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Seront E, Hermans C, Boon LM, Vikkula M. Targeted treatments for vascular malformations: current state of the art. J Thromb Haemost 2024:S1538-7836(24)00430-6. [PMID: 39097232 DOI: 10.1016/j.jtha.2024.07.013] [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: 03/30/2024] [Revised: 07/03/2024] [Accepted: 07/10/2024] [Indexed: 08/05/2024]
Abstract
Vascular malformations, which arise from anomalies in angiogenesis, encompass capillary, lymphatic, venous, arteriovenous, and mixed malformations, each affecting specific vessel types. Historically, therapeutic options such as sclerotherapy and surgery have shown limited efficacy in complicated malformations. Most vascular malformations stem from hereditary or somatic mutations akin to oncogenic alterations, activating the PI3K-AKT-mTOR, RAS-MAPK-ERK, and G-protein coupled receptor pathways. Recognizing the parallels with oncogenic mutations, we emphasize the potential of targeted molecular inhibitors in the treatment of vascular malformations by repurposing anticancer drugs. This review delves into the recent development and future use of such agents for the management of slow- and fast-flow vascular malformations, including in more specific situations, such as prenatal treatment and the management of associated coagulopathies.
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Affiliation(s)
- Emmanuel Seront
- Center for Vascular Anomalies (a VASCERN VASCA European Reference Centre), Cliniques universitaires St Luc, University of Louvain, Brussels, Belgium. https://twitter.com/emmanuelseront
| | - Cedric Hermans
- Center for Vascular Anomalies (a VASCERN VASCA European Reference Centre), Cliniques universitaires St Luc, University of Louvain, Brussels, Belgium; Institut Roi Albert II, Division of Hematology, Cliniques universitaires Saint-Luc, University of Louvain, Brussels, Belgium. https://twitter.com/HermansCedric
| | - Laurence M Boon
- Center for Vascular Anomalies (a VASCERN VASCA European Reference Centre), Cliniques universitaires St Luc, University of Louvain, Brussels, Belgium; Division of Plastic Surgery, Cliniques universitaires Saint-Luc, University of Louvain, Brussels, Belgium. https://twitter.com/LaurenceBoon4
| | - Miikka Vikkula
- Center for Vascular Anomalies (a VASCERN VASCA European Reference Centre), Cliniques universitaires St Luc, University of Louvain, Brussels, Belgium; Deprtment of Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium; Walloon ExceLlence in Life Sciences and Biotechnology (WELBIO) and Walloon ExceLlence Research Institute (WEL Research Institute), Wavre, Belgium.
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Purpura KR, Schindler JS. Airway Considerations in Vascular Lesions. Oral Maxillofac Surg Clin North Am 2024; 36:73-80. [PMID: 37981345 DOI: 10.1016/j.coms.2023.09.002] [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] [Indexed: 11/21/2023]
Abstract
Vascular anomalies of the head and neck frequently involve the upper aerodigestive tract and can cause some level of airway obstruction. It is important to fully evaluate the extent of a lesion and resultant functional impairment with a flexible fiberoptic laryngoscopy. Treating these lesions is difficult and considering how to manage the airway during a procedure is critical. A multidisciplinary approach should be used for airway management with alternative intubation plans established prior to induction of anesthesia. Edema and hemorrhage are expected complications from the treatment of vascular anomalies and should be considered when planning for extubation at the end of a procedure.
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Affiliation(s)
- Kaylee R Purpura
- Department of Otolaryngology - Head and Neck Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA.
| | - Joshua S Schindler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
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Shah R, Venkatesh R, Badi K, Shah K. Surgical management of intramuscular hemangioma of left masseter muscle: A case report. Natl J Maxillofac Surg 2024; 15:160-163. [PMID: 38690251 PMCID: PMC11057590 DOI: 10.4103/njms.njms_140_22] [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: 08/03/2022] [Revised: 09/05/2022] [Accepted: 12/09/2022] [Indexed: 05/02/2024] Open
Abstract
Hemangiomas are benign soft tissue tumors which are congenital and occur due to abnormal proliferations of blood vessels. Most common location of hemangiomas is subcutaneous adipose tissue, but skeletal muscle hemangiomas are very rare which make up to 0.8% of all hemangiomas. Usually, the intramuscular lesions are common in thigh region and calf muscles and are relatively rare in the facial muscles. Long-standing lesions results in phleboliths, and this may cause some symptoms. Conventional treatment of these isolated lesions may not yield satisfactory results. Hence, surgical excision of the lesion in toto results in aesthetically pleasing results with low chances of recurrence. In this article, we report a case of a left masseter intramuscular hemangioma in 19-year-old patient which was successfully managed by complete surgical excision.
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Affiliation(s)
- Rishabh Shah
- Department of Oral and Maxillofacial Surgery, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India
| | - Rashmi Venkatesh
- Department of Oral Medicine and Radiology, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India
| | - Kavita Badi
- Department of Oral Medicine and Radiology, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India
| | - Kreena Shah
- Department of Oral and Maxillofacial Surgery, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India
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Yang WH, Xiang XJ, Li HL. Sclerotherapy for congenital vascular malformations with mixing foam of polidocanol and liquid of bleomycin. Phlebology 2023; 38:451-457. [PMID: 37318342 DOI: 10.1177/02683555231184772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To evaluate the efficacy of sclerotherapy for congenital vascular malformation (CVM) using a combination of polidocanol foam and bleomycin liquid. METHODS A retrospective review of a prospectively collected data on patients who had sclerotherapy for CVM from May 2015 to July 2022 was performed. RESULTS A total of 210 patients with a mean age of 24.8 ± 2.0 years were included. Venous malformation (VM) was the most common type of CVM, accounting for 81.9% (172/210) of all patients. At 6 months follow-up, the overall clinical effective rate was 93.3% (196/210), and 50% (105/210) of patients were clinically cured. The clinical effective rates in VM, lymphatic, and arteriovenous malformation group were 94.2%, 100%, and 100%. CONCLUSION Sclerotherapy using a combination of polidocanol foam and bleomycin liquid is an effective and safe treatment for venous and lymphatic malformations. It is a promising treatment option with satisfactory clinical outcome in arteriovenous malformations.
