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Bouwman FCM, Verhoeven BH, Klein WM, Schultze Kool LJ, de Blaauw I. Congenital Vascular Malformations in Children: From Historical Perspective to a Multidisciplinary Approach in the Modern Era-A Comprehensive Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:567. [PMID: 38790562 PMCID: PMC11119901 DOI: 10.3390/children11050567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
Congenital vascular malformations (CVMs) are the result of an aberrant development during embryogenesis. Although these lesions are present at birth, they are not always visible yet. Once symptomatic, patients suffer from pain, bleeding, ulcers, infections or lymphatic leakage, depending on the subtype of vessels involved. Treatment includes conservative management, surgery, sclerotherapy, embolization and pharmacological therapy. The clinical presentation varies widely and treatment can be challenging due to the rarity of the disease and potential difficulties of treatment. This review gives an overview of the historical developments in diagnosis and classification and exposes the key elements of innovations in the past decades on the identification of genetic mutations and personalized treatment. These advances in the field and a multidisciplinary approach are highly valuable in the optimization of clinical care aimed at both curing or stabilizing the CVM and pursuing physical and psychosocial wellbeing.
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Affiliation(s)
- Frédérique C. M. Bouwman
- Department of Pediatric Surgery, Amalia Children’s Hospital, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.C.M.B.); (B.H.V.)
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.K.); (L.J.S.K.)
- Hecovan Center of Expertise for Hemangiomas and Vascular Malformations Nijmegen, VASCERN VASCA European Reference Center, Amalia Children’s Hospital, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Bas H. Verhoeven
- Department of Pediatric Surgery, Amalia Children’s Hospital, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.C.M.B.); (B.H.V.)
- Hecovan Center of Expertise for Hemangiomas and Vascular Malformations Nijmegen, VASCERN VASCA European Reference Center, Amalia Children’s Hospital, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Willemijn M. Klein
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.K.); (L.J.S.K.)
- Hecovan Center of Expertise for Hemangiomas and Vascular Malformations Nijmegen, VASCERN VASCA European Reference Center, Amalia Children’s Hospital, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Leo J. Schultze Kool
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.K.); (L.J.S.K.)
- Hecovan Center of Expertise for Hemangiomas and Vascular Malformations Nijmegen, VASCERN VASCA European Reference Center, Amalia Children’s Hospital, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Amalia Children’s Hospital, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.C.M.B.); (B.H.V.)
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Bouwman FCM, Verhaak C, de Blaauw I, Kool LJS, Loo DMWMT, van Rooij IALM, van der Vleuten CJM, Botden SMBI, Verhoeven BH. Health-related quality of life in children with congenital vascular malformations. Eur J Pediatr 2023; 182:5067-5077. [PMID: 37665335 PMCID: PMC10640403 DOI: 10.1007/s00431-023-05166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
A cross-sectional study was performed to evaluate health-related quality of life (HRQOL) in children with congenital vascular malformations (CVM) and to investigate factors associated with an impaired HRQOL. Children (2-17 years) with CVMs who visited the HECOVAN expertise center between 2016-2018 were included. The PedsQL 4.0 Generic Core Scales were used and a score ≥ 1.0 SD below the normative mean was defined as an impaired HRQOL. Factors associated with impairment were investigated using univariate and multivariate logistic regression analysis. The median overall HRQOL was 84.8/100 (n = 207; 41% boys, 59% girls; self-reported IQR 73.9-92.4 and parent-reported IQR 71.4-92.4). Patients aged 13-17 years reported significantly worse physical functioning than those aged 8-12 years (median 84.4, IQR 71.1-93.8 versus median 90.6, IQR 81.3-96.9; p = 0.02). Parents reported a significantly lower overall HRQOL than their children (median 80.4, IQR 70.7-90.8 versus median 85.9, IQR 76.1-92.4; p = 0.001). HRQOL was impaired in 25% of patients. Impairment occurred significantly more often in lower extremity CVMs (38%, p = 0.01) and multifocal CVMs (47%, p = 0.01) compared to CVMs in the head/neck region (13%). Other associated factors included invasive management (31% versus 14%; p = 0.01), age at first treatment ≤ 5 years (48% versus 25%; p = 0.02) and ongoing treatment (38% versus 18%; p = 0.004). After correction for other factors, significance remained for lower extremity CVMs and ongoing invasive treatment. CONCLUSIONS Overall median HRQOL was reasonable and not significantly different from the norm sample. Parental ratings were significantly lower than their children's ratings. A quarter of the patients had an impaired HRQOL, which seemed to worsen with age. Independently associated factors included a lower extremity CVM and invasive management. WHAT IS KNOWN • Congenital vascular malformations could affect health-related quality of life (HRQOL). • Studies on pediatric patients are limited and either very small or in combination with adult patient series. WHAT IS NEW • This study raises awareness of an impaired HRQOL in 25% of pediatric patients with congenital vascular malformations. • Associated factors included a lower extremity CVM and invasive management.
