The purpose of this retrospective study is to assess the accuracy of spot sign in predicting clinical outcomes in patients with ruptured AVM. MATERIALS AND METHODS A retrospective analysis of a prospectively maintained database was performed for patients who presented to West China Hospital with ICH secondary to AVM in the period between January 2009 and September 2016. Two radiologists blinded to the clinical data independently assessed the imaging data, including the presence of spot sign. Statistical analysis using univariate testing, multivariate logistic regression testing, and receiver operating characteristic curve (AUC) analysis was performed. RESULTS A total of 116 patients were included. Overall, 18.9% (22/116) of subjects had at least 1 spot sign detected by CT angiography, 7% (8/116) died in hospital, and 27% (31/116) of the patients had a poor outcome after 90 days. The spot sign had a sensitivity of 62.5% and specificity of 84.3% for predicting in-hospital mortality (p = .02, AUC 0.734). No correlation detected between the spot sign and 90-day outcomes under multiple logistic regression (p = .19). CONCLUSIONS The spot sign is an independent predictor for in-hospital mortality. The presence of spot sign did not correlate with the 90 day outcomes in this patient cohort. The results of this report suggest that patients with ruptured AVM with demonstrated the spot sign on imaging must receive aggressive treatment early on due to the high risk of mortality.
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Affiliation(s)
- Zengpanpan Ye
- a Department of Neurosurgery, Sichuan University West China Medical Center , Chengdu , China
| | - Xiaolin Ai
- a Department of Neurosurgery, Sichuan University West China Medical Center , Chengdu , China
| | - Jun Zheng
- a Department of Neurosurgery, Sichuan University West China Medical Center , Chengdu , China
| | - Xin Hu
- a Department of Neurosurgery, Sichuan University West China Medical Center , Chengdu , China
| | - Chao You
- a Department of Neurosurgery, Sichuan University West China Medical Center , Chengdu , China
| | - Faramand Andrew M
- b Department of Neurosurgery, University of Pittsburgh Medical Center Health System , Pittsburgh , PA , USA
| | - Fang Fang
- a Department of Neurosurgery, Sichuan University West China Medical Center , Chengdu , China
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