1
|
Cunha M, Gonçalves F, Almeida G, Azevedo MJ, Cunha J. Lower Extremity Fibro-Adipose Vascular Anomaly: A Post-surgical Rehabilitation Treatment. Cureus 2024; 16:e62708. [PMID: 39036281 PMCID: PMC11259521 DOI: 10.7759/cureus.62708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
Fibro-adipose vascular anomaly (FAVA) presents diagnostic and therapeutic challenges due to its rarity and overlapping features with other vascular malformations. Predominantly affecting the lower extremities, it manifests with pain and contracture, and surgical resection may be necessary in symptomatic cases. We present a case of a 36-year-old patient with FAVA in the right lower extremity, experiencing persistent symptoms since adolescence. The condition was managed with surgical gastrocnemius resection. Following surgery, the patient underwent a comprehensive rehabilitation program, resulting in significant clinical and functional improvement. This case highlights the importance of tailored interventions in FAVA. The challenges encountered in diagnosing and managing FAVA underscore the necessity for continued research and clinical discourse to improve patient care. Our report emphasizes the significance of collaborative and multidisciplinary care in maximizing functional recovery and quality of life post-gastrocnemius resection, highlighting the importance of optimized rehabilitation programs.
Collapse
Affiliation(s)
- Mafalda Cunha
- Physical Medicine and Rehabilitation, Hospital Senhora da Oliveira - Guimarães, Guimarães, PRT
| | - Filipa Gonçalves
- Physical Medicine and Rehabilitation, North Rehabilitation Centre, Gaia, PRT
| | - Gabi Almeida
- Physical Medicine and Rehabilitation, Hospital de Braga, Braga, PRT
| | - Maria João Azevedo
- Physical Medicine and Rehabilitation, Hospital Senhora da Oliveira - Guimarães, Guimarães, PRT
| | - João Cunha
- Physical Medicine and Rehabilitation, Hospital Senhora da Oliveira - Guimarães, Guimarães, PRT
| |
Collapse
|
2
|
Sun YR, Zou ML, Yuan SM. Progress about the fibro-adipose vascular anomaly: A review. Medicine (Baltimore) 2024; 103:e37225. [PMID: 38363925 PMCID: PMC10869078 DOI: 10.1097/md.0000000000037225] [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: 12/11/2023] [Accepted: 01/19/2024] [Indexed: 02/18/2024] Open
Abstract
Fibro-adipose vascular anomaly (FAVA) is a rare and complex vascular malformation associated with persistent pain, limb contracture, and even restriction of activity. However, the pathophysiology of FAVA remains unclear. Although FAVA is a benign vascular malformation, it is highly misdiagnosed and often thus undergoing repeated surgical resection and interventional sclerotherapy, resulting in worsening of symptoms and irreversible dysfunction. Therefore, aggressive diagnosis and treatment are essential. There are several different treatment options for FAVA, including surgical resection, sclerotherapy, cryoablation, drug therapy, and physical therapy. This article reviews the clinical manifestations, pathological features, pathogenesis, and treatment methods of FAVA.
Collapse
Affiliation(s)
- Yi-Ran Sun
- Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Ming-Li Zou
- Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Si-Ming Yuan
- Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| |
Collapse
|
3
|
Hu WJ, Li HT, Fan ZN, Gong YB, Guo XN, Dong CX, Fan PH, Yang X, Wu G. Summary of the application value of ultrasound imaging features in the clinical differential diagnosis of intramuscular capillary-type hemangioma and fibro-adipose vascular anomaly. Front Oncol 2023; 13:1256667. [PMID: 38125939 PMCID: PMC10731448 DOI: 10.3389/fonc.2023.1256667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Objective To investigate the value of ultrasonography as a diagnostic aid in differentiating intramuscular capillary-type hemangioma (ICTH) from fibro-adipose vascular anomaly (FAVA). Methods A retrospective analysis was conducted of the clinical and ultrasound imaging data of 20 patients with ICTH and 45 patients with FAVA who were admitted to and pathologically confirmed in hospital between January 2013 and April 2023. The clinical and ultrasonographic appearances of the lesions in the two groups were compared and analyzed. A stepwise regression analysis was performed, and a joint diagnostic equation was constructed using the final variables selected. The receiver operating characteristic (ROC) curve and indicators, including sensitivity and specificity, were used to evaluate the efficacy of the joint diagnostic model. Results The two groups of patients suffering from ICTH and FAVA presented a statistically significant difference (P< 0.05) in terms of 'age', 'lesion size', 'fascial tail sign', 'presence of a fatty-tissue-like hyperecho around the lesion', 'blood flow' and 'presence of straight blood capillaries within the lesion'. Finally, the variables 'fascial tail sign' and 'presence of straight blood capillaries within the lesion' were selected to construct the model. The constructed joint diagnostic model had a sensitivity value of 70.0% (95% CI: 59.00-81.00), a specificity value of 98.0% (95% CI: 94.70-100.00) and a ROC curve value of 0.908, indicating the high efficacy of the combined diagnosis method. Conclusions Ultrasonography can be utilized to differentiate ICTH from FAVA, and the combined diagnosis method can further improve the technique's diagnostic efficacy.