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Affiliation(s)
- Frédérique C M Bouwman
- Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
- Department of Radiology and Nuclear Medicine, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
- Radboudumc Center of Expertise for Vascular Anomalies Hecovan, VASCERN VASCA European Reference Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Chris Verhaak
- Department of Medical Psychology, Radboudumc, Nijmegen, the Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Leo J Schultze Kool
- Department of Radiology and Nuclear Medicine, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
- Radboudumc Center of Expertise for Vascular Anomalies Hecovan, VASCERN VASCA European Reference Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - D Maroeska W M Te Loo
- Radboudumc Center of Expertise for Vascular Anomalies Hecovan, VASCERN VASCA European Reference Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
- Department of Pediatric Hematology, Radboudumc-Amalia Children's Hospital, Nijmegen, the Netherlands
| | | | - Carine J M van der Vleuten
- Radboudumc Center of Expertise for Vascular Anomalies Hecovan, VASCERN VASCA European Reference Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
- Department of Dermatology, Radboudumc, Nijmegen, the Netherlands
| | - Sanne M B I Botden
- Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
- Radboudumc Center of Expertise for Vascular Anomalies Hecovan, VASCERN VASCA European Reference Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Bas H Verhoeven
- Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
- Radboudumc Center of Expertise for Vascular Anomalies Hecovan, VASCERN VASCA European Reference Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
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Berger S, Andersen R, Smaastuen MC, Rosseland LA, Dorenberg E. Long-term changes of health-related quality of life in patients with peripheral vascular malformations - a prospective observational study. J Plast Reconstr Aesthet Surg 2023; 77:46-53. [PMID: 36549122 DOI: 10.1016/j.bjps.2022.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/30/2022] [Accepted: 10/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this observational study was to assess health-related quality of life (HRQOL) changes in patients with vascular malformations, over a period of almost eight years, and to assess clinical and demographic characteristics possibly associated with HRQOL changes. METHODS Eighty out of 111 patients who were included in a previously published comparative HRQOL study accepted inclusion in this follow-up study. HRQOL at baseline and follow-up was assessed with the Short-Form 36-item questionnaire (SF-36). Median observation time was 7.9 years. Linear mixed models and linear regression models were applied to assess HRQOL change and possible associations with demographic and clinical variables. RESULTS The median age of the patient cohort at baseline evaluation (n = 111) was 27.0 years. Ninety-six out of 111 (86.5%) patients were diagnosed with venous malformations. Significantly higher SF-36 scores at follow-up were found for the physical domains Role limitations due to (RLDT) physical problems (difference=13.5; 95% CI [1.6, 25.3]) and Bodily pain (difference=11.3; 95% CI [3.8, 18.8]). No deterioration of HRQOL was found in any domain. In multivariate analyses, female gender, muscle/bone involvement, and higher age were associated with a positive relative change in SF-36 in the domains Physical functioning, RLDT physical problems, and RLDT emotional problems, respectively. Invasive treatment was not associated with long-term HRQOL change. CONCLUSIONS Over a period of almost eight years, significant improvement of SF-36 scores was observed in the physical domains RLDT physical problems and bodily pain. Female gender, muscle/bone involvement, and higher age were associated with HRQOL improvement in certain domains.
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Affiliation(s)
- Sigurd Berger
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway.
| | - Rune Andersen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Milada Cvancarova Smaastuen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway
| | - Leiv Arne Rosseland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway
| | - Eric Dorenberg
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
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Harbers VEM, Bouwman FCM, van Rijnsoever IMP, Verhoeven BH, van der Vleuten CJM, Schultze Kool LJ, de Laat PCJ, van der Horst CMAM, Kievit W, te Loo DMWM. Magnitude and relevance of change in health-related quality of life in patients with vascular malformations treated with sirolimus. Front Med (Lausanne) 2023; 10:1155476. [PMID: 37153086 PMCID: PMC10157393 DOI: 10.3389/fmed.2023.1155476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/24/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Vascular malformations are rare congenital anomalies of the vascular system, which can involve the capillaries, veins, arteries, lymphatics, or a combination of vessel types. Patients with vascular malformations experience an impaired health-related quality of life (HRQoL) because of their symptoms (e.g., pain, swelling, and bleeding) and psychosocial distress. Sirolimus is an effective drug used in the medical treatment of these patients; however, relatively little is known about the effect of sirolimus on specific changes in the HRQoL domains and its magnitude. Methods The magnitude of change (effect size) following intervention is more informative to clinical practitioners than statistically significant but clinically unimportant changes; therefore, this study aimed to examine the magnitude and meaningfulness of change in the HRQoL of children and adults with vascular malformations following sirolimus treatment using low target levels. Results In total, 50 patients with vascular malformations (19 children, 31 adults) were included in this study. These patients experienced a lower HRQoL than the general population, with the adults reporting a significantly lower score in almost all domains. A 6-month sirolimus treatment improved the HRQoL in 29 patients, including 77.8% of the children (Pediatric Quality of Life Inventory score [PedsQL]) and 57.7% of the adults (Short Form 36 [SF-36]). The effect sizes of sirolimus for each SF-36/PedsQL domain ranged from 0.19 to 1.02. The clinically relevant moderate magnitude of changes was seen in the domains of the children's reports: "Physical functioning" and "Social functioning" and in the domains of the parent reports: "Social functioning," "School functioning," and "Psychosocial." A high-magnitude change was seen in the domains "Emotional functioning" and "Psychosocial" in the children's reports and "Physical functioning" in the parent reports. In addition, the moderate magnitude of changes was also seen in the adults SF-36: in all domains except for "Role limitations-physical problems," "Role limitations-emotional problems," and "General health perception." Conclusion We believe this is the first study showing the magnitude of change in HRQoL after sirolimus treatment in patients with vascular malformations. Before treatment, these patients experienced an impaired HRQoL compared with the general Dutch population. A 6-month sirolimus treatment with low target levels led to moderate-to-high clinically relevant changes in multiple domains, which significantly improved the HRQoL. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT03987152?cond=Vascular+Malformations&cntry=NL&city=Nijmegen&draw=2&rank=1, identifier: NCT03987152.