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Affiliation(s)
- Wei-Hong Yang
- Department of Interventional Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xian-Jun Xiang
- Department of Interventional Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Hai-Lei Li
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Hyvönen H, Salminen P, Kyrklund K. Long-term outcomes of lymphatic malformations in children: An 11-year experience from a tertiary referral center. J Pediatr Surg 2022; 57:1005-1010. [PMID: 35973860 DOI: 10.1016/j.jpedsurg.2022.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/05/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lymphatic malformations (LMs) are benign, congenital lesions that display considerable heterogeneity in terms of size, location and characteristics. This study aims to describe the long-term outcomes of current management strategies for patients with simple (cystic) LMs. METHODS The case records of all patients (age ≤16 years) with simple (cystic) LMs at our tertiary institution between 2008 and 2019 were assessed for clinical features, imaging and details of management, including complications. RESULTS Of a total of 164 patients (60% male), 66% were diagnosed aged <2 years. The median follow-up was 5 (0.3-16) years from diagnosis. LMs were located in the head and neck (40%), extremities (27%), trunk (23%), mediastinum (4%), or intra-abdominally (6%). Types were macrocystic in 47%, microcystic in 21% and mixed in 32%. Sclerotherapy was the most common intervention (38%). Primary surgery had been performed in 12%. Symptomatic improvement, reduction in size, or complete regression were observed in 82/102 (80%) of LMs after interventions; complications from treatment were uncommon (Clavien-Dindo grade I-II: 6%; grade III-IIId: 1%). Sixty-two patients (38%; median age 0.5 (range, 0-12) years) had not required interventions to date; spontaneous regression of the LM occurred in 16 (26%) of these expectantly followed-up cases. CONCLUSIONS Most studies to date have focused on LMs in selected anatomical locations. Herein the outcomes of an entire population from a single tertiary unit of patients are presented, demonstrating the wide heterogeneity of simple (cystic) LMs and highlighting the importance of individualized, multidisciplinary approaches to care in achieving optimal outcomes.
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Affiliation(s)
- Hanna Hyvönen
- New Children's Hospital, Department of Pediatric Surgery, Helsinki University Hospital and University of Helsinki, Stenbäckinkatu 9, 00029 HUS, Helsinki, Finland.
| | - Päivi Salminen
- New Children's Hospital, Department of Pediatric Surgery, Helsinki University Hospital and University of Helsinki, Stenbäckinkatu 9, 00029 HUS, Helsinki, Finland; Rare Disease Centre, Department of Pediatric Surgery, Helsinki University Hospital and University of Helsinki, Finland; VASCERN VASCA European Reference Centre, Stenbäckinkatu 9, 00029 HUS, Helsinki, Finland
| | - Kristiina Kyrklund
- New Children's Hospital, Department of Pediatric Surgery, Helsinki University Hospital and University of Helsinki, Stenbäckinkatu 9, 00029 HUS, Helsinki, Finland; Rare Disease Centre, Department of Pediatric Surgery, Helsinki University Hospital and University of Helsinki, Finland; VASCERN VASCA European Reference Centre, Stenbäckinkatu 9, 00029 HUS, Helsinki, Finland
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Qu H, Lei X, Hu L, Yin X, Du X, Zhang L, Sun C. Successful Endoscopic Sclerotherapy Using Lauromacrogol Injection for Laryngopharyngeal Hemangioma. EAR, NOSE & THROAT JOURNAL 2021; 100:662-666. [PMID: 34551625 DOI: 10.1177/01455613211043690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: This study aims to investigate the efficacy and safety of local lauromacrogol injection in the treatment of hypopharyngeal hemangioma. Methods: From Aug 2015 to May 2021, 13 consecutive patients suffering from hypopharyngeal hemangioma underwent local lauromacrogol injection assisted by endoscope in this prospective clinical series. All patients were followed up regularly and the therapeutic effects and complications were observed. Results: A total 13 of patients were enrolled, including 11 men and 2 women, with an average age of 48.5 years (range 25-76 years). The sizes of the hemangioma ranged from 0.5 × 1.0 cm to 3.5 × 3.5 cm. After 1 to 40 months of follow-up, 12 patients were cured and 1 was significantly effective after 1 to 4 (mean 1.8) injections. All patients suffered varying degrees of postoperative pain or foreign body sensation. 3 patients were significantly affected by local swelling of the injection site, 2 of which underwent prophylactic tracheostomy postoperatively and 1 patient returned to the ward with endotracheal intubation postoperatively. No complications such as mucosal ulceration, fever, and allergies occurred. Conclusions: Lauromacrogol injection is a safe and effective method to treat hypopharyngeal hemangioma.