Collapse
Affiliation(s)
- Wen-Jia Hu
- Department of Ultrasound, Henan Provincial People’s Hospital & Zhengzhou University People’s Hospital & Henan University People’s Hospital, Zhengzhou, China
| | - Hai-Ting Li
- Department of Medical imaging, Henan Provincial People’s Hospital & Zhengzhou University People’s Hospital & Henan University People’s Hospital, Zhengzhou, China
| | - Zhi-Na Fan
- Department of Ultrasound, Henan Provincial People’s Hospital & Zhengzhou University People’s Hospital & Henan University People’s Hospital, Zhengzhou, China
| | - Yu-Bin Gong
- Department of Hemangioma and vascular malformations, Henan Provincial People’s Hospital & Zhengzhou University People’s Hospital & Henan University People’s Hospital, Zhengzhou, China
| | - Xiao-Nan Guo
- Department of Hemangioma and vascular malformations, Henan Provincial People’s Hospital & Zhengzhou University People’s Hospital & Henan University People’s Hospital, Zhengzhou, China
| | - Chang-Xian Dong
- Department of Hemangioma and vascular malformations, Henan Provincial People’s Hospital & Zhengzhou University People’s Hospital & Henan University People’s Hospital, Zhengzhou, China
| | - Pan-Hong Fan
- Department of Pathology, Henan Provincial People’s Hospital & Zhengzhou University People’s Hospital & Henan University People’s Hospital, Zhengzhou, China
| | - Xiao Yang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Gang Wu
- Department of Ultrasound, Henan Provincial People’s Hospital & Zhengzhou University People’s Hospital & Henan University People’s Hospital, Zhengzhou, China
| |
Collapse
|
4
|
Wang H, Xie C, Lin W, Wang P, Yang W, Guo Z. Fibro-adipose vascular anomaly (FAVA) - diagnosis, staging and management. Orphanet J Rare Dis 2023; 18:347. [PMID: 37936141 PMCID: PMC10631057 DOI: 10.1186/s13023-023-02961-6] [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] [Received: 12/05/2022] [Accepted: 10/28/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The diagnosis and treatment of fibro-adipose vascular anomaly (FAVA) of the limb remains challenging since this entity is rare and complex. This paper is aimed to describe the clinical and imaging features, staging and management of this underrecognized disease of the limb. MATERIAL AND METHOD Patients diagnosed with FAVA and managed between September 2019 and May 2022 in department of pediatric surgery & vascular anomalies of Xi'an international medical center hospital were retrospectively reviewed. Data extracted include age at presentation, previous diagnosis, affected muscles, symptoms, previous treatment, our management, and follow-up. RESULTS Thirty-two patients with FAVA were diagnosed and managed in our center. There was a female sex predominance, with 23 female (72%) and 9 male (28%) in the cohort. Only one lesion was noticed during infancy; the remaining presented at age 1 to 20 years (median, 7 years). The most commonly involved muscles were gastrocnemius (14/32, 44%) and soleus (13/32, 40%). Swelling (mass), pain and contractures were the most common presentations. MRI featured a heterogeneous and ill-defined intramuscular high signal intensity. Diseases were staged according to clinical features: stage I (pain stage, n = 4), stage II (contracture stage, n = 20) and stage III (deformity stage, n = 8). Patients with stage I disease underwent radical resection and obtained a cure. Patients with stage II disease received radical resection and possible Achilles lengthening, having an outcome of cure. Personalized treatment was required in patients with stage III disease, including radical/partial/staged resection, Achilles lengthening/tenotomy, joint capsulotomy, neurolysis/neurectomy, tendon transfer, stretching exercises, and oral sirolimus/alpelisib. Significant improvement of symptoms was achieved in most. CONCLUSION The most distinct features of FAVA include enlarging mass, severe pain and contracture. Based on distinct clinical and radiologic features, it is not difficult to make the diagnosis of FAVA. Earlier awareness of this disease can reduce misdiagnoses. Surgery-based comprehensive management can typically improve pain and contracture. Oral sirolimus or alpelisib plays an important role in treatment of unresectable lesions and major nerve involvement. Surgery alone can be curative in early stage FAVA.