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Affiliation(s)
- Veroniek E. M. Harbers
- Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
- Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frédérique C. M. Bouwman
- Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ingrid M. P. van Rijnsoever
- Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bas H. Verhoeven
- Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Carine J. M. van der Vleuten
- Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Dermatology, Radboud University Medical Center, Nijmegen, Netherlands
- Members of the Vascular Anomalies Working Group (VASCA WG) of the European Reference Network for Rare Multisystemic Vascular Diseases (VASCERN), Paris, France
| | - Leo J. Schultze Kool
- Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
- Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
- Members of the Vascular Anomalies Working Group (VASCA WG) of the European Reference Network for Rare Multisystemic Vascular Diseases (VASCERN), Paris, France
| | - Peter C. J. de Laat
- Department of Pediatric Oncology, WEVAR-Team, Rotterdam Erasmus MC-Sophia, Rotterdam, Netherlands
| | - Chantal M. A. M. van der Horst
- Department of Plastic Reconstructive and Hand Surgery, AVA-Team, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Wietske Kievit
- Health Technology Assessment, Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - D. Maroeska W. M. te Loo
- Radboudumc Center of Expertise HECOVAN, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Pediatric Hematology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
- *Correspondence: D. Maroeska W. M. te Loo
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Isozaki Y, Kato M, Fujita N, Tojo S, Fujiki M, Watanabe A, Watanabe S. A case of topical rapamycin effective for postsurgical hypertrophic scar of superficial lymphatic malformation with possible quality-of-life improvement. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2022. [DOI: 10.4103/jdds.jdds_38_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lokhorst MM, Horbach SER, Young-Afat DA, Stor MLE, Haverman L, Spuls PI, van der Horst CMAM. Development of a condition-specific patient-reported outcome measure for measuring symptoms and appearance in vascular malformations: the OVAMA questionnaire. Br J Dermatol 2021; 185:797-803. [PMID: 33937977 PMCID: PMC8518089 DOI: 10.1111/bjd.20429] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 12/16/2022]
Abstract
Background The symptoms and appearance of vascular malformations can severely harm a patient’s quality of life. The aim of treatment of vascular malformations generally is to improve condition‐specific symptoms and/or appearance. Therefore, it is highly important to start testing treatment effects in clinical studies from the patient’s perspective. Objectives To develop a patient‐reported outcome measure for measuring symptoms and appearance in patients with vascular malformations. Methods A first draft of the patient‐reported outcome measure was based on the previously internationally developed core outcome set. The qualitative part of this study involved interviews with 14 patients, which led to a second draft. The second draft was field tested cross‐sectionally, after which groups of items were evaluated for adequate internal consistency (Cronbach’s alpha > 0·7) to form composite scores. Construct validity was evaluated by testing 13 predefined hypotheses on known‐group differences. Results The patient interviews ensured adequate content validity and resulted in a general symptom scale with six items, a head and neck symptom scale with eight items, and an appearance scale with nine items. Cronbach’s alpha was adequate for two composite scores: a general symptom score (0·88) and an appearance score (0·85). Ten out of 13 hypotheses on known‐group differences were confirmed, confirming adequate construct validity. Conclusions With the development of the OVAMA questionnaire, outcomes of patients with vascular malformations can now be evaluated from the patient’s perspective. This may help improve the development of evidence‐based treatments and the overall care for patients with vascular malformations. What is already known about this topic?The symptoms and appearance of vascular malformations may severely impact the patient’s physical, mental and social functioning. Condition‐specific symptoms and appearance are the main drivers for treatment of vascular malformations. Symptoms and appearance were determined to be core outcome domains and should be measured in all clinical research on vascular malformations. No instrument exists for measuring patient‐reported symptoms and appearance problems in vascular malformations. Vascular malformation research is hampered by heterogeneity in outcome measures.
What does this study add?With this study, a condition‐specific patient‐reported outcome measure was developed for measuring symptoms and appearance in patients with vascular malformations: the OVAMA questionnaire. This study confirms adequate content and construct validity.
What are the clinical implications of this work?The problems that matter most to patients with vascular malformations can now be evaluated from the patient’s perspective. Treatments can be evaluated and compared for effects on these core outcome domains. This study is a big step in tackling current heterogeneity in outcome measures. Clinically distinct groups can be determined based on disease severity. The many applications of the OVAMA questionnaire may significantly improve research and, ultimately, the care for patients with vascular malformations.
Linked Comment: J. Tan. Br J Dermatol 2021; 185:695–696.
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Affiliation(s)
- M M Lokhorst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - S E R Horbach
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - D A Young-Afat
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - M L E Stor
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - L Haverman
- Psychosocial Department, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam and Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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Casassa E, Bergeron A, Maruani A, Labreze C, Barbarot S, Aubert H, Malloizel-Delaunay J, Shourick J, Croiset A, Dreyfus I, Mazereeuw-Hautier J. Factors influencing quality of life in children with low-flow vascular malformations: a qualitative study using focus groups. J Eur Acad Dermatol Venereol 2020; 35:755-761. [PMID: 33211344 DOI: 10.1111/jdv.17037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 09/12/2020] [Accepted: 10/27/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Very few studies have evaluated the quality of life (QoL) of children suffering from low-flow vascular malformations. This is the first study investigating the influencing factors. OBJECTIVES To identify the factors influencing QoL in children with low-flow vascular malformations. METHODS We conducted a qualitative study employing focus group interviews (Clinical Trials Number: NCT03440827). The study was a prospective, interventional, non-comparative, multicentre study performed in four expert centres for vascular anomalies. Qualitative data about personal experiences, feelings, difficulties, needs and various factors influencing behaviours were collected. Theme-based content analysis (manual and specialist textural software guided) were used to analyse the verbatim transcripts of all focus group sessions. Manual qualitative discourse analysis was performed to identify the different themes and categories. Informatics' analyses were subsequently performed for each individual category. RESULTS Ten focus groups (26 individuals including 10 children aged 11 to 15 years) were conducted until saturation. Influencing factors were related to 4 categories: medical care, self-image, social impact on daily activities and challenging social relationships. These factors were responsible for intrafamily upheavals and may lead to future identity-building problems. CONCLUSIONS This study provides an essential framework from which physicians can develop strategies to improve patient care and quality of life. These data may also be useful to develop specific age-sensitive QoL questionnaires.