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Affiliation(s)
- Hongyang Qu
- Department of Otolaryngology-Head and Neck Surgery, 199193Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Xia Lei
- Department of Otolaryngology-Head and Neck Surgery, 199193Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Lin Hu
- Department of Otolaryngology-Head and Neck Surgery, 199193Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Xiao Yin
- Department of Otolaryngology-Head and Neck Surgery, 199193Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Xiaodong Du
- Department of Otolaryngology-Head and Neck Surgery, 199193Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Lei Zhang
- Department of Otolaryngology-Head and Neck Surgery, 199193Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Changling Sun
- Department of Otolaryngology-Head and Neck Surgery, 199193Affiliated Hospital of Jiangnan University, Wuxi, China
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Makkad RS, Agarwal G, Gupta S, Nagi R, Ragit A, Jamal F. Intramuscular Hemangioma of Masseter Muscle: Case Report of Rare Clinical Entity. Ann Maxillofac Surg 2021; 11:148-151. [PMID: 34522672 PMCID: PMC8407625 DOI: 10.4103/ams.ams_100_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/19/2021] [Accepted: 02/03/2021] [Indexed: 12/03/2022] Open
Abstract
Rationale: Intramuscular hemangiomas are unique benign vascular tumours of skeletal muscles; involving masseter and trapezius muscles in the majority of cases. The rationale was to emphasize that the diagnosis of asymptomatic swelling in the masseteric region is important as due to their deep anatomic location and unfamiliar presentation, they are often misdiagnosed as a parotid swelling or other muscular pathologies. Patient Concern: This report describes a rare case of a 25-year-old healthy male patient who presented with an asymptomatic swelling in the right masseteric region. The patient had cosmetic concerns due to the large size. Diagnosis: Colour Doppler ultrasonography was done to assess the vascularity within the lesion. Treatment: Complete excision was successfully achieved using combined Risdon's and preauricular approach. Outcome: No signs of recurrence were observed after 6 months Take-away Lessons: Appropriate selection of diagnostic modalities enables the clinician in making an accurate preoperative diagnosis of progressive swelling in the masseteric region.
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Affiliation(s)
- Ramanpal Singh Makkad
- Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
| | - Gunjan Agarwal
- Department of Surgical Oncology, JNM Medical College, Raipur, Chhattisgarh, India
| | - Santosh Gupta
- Department of Pathology, Suyash Hospital, Raipur, Chhattisgarh, India
| | - Ravleen Nagi
- Department of Oral Medicine and Radiology, Saveetha Dental College, Chennai, Tamil Nadu, India
| | - Akshay Ragit
- Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
| | - Farhin Jamal
- Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
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Ultrasound-Guided Moving Shot Radiofrequency Ablation of Benign Soft Tissue Neoplasm. ACTA ACUST UNITED AC 2021; 57:medicina57080830. [PMID: 34441036 PMCID: PMC8402204 DOI: 10.3390/medicina57080830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 12/16/2022]
Abstract
Background and Objective: To evaluate the effectiveness of radiofrequency ablation (RFA) using the moving-shot technique for benign soft tissue neoplasm. Materials and Methods: This retrospective study reviewed eight patients with benign soft tissue neoplasm presenting with cosmetic concerns and/or symptomatic issues who refused surgery. Six patients had vascular malformation, including four with venous malformation and two with congenital hemangioma. The other two patients had neurofibroma. All patients underwent RFA using the moving-shot technique. Imaging and clinical follow-up were performed in all patients. Follow-up image modalities included ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging. The volume reduction ratio (VRR), cosmetic scale (CS), and complications were evaluated. Results: Among the seven patients having received single-stage RFA, there were significant volume reductions between baseline (33.3 ± 21.2 cm3), midterm follow-up (5.1 ± 3.8 cm3, p = 0.020), and final follow-up (3.6 ± 1.4 cm3, p = 0.022) volumes. The VRR was 84.5 ± 9.2% at final follow-up. There were also significant improvements in the CS (from 3.71 to 1.57, p = 0.017). The remaining patient, in the process of a scheduled two-stage RFA, had a 33.8% VRR after the first RFA. The overall VRR among the eight patients was 77.5%. No complications or re-growth of the targeted lesions were noted during the follow-up period. Of the eight patients, two received RFA under local anesthesia, while the other six patients were under general anesthesia. Conclusions: RFA using the moving-shot technique is an effective, safe, and minimally invasive treatment for benign soft tissue neoplasms, achieving mass volume reduction within 6 months and significant esthetic improvement, either with local anesthesia or with general anesthesia under certain conditions.
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Chauhan R, Luthra A, Sethi S, Panda N, Meena SC, Bhatia V, Bloria SD. A Prospective Randomized Controlled Trial Using Propofol or Dexmedetomidine for Conscious Sedation in Pediatric Patients Undergoing Sclerotherapy. J Pediatr Neurosci 2021; 15:379-385. [PMID: 33936302 PMCID: PMC8078632 DOI: 10.4103/jpn.jpn_167_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/26/2022] Open
Abstract
Aim: Sodium tetradecyl sulfate (STS) sclerotherapy in pediatric patients is usually undertaken under sedation inside digital subtraction angiography (DSA) suite. These patients are day-care patients and need adequate sedation for small duration. We performed this study to compare propofol and dexmedetomidine as sedative agents in these patients. Materials and Methods: Seventy American Society of Anesthesiologists (ASA) physical status I patients scheduled to undergo sclerotherapy for low-flow venous malformations under sedation were randomized to be administered either dexmedetomidine (Group D) or propofol (Group P). In Group D, initially 2 µg/kg of dexmedetomidine was administered over 10min (or till attainment of a Ramsay sedation score [RSS] of 5), followed by an infusion at the rate of 0.3 µg/kg/h. In Group P, propofol 1mg/kg bolus followed by an infusion at 100 µg/kg/min was administered, titrated to an RSS of 5. We measured intraoperative heart rate, blood pressure, respiratory rate, duration of procedure, and incidence of arterial desaturation, bradycardia, and respiratory depression in the two groups. Results: All the patients in both groups completed the procedure. The mean anesthesia time was significantly longer in Group D. Intraoperative heart rates remained comparable in the two groups, whereas systolic and diastolic BP were significantly higher in Group D throughout the procedure. No patient in Group D experienced arterial desaturation, whereas five patients in Group P reported a SpO2 of <90%. Conclusion: Both propofol and dexmedetomidine can be used for administering sedation in pediatric patients undergoing sclerotherapy for superficial venous malformations in DSA suite. Although propofol provides a rapid onset and reduced duration of action, dexmedetomidine provides reduced episodes of arterial desaturation and respiratory depression.