Collapse
Affiliation(s)
- Huaijie Wang
- Department of Pediatric Surgery& Vascular Anomalies, Xi'an International Medical Center Hospital, Xi'an, 710100, China
| | - Chong Xie
- Department of Pediatric Surgery& Vascular Anomalies, Xi'an International Medical Center Hospital, Xi'an, 710100, China
| | - Weilong Lin
- Department of Pediatric Surgery& Vascular Anomalies, Xi'an International Medical Center Hospital, Xi'an, 710100, China
| | - Peihua Wang
- Department of Pediatric Surgery& Vascular Anomalies, Xi'an International Medical Center Hospital, Xi'an, 710100, China
| | - Weijia Yang
- Department of Pediatric Surgery& Vascular Anomalies, Xi'an International Medical Center Hospital, Xi'an, 710100, China
| | - Zhengtuan Guo
- Department of Pediatric Surgery& Vascular Anomalies, Xi'an International Medical Center Hospital, Xi'an, 710100, China.
| |
Collapse
|
5
|
Wang H, Xie C, Lin W, Zhou J, Yang W, Guo Z. Endoscopic Resection for Vascular Anomalies in Children: A New Standard. Ann Surg 2023; 278:e870-e875. [PMID: 36825502 PMCID: PMC10481932 DOI: 10.1097/sla.0000000000005832] [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: 02/25/2023]
Abstract
OBJECTIVE To report an innovative endoscopic surgery for subcutaneous vascular malformations and intramuscular fibro-adipose vascular anomaly (FAVA) at our center. BACKGROUND Historically, open surgical resection has been the treatment of choice. Recent advances in minimally invasive surgery have led to the successful application of endoscopic resection techniques for the surgical management of diseases of soft tissue. METHODS Patients who underwent endoscopic resection of vascular anomalies were included in this retrospective review. Data were extracted from our Vascular Anomalies Center database between September 2019 and October 2022, including sex, age, symptoms, diagnosis, sites of surgery, previous treatment, surgery, and follow-up. RESULTS There were 13 females and 15 males in the current study, with ages ranging from 1 to 17 years. The diagnoses included microcystic lymphatic malformation (LM) (n = 8), Klippel-Trénaunay syndrome (n = 7), venous malformation (n = 6), FAVA (n = 6), and mixed cystic LM (n = 1). Surgical sites included the lower extremity (n = 24), abdominal wall (n = 2), upper extremity (n = 1), and thoracic wall (n = 1). Five patients had an intramuscular lesion (FAVA). The endoscopic technique used 2 or 3 small ports in a gas inflation manner. Surgery included thrombectomy, radical resection, and debulking of vascular anomalies. Postoperative sclerotherapy with bleomycin was performed through a drainage tube in 6 patients with microcystic LM. Technical success was obtained in 27 patients. The conversion to open surgery was performed in one patient owing to the deep location of the lesion. No wound-related complication was observed. CONCLUSIONS Endoscopic surgery is a minimally invasive, effective, and safe treatment for subcutaneous vascular malformations and intramuscular FAVA. This approach can set a new standard that minimizes wound complications and reduces recovery time in patients undergoing resection for benign soft-tissue lesions.