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Affiliation(s)
- E Casassa
- Reference Centre for Rare Skin Diseases, Dermatology Department, CHU Toulouse, Paul Sabatier University, Toulouse, France
| | - A Bergeron
- Psycholopathology Department, Centre d'Etudes et de Recherches en Psychopathologie et psychologie de la Santé, Toulouse II Jean Jaurès University, Toulouse, France
| | - A Maruani
- Dermatology Department, CHU Tours, Tours, France
| | - C Labreze
- Reference Centre for Rare Skin Diseases, Dermatology Department, U-1035 Inserm, University of Bordeaux, Bordeaux, France
| | - S Barbarot
- Dermatology Department, CHU Nantes, Nantes, France
| | - H Aubert
- Dermatology Department, CHU Nantes, Nantes, France
| | | | - J Shourick
- Epidémiologie, Pôle santé publique et médecine sociale, Faculté de médecine de Purpan, CHU Toulouse, Toulouse, France
| | - A Croiset
- Dermatology Department, CHU Tours, Tours, France
| | - I Dreyfus
- Reference Centre for Rare Skin Diseases, Dermatology Department, CHU Toulouse, Paul Sabatier University, Toulouse, France
| | - J Mazereeuw-Hautier
- Reference Centre for Rare Skin Diseases, Dermatology Department, CHU Toulouse, Paul Sabatier University, Toulouse, France
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Cubiró X, Rozas-Muñoz E, Castel P, Roé Crespo E, Garcia-Melendo C, Puig L, Baselga E. Clinical and genetic evaluation of six children with diffuse capillary malformation and undergrowth. Pediatr Dermatol 2020; 37:833-838. [PMID: 32608066 DOI: 10.1111/pde.14252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Diffuse capillary malformation with overgrowth (DCMO) has been well described. However, capillary malformation with undergrowth (CMU) has been less reported in the literature. OBJECTIVES We sought to describe the clinical features and determine associated somatic mutations in patients with CMU. METHODS We searched our multidisciplinary vascular anomalies clinic database for patients with CMU. Girth and length limb measurements were performed. In case of discrepancies in length, long leg radiograph studies were obtained. Whole-exome sequencing of blood and involved tissue DNA was carried out. RESULTS We included six patients with CM and soft-tissue and bone undergrowth. CMs were patchy, reticulated, segmental, poorly demarcated, pink-red stains affecting the lower limb (five patients) or the whole hemibody (one patient). In five patients, the stain was diffuse, affecting more than one anatomic region. Prominent superficial veins were observed in three patients. Five patients presented with lower limb girth discrepancy; in three of them, there was also lower limb length discrepancy. In the remaining patient, only lower limb length discrepancy was found. Whole-exome sequencing from DNA tissue/blood detected previously described pathogenic somatic mutations on DDR2 (c.314G > A; p.Arg105His), GRHL2 (c.791A > G; p.Glu264Gly), and PIK3CA (c.2740G > A; p.Gly914Arg) genes. CONCLUSION We propose the term "diffuse capillary malformation with undergrowth" for extensive reticular CMs associated with proportionate undergrowth. All our patients had a favorable outcome, and no genotype-phenotype association was found.
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Affiliation(s)
- Xavier Cubiró
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eduardo Rozas-Muñoz
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pau Castel
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Esther Roé Crespo
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Lluis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Qualitative study of patients with venous malformations: symptom experiences and content validity of patient-reported outcome measures. Qual Life Res 2020; 29:1707-1719. [PMID: 32020564 DOI: 10.1007/s11136-020-02435-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine important symptoms and functional effects of venous malformations (VMs) to assess the content validity of commonly used patient-reported outcome (PRO) measures for use with VM patients. METHODS This cross-sectional, qualitative study involved cognitive interviews with participants with VM aged ≥ 14 years. From February to June 2016, 11 participants (8 female) with a mean (± standard deviation) age of 31 ± 15 years were recruited from three clinical sites. The following subgroups were evaluated: 5 adults (aged ≥ 18) with trunk/extremity VMs; 3 adolescents (aged 14-17) with trunk/extremity VMs; and 3 adults with head/neck VMs. We evaluated the content validity of the Worst Pain Numeric Rating Scale (NRS), Patient-Reported Outcomes Measurement Information System (PROMIS®) Pain Interference 8-item short form, and PROMIS Physical Function 8-item short form. RESULTS The most common participant-reported VM symptoms were swelling (n = 10), skin discoloration (n = 8), acute episodic pain (n = 8), chronic pain (n = 7), numbness (n = 7), and tingling/burning (n = 6). Participants reported that VMs affected their physical function (n = 10), appearance (n = 10), relationships/social activities (n = 7), and emotional health (n = 3). The Worst Pain NRS and PROMIS Pain Interference measures were relevant to all participants' VM experience. Only adults with head/neck VMs found the PROMIS Physical Function measure to be irrelevant. The assessed PRO measures did not address several symptoms commonly reported by VM patients (swelling, skin discoloration, numbness, and appearance). CONCLUSION These results suggest that several VM symptoms are not assessed fully by commonly used PRO measures, and that the relevance of functional limitation questions may vary by VM location.