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Affiliation(s)
- Rajeev Chauhan
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ankur Luthra
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sameer Sethi
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Nidhi Panda
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Shyam Charan Meena
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Vikas Bhatia
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Summit D Bloria
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Dharmarajan H, McCoy JL, Jabbour N, McCormick A, Xavier F, Correa D, Padia R. Peri-procedural Anticoagulation in Patients with Head and Neck Versus Extremity Venous Malformations. Laryngoscope 2020; 131:1163-1167. [PMID: 33037831 DOI: 10.1002/lary.29123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/13/2020] [Accepted: 09/02/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE (1) Review a multidisciplinary vascular anomalies center's practice regarding periprocedural anticoagulation for venous malformations (VM) and the associated risk of thromboembolic and disseminated intravascular coagulation (DIC) events. (2) Compare the risk of thromboembolic events and DIC post-procedure between head and neck (H&N) and extremity VM patients. METHODS An Institutional Review Board (IRB)-approved, retrospective chart review was performed on 120 VM patients. A thromboembolic event was defined as a thrombus formation post-sclerotherapy or post-surgery within 2 months in a distant or local venous structure not directly addressed by the procedure. RESULTS There were 39 cases involving the H&N and 81 cases based at the extremities. There were eight cases of post-procedure thrombus formation within the extremity VM group (8/71; 11.3%) as opposed to 0 cases in the H&N group (OR: 0, 95% CI .00-.09), p = .049. There was no difference in incidence of post-procedure thromboembolic events between those with elevated D-dimer (H&N: 0%, extremity: 22.7%, 5/22) and normal D-dimer values (H&N: 0%, extremity: 6.3% [1/16], P = .370). There was no difference in incidence of post-procedure thromboembolic events between those who received periprocedural anticoagulation (H&N: 0%, extremity: 21%, 4/19) and those who did not (H&N: 0%, extremity: 8.2%, 4/49), (Extremity: OR: 3.00, .67-13.50, P = .206). CONCLUSION Post-procedure thromboembolism is rare in the treatment of venous malformations, especially in the head and neck subsite. Regardless of anticoagulation use, there were no thromboembolic events for H&N VM patients. Such events are rare, and the odds may approach zero, especially with small sample size. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1163-1167, 2021.
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Affiliation(s)
- Harish Dharmarajan
- Division of Pediatric Otolaryngology, Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jennifer L McCoy
- Division of Pediatric Otolaryngology, Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Noel Jabbour
- Division of Pediatric Otolaryngology, Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andrew McCormick
- Department of Pediatrics, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Frederico Xavier
- Department of Hematology/Oncology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Debra Correa
- Department of Hematology/Oncology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Reema Padia
- Division of Pediatric Otolaryngology, Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Evaluation of sclerotherapy of benign oral vascular lesions with monoethanolamine oleate. Clin Oral Investig 2020; 25:1767-1774. [PMID: 32748074 DOI: 10.1007/s00784-020-03479-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the efficacy of sclerotherapy with monoethanolamine oleate (MEO) in a series of cases of benign oral vascular lesions (BOVL). MATERIAL AND METHODS Clinical records and images were retrieved (2015-2019), and data regarding age, gender, location, size, symptomatology, treatment and outcomes of patients were collected. All patients were diagnosed according to the classification of International Society for the Study of Vascular Anomalies and received the same treatment protocol (MEO 0.05 g/mL). The collected data were submitted to descriptive analysis and Pearson's chi-square test (p ≤ 0.05). RESULTS Thirty-seven patients were treated. Most were female (70.3%) aged 9 to 88 years (median, 57.5 ± 17.4 years). Lower lip (54.1%) was the most affected site followed by buccal mucosa (16.2%). Thirty-two lesions were asymptomatic and 35.1% showed ≤ 0.5 cm in size. In 48.6% of the patients, only one application of MEO was performed. Complete regression occurred in 62.2% of cases, whereas 27% showed partial regression. One patient showed hypersensitivity during treatment. There was no significant difference between clinical outcome and age, anatomic site, size, and number of applications of MEO. CONCLUSIONS Sclerotherapy with MEO is an acceptable and affordable treatment and can provide satisfactory results in BOVL, especially where other treatment options could compromise the esthetic aspects. CLINICAL RELEVANCE As it is a non-invasive therapy leading, in most cases, to adequate clinical results, safety, and tolerability, sclerotherapy with MEO can be considered an effective treatment for BOVL.
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Huang Y, Yang C, Wang T, Liu S, Chen A. Preliminary experience with promethazine hydrochloride injection in the sclerotherapy of oral mucocele. Int J Oral Maxillofac Surg 2020; 50:516-521. [PMID: 32682647 DOI: 10.1016/j.ijom.2020.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/29/2020] [Accepted: 06/30/2020] [Indexed: 02/07/2023]
Abstract
Mucoceles are common in the minor salivary and sublingual glands. Sclerotherapy is a possible treatment strategy for mucoceles. The purpose of this study was to evaluate the clinical outcomes of sclerotherapy with promethazine hydrochloride injection in treating mucoceles. Thirty-seven patients were enrolled. Sclerotherapy was performed with promethazine hydrochloride injection (25mg/ml) through the mucosa. Patients were followed up at 1, 3, and 6 months after the last sclerotherapy. Clinical data were reviewed. The lesions (range 2-30mm in diameter) occurred on the ventral tongue tip (20 patients), lower lip (11 patients), and floor of the mouth (six patients). The amount of sclerosant per injection ranged from 0.2ml to 1ml. At the 6-month follow-up, 33 patients showed resolution with no recurrence. One patient showed a significant response with a 5-mm-diameter nodule remaining after two sclerotherapies. Three patients who underwent two or more sclerotherapies failed to show an improvement. The overall cure rate was 91.9% (96.8% for mucoceles of the minor salivary gland, 66.7% for ranulas). Complications were rare and mild. Sclerotherapy with promethazine hydrochloride injection for the treatment of mucoceles is safe. It is effective for mucoceles of the minor salivary glands, but its application for ranulas requires further investigation.
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Affiliation(s)
- Y Huang
- Department of Oral and Maxillofacial Surgery, Qilu Hospital, Institute of Stomatology, Shandong University, Jinan, Shandong Province, PR China
| | - C Yang
- Department of Oral and Maxillofacial Surgery, Qilu Hospital, Institute of Stomatology, Shandong University, Jinan, Shandong Province, PR China
| | - T Wang
- Department of Oral and Maxillofacial Surgery, Qilu Hospital, Institute of Stomatology, Shandong University, Jinan, Shandong Province, PR China
| | - S Liu
- Department of Oral and Maxillofacial Surgery, Qilu Hospital, Institute of Stomatology, Shandong University, Jinan, Shandong Province, PR China
| | - A Chen
- Department of Oral and Maxillofacial Surgery, Qilu Hospital, Institute of Stomatology, Shandong University, Jinan, Shandong Province, PR China.
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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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14
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Hou F, Chen J, Xia M, Ding K, Zeng Q, Liu W. Percutaneous sclerotherapy with polidocanol under the guidance of ultrasound for venous malformations in children - A retrospective cohort study from a single tertiary medical center. Medicine (Baltimore) 2020; 99:e18839. [PMID: 32118707 PMCID: PMC7478829 DOI: 10.1097/md.0000000000018839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study reports our experience, the therapeutic outcomes and complications of percutaneous sclerotherapy (PS) with polidocanol to treat venous malformations (VMs) in children.A retrospective analysis was conducted of pediatric patients with VMs who underwent PS using polidocanol under continuous ultrasound (US) guidance between January 2015 and January 2018 at our department. Medical records were reviewed to record demographic information, lesion characteristics, treatment sessions, therapeutic outcomes and complications. χ analysis was employed to evaluate the effects of these characteristics on outcomes.Hundred treatment sessions were performed for lesions in 47 patients. The mean age of the patients was 4.1 ± 3.6 years (mean ± SD). The female to male ratio was almost 2:1 (female 32, male 15). The location of the VMs included the head and neck in 16 cases (34.0%), upper extremity in 11 cases (23.4%), lower extremity in 10 cases (21.3%), and trunk and perineum in 10 cases (21.3%). The majority of the lesions were focal in 36 cases (76.6%), while 11 (23.4%) were diffuse. Seventeen patients (36.2%) underwent single PS session, 14 patients (29.8%) underwent 2 sessions, 10 patients (21.3%) underwent 3 sessions and 6 patients (12.7%) underwent ≧4 sessions. The mean PS session per patient was 2.1 ± 1.1. The mean follow-up duration was 11.4 ± 7.6 months. After the last PS session, 8 patients (17.0%) had excellent outcomes, 27 (57.4%) had good outcomes, 10 (21.3%) had fair outcomes, and 2 (4.3%) had poor outcomes. Focal lesions were more likely to have good or excellent outcomes than diffuse lesions (χ = 4.522, P = .033). No other lesion characteristic significantly affected the outcomes (good or excellent outcomes), including lesion location (χ = 2.011, P = .570) or lesion size (χ = 1.045, P = .307). After the PS procedure, temporary local swelling occurred in 81 sessions (81.0%), local pain occurred in 15 sessions (15.0%), fever occurred in 27 (27.0%) sessions, and transient local numbness occurred in four sessions (4.0%).PS with polidocanol under the guidance of US appears to be safe and effective for the treatment of VMs in children, especially for focal lesions.
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Affiliation(s)
- Fang Hou
- Department of Pediatric Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital
- Department of Pediatric Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China
| | - Jidong Chen
- Department of Ultrasound, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Meng Xia
- Department of Pediatric Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital
| | - Ke Ding
- Department of Pediatric Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital
- Department of Pediatric Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China
| | - Qiang Zeng
- Department of Pediatric Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital
| | - Wenying Liu
- Department of Pediatric Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital
- Department of Pediatric Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China
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De Maria L, De Sanctis P, Balakrishnan K, Tollefson M, Brinjikji W. Sclerotherapy for Venous Malformations of Head and Neck: Systematic Review and Meta-Analysis. Neurointervention 2020; 15:4-17. [PMID: 31940716 PMCID: PMC7105094 DOI: 10.5469/neuroint.2019.00213] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/23/2019] [Indexed: 01/23/2023] Open
Abstract
We performed a systematic review and meta-analysis of studies performing sclerotherapy for treatment of venous malformations (VMs) of the face, head and neck. It is our hope that data from this study could be used to better inform providers and patients regarding the benefits and risks of percutaneous sclerotherapy for treatment of face, head and neck VMs. We searched PubMed, MEDLINE, and EMBASE from 2000–2018 for studies evaluating the safety and efficacy of percutaneous sclerotherapy of neck, face and head VMs. Two independent reviewers selected studies and abstracted data. The primary outcomes were complete and partial resolution of the VM. Data were analyzed using random-effects meta-analysis. Thirty-seven studies reporting on 2,067 patients were included. The overall rate of complete cure following percutaneous sclerotherapy with any agent was 64.7% (95% confidence interval [CI], 57.4–72.0%). Sodium tetradecyl sulfate had the lowest complete cure rate at 55.5% (95% CI, 36.1–74.9%) while pingyangmycin had the highest cure rate at 82.9% (95% CI, 71.1–94.7%). Overall patient satisfaction rates were 91.0% (95% CI, 86.1–95.9%). Overall quality of life improvement was 78.9% (95% CI, 67.0–90.8%). Overall permanent morbidity/mortality was 0.8% (95% CI, 0.3–1.3%) with no cases of mortality. Our systematic review and meta-analysis of 37 studies and over 2,000 patients found that percutaneous sclerotherapy is a very safe and effective treatment modality for treatment of VMs of the head, neck and face.