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Lokhorst MM, Horbach SER, Waner M, O TM, van der Vleuten CJM, Mokkink LB, van der Horst CMAM, Spuls PI. Responsiveness of quality-of-life measures in patients with peripheral vascular malformations: the OVAMA project. Br J Dermatol 2019; 182:1395-1403. [PMID: 31628861 PMCID: PMC7318211 DOI: 10.1111/bjd.18619] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 12/20/2022]
Abstract
Background The OVAMA (Outcome Measures for Vascular Malformations) project determined quality of life (QoL) as a core outcome domain for patients with vascular malformations. In order to measure how current therapeutic strategies alter QoL in these patients, a patient‐reported outcome measurement (PROM) responsive to changes in QoL is required. Objectives To assess the responsiveness of two widely used generic QoL PROMs, the Medical Outcomes Study Short Form 36 (SF‐36) and Skindex‐29, in adult patients with vascular malformations. Methods In an international multicentre prospective study, treated and untreated patients completed the SF‐36 and Skindex‐29 at baseline and after a follow‐up period of 6–8 weeks. Global rating of change (GRC) scales assessing various QoL‐related outcome domains were additionally completed. Per subscale, responsiveness was assessed using two methods: by testing hypotheses on expected correlation strength between change scores of the questionnaires and the GRC scales, and by calculating the area under the receiver operating characteristics curve (AUC). The questionnaires were considered responsive if ≥ 75% of the hypotheses were confirmed or if the AUC was ≥ 0·7. Results Eighty‐nine participants were recruited in three centres in the Netherlands and the U.S.A., of whom 67 completed all baseline and follow‐up questionnaires. For all subscales of the SF‐36 and Skindex‐29, < 75% of the hypotheses were confirmed and the AUC was < 0·7. Conclusions Our findings suggest that the SF‐36 and Skindex‐29 seemed unresponsive to change in QoL. This suggests that alternative PROMs are needed to measure – and ultimately improve – QoL in patients with vascular malformations. What's already known about this topic? Quality of life is often impaired in patients with vascular malformations. Quality of life is considered a core outcome domain for evaluating treatment of vascular malformations. To measure the effect of treatment on quality of life, a patient‐reported outcome measure is required that is responsive to changes in quality of life.
What does this study add? This is the first study assessing the responsiveness of quality‐of‐life measures in patients with vascular malformations. The results seem to indicate that the Medical Outcomes Study Short Form 36 (SF‐36) and Skindex‐29 are not responsive to changes in quality of life in patients with vascular malformations.
What are the clinical implications of this work? Medical Outcomes Study Short Form 36 (SF‐36) and Skindex‐29 are not ideal to assess the effect on quality of life over time, of treatment strategies for peripheral vascular malformations.
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Affiliation(s)
- M M Lokhorst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - S E R Horbach
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - M Waner
- Department of Otolaryngology, Vascular Birthmark Institute of New York, Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, New York, NY, U.S.A
| | - T M O
- Department of Otolaryngology, Vascular Birthmark Institute of New York, Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, New York, NY, U.S.A
| | - C J M van der Vleuten
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L B Mokkink
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
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Berger S, Andersen R, Dorenberg E, Meyer T, Weiss I, Smaastuen MC, Rosseland LA. Quality of life in patients with vascular malformations outside the central nervous system: Comparison with the general Norwegian population. J Plast Reconstr Aesthet Surg 2019; 72:1880-1886. [PMID: 31636028 DOI: 10.1016/j.bjps.2019.09.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/01/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to assess Health-Related Quality of Life (HRQoL) in a population of patients with vascular malformations outside the central nervous system (CNS) and to compare the results with data from a national reference population. METHODS In total, 111 consecutive patients above 14 years of age and referred for the first time to the national vascular malformation center from September 2011 to December 2012 were included. HRQoL was assessed using the Short-Form 36-item questionnaire (SF-36), which is a validated questionnaire with eight domains, covering both physical and mental aspects of HRQoL. The results were compared with national reference values. Possible association between HRQoL and selected demographic and clinical variables was analyzed using linear regression analysis. RESULTS The sample consisted of 47 men (42.3%) and 64 women (57.7%). The median age of patients was 27 years (range 14-63 years). Ninety-six patients (86.5%) were diagnosed with venous malformations and nine patients (8.1%) with arteriovenous malformations. Six patients had other types of malformations (9%). The patients had significantly lower SF-36 scores in all domains, except for General health, than the general population. There was a significant association between muscular involvement and lower SF-36 scores in the physical domains Bodily pain and Role limitation due to physical problems. CONCLUSIONS Our data suggest that patients with vascular malformations outside the CNS have impaired quality of life when compared with the general population. Muscular involvement seems to be associated with worse HRQoL in the physical aspects.
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Affiliation(s)
- Sigurd Berger
- Division of Radiology and Nuclear Medicine, Oslo University Hospital; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo.
| | - Rune Andersen
- Division of Radiology and Nuclear Medicine, Oslo University Hospital
| | - Eric Dorenberg
- Division of Radiology and Nuclear Medicine, Oslo University Hospital
| | - Tone Meyer
- Department of Radiology, Vestfold Hospital Trust
| | | | - Milada Cvancarova Smaastuen
- Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Norway
| | - Leiv Arne Rosseland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Norway
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Nguyen HL, Bonadurer GF, Tollefson MM. Vascular Malformations and Health-Related Quality of Life: A Systematic Review and Meta-analysis. JAMA Dermatol 2019; 154:661-669. [PMID: 29562060 DOI: 10.1001/jamadermatol.2018.0002] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Importance Patients with vascular malformations (VAMs) and vascular overgrowth syndromes have lower health-related quality of life (HRQoL) attributable to social stigmatization, poor mental health, severity, and pain. However, the factors that contribute to this decreased HRQoL are not clear. Objective To perform a systematic review and meta-analysis of studies that used validated HRQoL instruments to compare the HRQoL of persons with VAMs with the US general population. Data Sources A comprehensive search was performed in MEDLINE, Embase, PsycINFO, CINAHL, and Scopus from 1946 to March 31, 2017, with the consultation of an experienced librarian. Study Selection All VAM studies with validated HRQoL instruments published in the English language were included. Case reports, review articles, non-English-language publications, and studies about the development of new HRQoL instruments were not included. Data Extraction and Synthesis Two reviewers assessed studies' eligibility and the risk of bias and performed data extraction. The meta-analysis was performed using the random-effects model. Comparisons of means were performed using the unpaired, 2-sample t test. Main Outcomes and Measures The outcome was HRQoL. Results Eleven studies met the inclusion criteria for a total of 692 patients with VAMs. Six studies (320 patients) were included in the meta-analysis, whereas 5 studies were included in the qualitative analysis (372 patients). Those with VAMs had lower 36-Item Short-Form Health Survey scores in bodily pain (mean difference, -11.87; 95% CI, -21.45 to -2.29; I2 = 92%; P = .02) and mental health (mean difference, -6.04; 95% CI, -11.55 to -0.52; I2 = 83%; P = .03) compared with the US general population. Conclusions and Relevance Patients with VAMs had increased pain and psychosocial distress compared with the US general population. Pain and psychological morbidity are associated with poorer HRQoL and may serve as indicators for quality of life.
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Affiliation(s)
- Henry L Nguyen
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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13
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Horbach SER, van de Ven JS, Nieuwkerk PT, Spuls PI, van der Horst CMAM, Reekers JA. Patient-Reported Outcomes of Bleomycin Sclerotherapy for Low-Flow Vascular Malformations and Predictors of Improvement. Cardiovasc Intervent Radiol 2018; 41:1494-1504. [PMID: 29948003 PMCID: PMC6132854 DOI: 10.1007/s00270-018-1999-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/21/2018] [Indexed: 01/28/2023]
Abstract
Purpose There is paucity of data on patient-perceived outcomes of bleomycin sclerotherapy for low-flow vascular malformations. In this study, the long-term outcomes of bleomycin sclerotherapy were investigated in terms of quality of life (QoL) and patient-perceived changes in health. Materials and Methods A cohort of Dutch patients with vascular malformations treated with bleomycin sclerotherapy (June 2010-November 2015) completed a questionnaire evaluating disease symptoms, QoL (Short Form 36), patient-perceived change in health status (Global Rating of Change scales) and treatment satisfaction. QoL was assessed for the patient’s status before and after treatment and was analyzed relative to an age and sex-matched Dutch reference population. Predictive factors associated with QoL and patient-perceived improvement in overall health status were assessed using multivariable linear and logistic regression analyses, respectively. Results Seventy-seven patients, with a median follow-up of 22 months, were enrolled. About half of the respondents (49.3%) indicated that they perceived (any form of) improvement in their overall health status. Most often improved were the specific health aspects ‘pain’ (54.5%) and ‘overall severity of symptoms’ (57.1%). No factors were significantly predictive for patient-perceived improvement in health with respect to the vascular malformation. Impairment in work- or study-related activities prior to sclerotherapy was found to negatively impact physical QoL at follow-up (p = 0.03). Conclusion Approximately half of patients with low-flow vascular malformations indicate an improvement in overall health status following bleomycin sclerotherapy, particularly concerning pain and severity of symptoms. However, most patients only perceived little to moderate improvement to their health and desire further treatment.
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Affiliation(s)
- S E R Horbach
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center (AMC), P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - J S van de Ven
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center (AMC), P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P T Nieuwkerk
- Department of Medical Psychology, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Ph I Spuls
- Department of Dermatology, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center (AMC), P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J A Reekers
- Department of Radiology, Division of Interventional Radiology, Academic Medical Center (AMC), Amsterdam, The Netherlands
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Langbroek GB, Horbach SE, van der Vleuten CJ, Ubbink DT, van der Horst CM. Compression therapy for congenital low-flow vascular malformations of the extremities: A systematic review. Phlebology 2016; 33:5-13. [PMID: 28429627 DOI: 10.1177/0268355516684694] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction Low-flow vascular malformations are congenital abnormalities of the veins, capillaries or lymphatic vessels or a combination of the previous. Compressive garments are frequently used as a first-line treatment option for low-flow vascular malformations of the extremities with the purpose of relieving symptoms. Yet, the benefits and harms of compression stockings remain unclear. Methods A systematic search was performed in MEDLINE, Embase, Cochrane Central Register of Controlled Trials including a hand search for studies measuring the benefits and harms of compression garments in treating low-flow vascular malformations. Two investigators performed study selection, quality assessment and data extraction independently. Results Of the 565 studies found, eventually five (totalling 101 patients with venous malformations or Klippel-Trenaunay syndrome receiving compression therapy) observational studies were included in the systematic review. Although the overall quality of these studies was poor, results suggest that compression garments might lessen intravascular coagulation, improve symptoms and appearance, diminish oedema, and protect against minor trauma. None of the studies quantified any harms of compression therapy. Conclusion Even though compression therapy is commonly used in the treatment of low-flow vascular malformations, available literature does not provide high-quality evidence to validate its use. We therefore advocate the need for prospective comparative trials with standardised outcome measures to study the benefits and harms of this treatment option.