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Affiliation(s)
- Lucio De Maria
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Megha Tollefson
- Department of Dermatology and Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology and Vascular Centers, Mayo Clinic, Rochester, MN, USA
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16
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Zareena S, Dinesh KB, Narayanasami B, Marunraj G, Rekha A. Venous Malformation of the Parotid Gland. Int J Angiol 2019; 28:210-214. [PMID: 31452591 DOI: 10.1055/s-0039-1694296] [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: 10/26/2022] Open
Abstract
Vascular malformations of the parotid gland are extremely rare. A 23-year-old female presented with tender parotid swelling with mild compressibility. Diagnosis was made by ultrasonogram and confirmed by magnetic resonance imaging. Facial nerve preserving surgical excision of the superficial parotid gland with infiltration of foam sclerosant was done.
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Affiliation(s)
- Shifa Zareena
- Department of General Surgery, Saveetha Medical College Hospital, Chennai, Tamil Nadu, India
| | - K B Dinesh
- Department of General Surgery, Saveetha Medical College Hospital, Chennai, Tamil Nadu, India
| | - Bharath Narayanasami
- Department of General Surgery, Saveetha Medical College Hospital, Chennai, Tamil Nadu, India
| | - G Marunraj
- Department of Vascular Surgery, Saveetha Medical College Hospital, Chennai, Tamil Nadu, India
| | - Arcot Rekha
- Department of General Surgery, Saveetha Medical College Hospital, Chennai, Tamil Nadu, India
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17
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De Maria L, De Sanctis P, Tollefson M, Mardini S, Garrity JA, Morris PP, Bendel E, Brinjikji W. Sclerotherapy for low-flow vascular malformations of the orbital and periocular regions: Systematic review and meta-analysis. Surv Ophthalmol 2019; 65:41-47. [PMID: 31425703 DOI: 10.1016/j.survophthal.2019.08.003] [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: 01/26/2019] [Revised: 07/25/2019] [Accepted: 08/05/2019] [Indexed: 01/27/2023]
Abstract
Percutaneous sclerotherapy is an alternative strategy for the treatment of vascular malformations of the orbital and periorbital regions. The safety and efficacy of sclerotherapy in this setting have not been fully established. We present the results of a systematic review and meta-analysis examining the safety and efficacy of percutaneous sclerotherapy for the treatment of vascular malformations of the orbit. We searched PubMed, MEDLINE, and EMBASE from 2000 to 2018 for studies evaluating the safety and efficacy of percutaneous sclerotherapy for orbital and periorbital vascular malformations. Two independent reviewers selected studies and abstracted data. The primary outcome of this study is the efficacy of sclerotherapy which includes complete response, partial response, or no response to sclerotherapy. Data were analyzed using random-effects meta-analysis. Thirteen studies reporting on 154 patients were included. The rate of complete cure after percutaneous sclerotherapy was 54.9% (95% confidence interval [CI] = 34.2%-75.7%). The rate of emergent decompressive surgery was 3.4% (95% CI = 0.5%-6.2%), and the rate of vision loss was 2.7% (95% CI = 0.1%-5.3%). I2 values were above 50% for most outcomes indicating substantial heterogeneity. Our systematic review and meta-analysis of 13 studies and over 150 patients found that percutaneous sclerotherapy is a safe and effective treatment modality for the treatment of low-flow vascular malformations of the orbit.
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Affiliation(s)
- Lucio De Maria
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
| | | | - Megha Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA; Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - Samir Mardini
- Department of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| | - James A Garrity
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | | | - Emily Bendel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
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18
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Combination of Sclerotherapy and Dual-Wavelength Laser in the Management of Infantile Hemangiomas in Chinese Infants. Dermatol Surg 2019; 45:1253-1259. [PMID: 30882500 DOI: 10.1097/dss.0000000000001898] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of combination therapy with sclerotherapy and dual-wavelength pulsed dye laser (PDL) & Nd:YAG for infantile hemangiomas (IHs). PATIENTS AND METHODS Fifty-nine patients with IH received treatment with sclerotherapy and dual-wavelength PDL & Nd:YAG treatment at 4-week intervals. Observers assessed the size and color of IH using a size rating scale and color rating scale before and after treatments. RESULTS The study showed that IH improved significantly after several sessions of treatment. Sclerotherapy reduced the size of IH, whereas dual-wavelength laser lightened the color of IH. No serious adverse effects occurred. CONCLUSION Combined sclerotherapy and dual-wavelength laser treatment is an effective and safe option for IH.