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Affiliation(s)
- Ginger B Langbroek
- 1 Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Sophie Er Horbach
- 1 Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Dirk T Ubbink
- 3 Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Chantal Mam van der Horst
- 1 Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Ethanolgel sclerotherapy of venous malformations improves health-related quality-of-life in adults and children - results of a prospective study. Eur Radiol 2016; 27:2482-2488. [PMID: 27699470 DOI: 10.1007/s00330-016-4603-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/21/2016] [Accepted: 09/07/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the treatment-induced changes of health-related quality-of-life (HRQoL) in patients with venous malformations (VM) who underwent ethanol gel sclerotherapy. METHODS The prospective study in children and adults was approved by the local ethics committee. 31 patients (mean age 23.42 years, range 6.6 - 46.5; 26 female, 5 male) with VM were included. Patients' self-assessed HRQoL was measured before and after treatment using psychometrically validated questionnaires for adults and children. Differences were analysed with a paired t test. RESULTS 58 sclerotherapy sessions were performed. The Physical Component Summary (PCS) at baseline was 43.69 and increased significantly (p = 0.01122) to 48.95 after treatment. The bodily pain (BP) scale increased significantly from 37.94 to 48.56 (p = 0.00002), the general health (GH) scale increased significantly from 46.69 to 52.17 (p = 0.00609). Baseline Physical Summary Score (PHS) in children increased significantly after treatment (p < 0.00001) from 25.25 to 45.89. The baseline Psychosocial Summary Score (PSS) in children was 51.08 and increased significantly (p = 0.00031) after treatment to 58.84. CONCLUSION Paediatric and adult patients with VM suffer from bodily pain with overall reduced physical functioning. After sclerotherapy, these restrictions are successfully returning to normal levels with a positive effect on mental and psychosocial domains. KEY POINTS • Sclerotherapy in venous malformation patients has an unknown effect on health-related quality-of-life • Prospective study showed improvements in bodily pain and general health in adults • Children and adults improved from treatment with ethanol gel • Sclerotherapy is an appropriate therapy.
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Abstract
The Parkes Weber syndrome is a congenital vascular malformation, characterized by varicose veins, arterio-venous fistulas and overgrown limbs. No broadly accepted animal model of Parkes Weber syndrome has been described. We created side-to-side arterio-venous fistula between common femoral vessels with proximal non-absorbable ligature on common femoral vein limiting the enlargement of the vein diameter in Wistar rats. Contralateral limb was sham operated. Invasive blood pressure measurements in both iliac and inferior cava veins were performed in rats 30 days after fistula creation. Tight circumference and femoral bone length were measured. Histopathology and morphology of soleus muscle, extensor digitorum longus muscle, and the common femoral vessel were analyzed. 30 days following arterio-venous fistula creation, a statistically significant elevation of blood pressure in common iliac vein and limb overgrowth was observed. Limb enlargement was caused by muscle overgrowth, varicose veins formation and bone elongation. Arterio-venous fistula with proximal outflow limitation led to significant increase of femoral vein circumference and venous wall thickness. Our study indicates that the described rat model mimics major clinical features characteristic for the human Parkes Weber syndrome: presence of arterio-venous fistula, venous hypertension and dilatation, varicose veins formation, and the limb hypertrophy. We reveal that limb overgrowth is caused by bone elongation, muscle hypertrophy, and venous dilatation. The newly established model will permit detailed studies on the mechanisms underlying the disease and on the efficacy of novel therapeutic strategies for the Parkes Weber syndrome treatment.
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Fahrni JO, Cho EYN, Engelberger RP, Baumgartner I, von Känel R. Quality of life in patients with congenital vascular malformations. J Vasc Surg Venous Lymphat Disord 2013; 2:46-51. [PMID: 26992968 DOI: 10.1016/j.jvsv.2013.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 08/29/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess quality of life (QoL) in patients with congenital vascular malformations (CVMs) and to identify factors of CVMs associated with poor QoL, including high psychological and/or somatic (physical) distress. METHODS We evaluated 71 patients (mean age, 40 ± 16 years; 51% women) with arteriovenous (n = 10), venous/capillary (n = 34), lymphatic (n = 10), and combined (n = 17) malformations. All patients completed validated psychometric assessment tools, which were the 36-Item Short Form Health Survey, the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire-15, and the Pain Disability Index. RESULTS Compared with population norms, the group of CVM patients as a whole showed lower 36-Item Short Form Health Survey Physical (46 vs 50) and Mental (46 vs 52) Component Summary scores, indicating impaired physical and mental health. In addition, 13% of patients with CVMs had clinically relevant psychological distress (Hospital Anxiety and Depression Scale total scores ≥17), and 15% had increased somatic distress (Patient Health Questionnaire-15 total scores ≥10). Greater levels of psychological and somatic distress were significantly associated with lower scores of virtually all of the eight 36-Item Short Form Health Survey subscales (P < .05). CONCLUSIONS Our findings suggest that, compared with a normal population, CVM patients have a lower QoL that is accompanied by increased psychological and somatic distress. In treating patients with CVMs, it is important to be aware of the psychological impact of this rare illness and to offer appropriate support.
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Affiliation(s)
- Jennifer O Fahrni
- Swiss Cardiovascular Center, Division of Angiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - En-Young N Cho
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Bern University Hospital, Inselspital, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Rolf P Engelberger
- Swiss Cardiovascular Center, Division of Angiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Iris Baumgartner
- Swiss Cardiovascular Center, Division of Angiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Roland von Känel
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Bern University Hospital, Inselspital, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland.
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Vascular anomalies of the extremities. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e3182961675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Steigerung der Lebensqualität nach Schaumsklerosierung einer multipel voroperierten vaskulären Malformation. PHLEBOLOGIE 2013. [DOI: 10.12687/phleb2129_2_2013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ZusammenfassungVaskuläre Malformationen stellen aufgrund ihrer Seltenheit und heterogenen klinischen Ausprägung eine therapeutische Herausforderung dar. Im vorliegenden Fallbericht wurde eine ausgedehnte, vielfach voroperierte und stark schmerzhafte venöse Malformation bei einer 46-jährigen Patientin mit mehreren Schaumsklerosierungen erfolgreich behandelt. Es konnte eine bemerkenswert rasche, anhaltende Schmerzreduktion und eine Steigerung der Lebensqualität erzielt werden. Der Fall demonstriert, dass die Schaum -sklerosierungstherapie eine gute, nebenwirkungsarme Therapieoption bei operativ nicht mehr behandelbaren, anatomisch unübersichtlichen Malformationen sein kann.