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19
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Ghaffarpour N, Burgos CM, Wester T. Surgical excision is the treatment of choice for cervical lymphatic malformations with mediastinal expansion. J Pediatr Surg 2018; 53:1820-1824. [PMID: 29173777 DOI: 10.1016/j.jpedsurg.2017.10.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/04/2017] [Accepted: 10/13/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lymphatic malformations (LMs) in the mediastinum are uncommon. However, cervical LMs may expand into the mediastinum. The aim of this study was to review our experience with the management of patients with LMs involving the mediastinum and to propose a treatment algorithm to guide the management of these rare malformations. MATERIAL AND METHODS This was a descriptive retrospective chart review of all patients with LMs involving the mediastinum treated at our Institution between 2009 and 2015. We collected demographic data, data on investigations, management, and complications of the treatment, as well as outcomes at follow-up. Complications were defined and described according to the Clavien-Dindo classification. The clinical outcome was assessed using a clinical assessment scale. RESULTS The cohort consisted of seven patients. Airway compromise at the time of diagnosis was seen in 4 patients. Three patients had anatomical compression of the trachea and two patients had sub-total compression of the right lung. All three patients with tracheoscopy-verified compression of the trachea had compromise of the distal trachea, and a tracheostomy would not have been protective. All patients received sclerotherapy. The median time with mechanical ventilation at the neonatal intensive care unit after each sclerotherapy was eleven days (range 8-31). Each patient received sclerotherapy in median three times (range 1-9). Five of the patients (71%) were operated with excision of the LM in the mediastinum. Two of the patients were operated primarily and three patients were operated after major complications to sclerotherapy. The patients treated with sclerotherapy and the operated patients had comparable amount of mild complications, Clavien-Dindo grade I-II complications. Severe complications, Clavien-Dindo grade III-IV, were seen five times more commonly after sclerotherapy than after surgery. The clinical outcome was excellent for the operated patients and fair to good for the patients receiving only sclerotherapy. CONCLUSION Patients with cervical LM involving the mediastinum represent a high-risk group with respect to the severity of complications following sclerotherapy. The swelling is unpredictable and requires extended observation at an intensive care unit with ventilation support. Tracheostomy does not prevent tracheal compression in mediastinal LM, as the malformation may compress trachea distal to the stoma. Surgical resection of the LM in the mediastinum is recommended, with the possibility of intra-operative sclerotherapy as an adjunctive. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nader Ghaffarpour
- Unit of Pediatric Surgery, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Carmen Mesas Burgos
- Unit of Pediatric Surgery, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Wester
- Unit of Pediatric Surgery, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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20
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Weitz-Tuoretmaa A, Keski-Nisula L, Rautio R, Laranne J. Quality of life after endovascular sclerotherapy of low-flow venous malformations: the efficacy of polidocanol compared with ethanol. Acta Radiol 2018; 59:946-952. [PMID: 29124942 DOI: 10.1177/0284185117741774] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Limited information is available on mid-term results and quality of life (QOL) after endovascular sclerotherapy of venous malformations. Purpose To compare two agents-polidocanol and ethanol-with a focus on the influence on QOL after sclerotherapy. Material and Methods Forty-one consecutive patients with a venous malformation in the head and neck area or in the extremities were treated with polidocanol between 2008 and 2013. Pre- and post-treatment magnetic resonance imaging (MRI) scans were compared. All patients completed a self-evaluation form on symptoms as well as a QOL questionnaire. The results were compared with previously obtained material during 1991-2001, comprising 44 consecutive, similarly located venous malformation patients subject to ethanol sclerotherapy. Results No significant clinical complications were observed. Subjectively, 19 (46%) of the patients benefitted from the treatment. QOL results showed that 85% of patients had an index < 39 - where 0 represents the highest and 100 the lowest QOL. Patients in the ethanol group had marginally better overall post-treatment QOL results. Post-treatment MRI in 35 patients showed the size of the malformation unchanged in 19 (54%) patients, in ten (29%) there was a decrease (<50%) while in six (17%) the decrease was more significant (>50%). Post-treatment MRI results did not correlate with either subjective symptoms or QOL results. Conclusion Polidocanol sclerotherapy were found to be an effective, safe, and well tolerated treatment option for low flow venous malformations. Routine MRI for follow-up appears redundant and may be omitted.
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Affiliation(s)
| | - Leo Keski-Nisula
- Department of Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Riitta Rautio
- Department of Interventional Radiology, Turku University Hospital, Turku, Finland
| | - Jussi Laranne
- Department of Otorhinolaryngology, Kokkola Central Hospital, Kokkola, Finland
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21
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Tahir M, Mumtaz MA, Sultan A, Iqbal J, Sayani R. Role of Interventional Radiology in the Management of Peripheral Vascular Malformations: A Tertiary Care Center Experience. Cureus 2018; 10:e2335. [PMID: 29774173 PMCID: PMC5955714 DOI: 10.7759/cureus.2335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Peripheral vascular malformations (PVMs) represent a wide spectrum of vascular abnormalities occurring due to anomalous connections between arteries, veins, capillaries, and lymphatic channels at the microscopic level, in different combinations. They are rare and challenging to treat. Different operators may have different approaches based on their experience and expertise. Sclerotherapy either alone or in combination with embolization has been used as an independent method for the treatment of PVMs. Purpose The aim of this study is to assess the safety and efficacy of sclerotherapy and embolization, with or without surgery, for the treatment of peripheral vascular malformations, based on our approach. Materials and methods A retrospective review of all patients with PVMs treated in our interventional radiology department from 2011 to 2017 was carried out. Medical records, imaging, and follow-up notes were reviewed to evaluate the response to treatment and post-procedure complications. Results Thirty-four sessions were performed in 15 patients (eight male, seven female) with PVMs. Low-flow lesions were identified in 10, intermediate flow in one, and high flow in four patients. Sodium tetradecyl sulfate (STS) was used as the sclerotherapeutic agent in 10 (66.67%), glue with lipoidal in three (20.0%), and bleomycin in one patient (6.67%). Coils with PVA and a covered stent were used in one and a combination of coil, PVA, and gel foam was used in one patient. A marked response was seen in 11 and a partial response in four patients. One patient developed foot gangrene. Stent thrombosis was noted in one patient with no clinical consequences. Recurrence was seen in two patients, who were lost to follow up. Conclusion PVMs are complex lesions. Sclerotherapy with or without embolization is a safe and effective treatment modality, with clinical response approaching 100%.