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Diagnosis and management of extensive vascular malformations of the lower limb: part II. Systemic repercussions [corrected], diagnosis, and treatment. J Am Acad Dermatol 2011; 65:909-23; quiz 924. [PMID: 22000871 DOI: 10.1016/j.jaad.2011.03.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
At least nine types of vascular malformations with specific clinical and radiologic characteristics must be distinguished in the lower limbs: Klippel-Trénaunay syndrome, port-wine stain with or without hypertrophy, cutis marmorata telangiectatica congenita, macrocephaly-capillary malformation, Parkes Weber syndrome, Stewart-Bluefarb syndrome, venous malformation, glomuvenous malformation, and lymphatic malformation. Extensive vascular malformations are often more complex than they appear and require a multidisciplinary therapeutic approach. Vascular malformations may be associated with underlying disease or systemic anomalies. Part II of this two-part series on the diagnosis and management of extensive vascular malformations of the lower limb highlights the systemic repercussions [corrected] (bone, articular, visceral, and hematologic involvement), diagnosis, and treatment of these lesions.
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Glade RS, Richter GT, James CA, Suen JY, Buckmiller LM. Diagnosis and management of pediatric cervicofacial venous malformations: retrospective review from a vascular anomalies center. Laryngoscope 2010; 120:229-35. [PMID: 20013849 DOI: 10.1002/lary.20715] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Venous malformations are rare congenital aberrations of vein development frequently presenting in the head and neck. Without treatment, venous malformations cause progressive disfigurement, dysfunction, and bleeding. In this study, we analyzed a cohort of pediatric patients with cervicofacial venous malformations (CFVM), with the goal of developing a treatment algorithm for these complex lesions. STUDY DESIGN Eleven-year retrospective chart review. The setting was a vascular anomalies center at a pediatric tertiary hospital. Nineteen patients (10 male, 9 female), aged 11 months to 17 years, presented with CFVM. METHODS Patient charts were reviewed for demographics, signs and symptoms, timing of first and subsequent interventions, total number and type of interventions performed, and procedural complications. A family questionnaire supplemented outcome measures by determining the perception of disease control. RESULTS Presenting symptoms for CFVM include growth (100%), disfigurement (63%), pain (58%), respiratory compromise (42%), and dysphagia (32%). A mean of 6.7 interventions were performed per patient (median, 6; range, 2-12), requiring a mean of 0.8 excisions, 4.6 laser treatments, and 1.3 sclerotherapy injections. Average age at first procedure was 8.5 years. Time between treatments averaged 8.9 months. Four complications occurred in 127 procedures (3.1%). Questionnaire responses indicated subjective improvement following therapy. A management algorithm could be developed from therapeutic outcomes. CONCLUSIONS Treatment of CFVM can be safely and successfully performed with a combination of laser therapy, sclerotherapy, and surgical excision. A treatment algorithm involving multiple procedures during childhood can lead to successful management of CFVM.
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Affiliation(s)
- Robert S Glade
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital at OU Medical Center, Oklahoma City, Oklahoma, USA
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Oduber CEU, Khemlani K, Sillevis Smitt JH, Hennekam RCM, van der Horst CMAM. Baseline Quality of Life in patients with Klippel-Trenaunay syndrome. J Plast Reconstr Aesthet Surg 2009; 63:603-9. [PMID: 19289309 DOI: 10.1016/j.bjps.2009.01.055] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 12/29/2008] [Accepted: 01/30/2009] [Indexed: 01/19/2023]
Abstract
BACKGROUND Klippel-Trenaunay syndrome (KTS) is a congenital group of disorders characterised by vascular malformations (capillary malformation (CM), venous malformation (VM), and lymphatic malformation (LM)) and disturbed growth regulation. The burden caused by KTS symptoms can be evaluated using Quality of Life (QoL)-measuring questionnaires. This study aimed to assess the QoL in KTS patients using the Short Form Health Survey Questionnaire (SF-36) and Skindex-29 questionnaires, and to determine three grades of severity (mild, moderate and severe) according to the scores obtained. In addition, we compared the SF-36 results to those of a general Dutch population sample and a selected group of other chronic conditions. METHODS KTS patients of the Dutch KTS foundation and of two medical centres answered SF-36 and Skindex-29 questionnaires. Control data of validated Dutch population SF-36 scores and literature-acquired scores for other diseases were available. RESULTS A total of 78 patients were enrolled, of whom 34 (43.6%) were male; the mean age was 39.3 years (SD: 17.1; range: 12-78 years). The Dutch KTS group scored significantly lower than the general Dutch population on all SF-36 scales except Mental Health and Role Emotional. Furthermore, they scored significantly lower than other medical conditions on the Physical Functioning and Bodily Pain scales. According to the Skindex-29 results, KTS patients fall in the categories - symptoms: severe to very severe; emotions: diminutive to mild and functions: mild. The total score is lower than 40, indicating a negligible negative impact on QoL; however, new cut-off values are being calculated. CONCLUSIONS Classification according to severity is important to educate patients accordingly, predict prognosis and set treatments. Especially in cases of severe KTS, physicians should not only be attentive to the physical aspects but also to the psychological and social aspects of KTS.
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Affiliation(s)
- Charlène E U Oduber
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Centre, P.O. Box 22700, 1100 DD Amsterdam, The Netherlands.
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