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Affiliation(s)
- Misbah Tahir
- Radiology, Liaquat National Hospital and Medical College
| | | | - Anum Sultan
- Radiology, Liaquat National Hospital and Medical College
| | - Jawaid Iqbal
- Radiology, Liaquat National Hospital and Medical College
| | - Raza Sayani
- Department of Radiology, The Aga Khan University, Karachi
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22
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Lyly A, Castrén E, Aronniemi J, Klockars T. Plunging ranula - patient characteristics, treatment, and comparison between different populations. Acta Otolaryngol 2017; 137:1271-1274. [PMID: 28754079 DOI: 10.1080/00016489.2017.1357082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To review our clinical experience and characteristics of Finnish patients with plunging ranula and compare our results with reports from other populations. DESIGN A retrospective study from the electronic hospital records between 2005 and 2016. SETTING The Department of Otorhinolaryngology and Head and Neck Surgery of Helsinki University Hospital, Finland. RESULTS We describe the characteristics and treatment of 41 patients with MRI-confirmed plunging ranula. Most of our patients were young adults and 88% of them were male. Surgery and sclerotherapy were used for treatment. CONCLUSIONS The vast majority of Finnish plunging ranula patients in our cohort were male, suggesting significant population-related differences in plunging ranula gender distribution. Transoral surgery seemed to result in lowest recurrence rate and was the most common treatment in our clinic.
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Affiliation(s)
- Annina Lyly
- Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eeva Castrén
- Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Johanna Aronniemi
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tuomas Klockars
- Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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23
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Sio WS, Lee SH, Liang IC. Orbital infarction syndrome after multiple percutaneous sclerotherapy sessions for facial low-flow vascular malformation: A case report and literature review. Indian J Ophthalmol 2017; 64:595-7. [PMID: 27688283 PMCID: PMC5056549 DOI: 10.4103/0301-4738.191508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Vision loss following sclerotherapy for facial vascular malformations (VMs) is a rare but detrimental complication. Here, we report a case of an 11-year-old boy with acute onset blepharoptosis, ophthalmoplegia, and blindness in his right eye after the 14th sclerotherapy session (percutaneous intralesional injection of sodium tetradecyl sulfate) for a right facial low-flow VM without orbital involvement. Computed tomography angiography revealed no contrast enhancement in the right ophthalmic artery, superior ophthalmic vein, or extraocular muscles. He presented with the hallmarks of orbital infarction syndrome: Clear signs of anterior and posterior segment ischemia and disrupted arterial flow to the extraocular muscles. His blepharoptosis and eye movement improved 4 months later; however, he remained blind, and phthisis bulbi developed eventually. Thus, sclerotherapy for facial VM—even without orbital involvement—may result in severe ocular and orbital complications.
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Affiliation(s)
- Weng Sut Sio
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan
| | - Shwu-Huey Lee
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan
| | - I-Chia Liang
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan
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24
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Wolter NE, Siegele B, Cunningham MJ. Cystic cervical teratoma: A diagnostic and management challenge. Int J Pediatr Otorhinolaryngol 2017; 95:97-100. [PMID: 28576544 DOI: 10.1016/j.ijporl.2017.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/08/2017] [Accepted: 02/11/2017] [Indexed: 02/07/2023]
Abstract
Cervical teratomas are relatively rare congenital tumors pathologically defined by their three germ cell layer composition. Classically they manifest as solid or mixed solid-cystic lesions. Purely cystic teratomas pose a diagnostic challenge due to their clinical and radiologic similarity to lymphatic vascular malformations. Sclerotherapy, rather than operative excision, may be offered as therapy. We present an unusual cystic neck mass to highlight this dilemma.
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Affiliation(s)
- Nikolaus E Wolter
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA.
| | - Bradford Siegele
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA
| | - Michael J Cunningham
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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25
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Xia HF, Ren JG, Zhu JY, Yu ZL, Zhang W, Sun YF, Zhao YF, Chen G. Downregulation of miR-145 in venous malformations: Its association with disorganized vessels and sclerotherapy. Eur J Pharm Sci 2017; 100:126-131. [DOI: 10.1016/j.ejps.2017.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/02/2017] [Accepted: 01/16/2017] [Indexed: 01/04/2023]
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26
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Fowell C, Verea Linares C, Jones R, Nishikawa H, Monaghan A. Venous malformations of the head and neck: current concepts in management. Br J Oral Maxillofac Surg 2016; 55:3-9. [PMID: 27894790 DOI: 10.1016/j.bjoms.2016.10.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/31/2016] [Indexed: 01/20/2023]
Abstract
Low-flow venous malformations are congenital lesions and they are the third most common vascular anomaly in the head and neck. In this paper, the third in a series of three educational reviews, we discuss current trends in their management, and include a summary of common sclerosant agents used in their control.
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Affiliation(s)
- C Fowell
- Consultant, Oral & Maxillofacial Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ.
| | - C Verea Linares
- Oral and Maxillofacial Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB
| | - R Jones
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB
| | - H Nishikawa
- Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH
| | - A Monaghan
- Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB
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