Collapse
|
6
|
Wang Z, Yan H, Ding Y, Gong Y, Ma Y, Yao W, Li K. Successful treatment of fibro-adipose Vascular Anomaly with sirolimus. J Pediatr Surg 2023:S0022-3468(23)00100-8. [PMID: 36898877 DOI: 10.1016/j.jpedsurg.2023.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/23/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND The purpose of this study was to present our initial experience in using sirolimus therapy to treat fibro-adipose vascular anomaly (FAVA). METHODS We retrospectively reviewed the medical records of eight patients with FAVA who were treated with sirolimus at our hospital between July 2017 and October 2020. RESULTS Six girls (75%) and two boys (25%) were included in the cohort; the average age was 8 years (range, 1-13 years). Vascular tumors developed mainly on the extremities, including the forearm (n = 2; 25.0%), calf (n = 4; 50.0%), and thigh (n = 2; 25.0%). The predominant symptoms included swelling of the lesion (n = 8; 100%), pain (n = 7; 87.5%), contracture (n = 3; 37.5%), and phlebectasia (n = 3; 37.5%). Magnetic resonance imaging was the primary method used for FAVA diagnosis, and all patients underwent enhanced MRI. All lesions were heterogeneous with hyperintense T1 signals. The fat-suppressed T2-weighted images also revealed heterogeneous hyperintense masses, thus indicating fibrofatty infiltration. All eight patients received a sirolimus treatment regimen after FAVA diagnosis. One patient underwent tumor resection but experienced recurrence, whereas the other six patients underwent biopsy. Histological examination revealed that the lesions consisted of fibrofatty tissue with abnormal venous channels and anomalous lymphatic vascular components. Sirolimus softened the masses and caused tumor shrinkage within 5.25 ± 2.6 weeks (range, 2-10 weeks) after treatment initiation. The tumors also involuted rapidly and became stable within 7.75 ± 2.25 months after treatment initiation (range, 6-12 months). All seven patients experiencing pain reported relief within 3.8 ± 1.8 weeks (range, 2-7 weeks) after initiation of sirolimus therapy. Sirolimus alleviated but did not fully resolve the contracture in three patients. Remarkably, five patients exhibited a complete response, and three patients exhibited a partial response. At the time of the last follow-up, three patients had begun to gradually taper off sirolimus after 24 months of treatment and maintained a low blood sirolimus concentration. No serious adverse effects were observed during treatment. CONCLUSION FAVA is a complex vascular malformation that appears to respond well to sirolimus treatment. Thus, sirolimus may be an effective and safe treatment for FAVA. LEVEL OF EVIDENCE LEVEL IV.
Collapse
Affiliation(s)
- Zuopeng Wang
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Hanlei Yan
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yingjing Ding
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ying Gong
- Department of Radiology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yangyang Ma
- Department of Pathology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Wei Yao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Kai Li
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
| |
Collapse
|
7
|
Watson KD, Kim KR, Blatt J. How we approach complex vascular anomalies and overgrowth syndromes. Pediatr Blood Cancer 2022; 69 Suppl 3:e29273. [PMID: 36070209 DOI: 10.1002/pbc.29273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 01/19/2023]
Abstract
Vascular anomalies, both vascular tumors and vascular malformations, can occur in isolation or as part of syndromes including those which feature phenotypic overgrowth. To update what is known about vascular anomalies associated with overgrowth, PubMed was searched for "overgrowth syndromes and vascular anomalies or malformations." PubMed, OMIM, and the Rare Disease Database also were searched for specific diagnoses. We review individual overgrowth syndromes, provide a case-based approach to the clinical, radiographic, pathologic, and genetic basis for diagnosis, to complications of both the vascular anomalies and the overgrowth, and emphasize the need for a multidisciplinary approach to care.
Collapse
Affiliation(s)
- Katherine D Watson
- Division of Pediatric Hematology/Oncology, Children's Cancer and Blood Disorders Center, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA
| | - Kyung R Kim
- Division of Vascular & Interventional Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Julie Blatt
- Division of Pediatric Hematology Oncology, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
8
|
Fish A, Moushey A, Mei S, Staib L, Marino A, Schlachter T. CRYOABLATION OF VENOUS MALFORMATIONS: A SYSTEMATIC REVIEW. J Vasc Interv Radiol 2022; 33:993-1000. [DOI: 10.1016/j.jvir.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/14/2022] [Accepted: 04/15/2022] [Indexed: 11/25/2022] Open
|
9
|
Driskill JH, Hwang H, Callan AK, Oliver D. Case Report of Fibro-Adipose Vascular Anomaly (FAVA) with Activating Somatic PIK3CA Mutation. Case Rep Genet 2022; 2022:9016497. [PMID: 35967928 PMCID: PMC9363927 DOI: 10.1155/2022/9016497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/08/2022] [Indexed: 02/05/2023] Open
Abstract
Fibro-adipose vascular anomaly (FAVA) is a recently described complex and painful benign lesion found in young adults and the pediatric population composed of intramuscular vascular, fibrous, and adipose tissues. A previous report has identified the presence of somatic mosaic mutations in the gene for the catalytic subunit of phosphatidylinositol 3-kinase (PIK3CA) in cases of FAVA. Herein, we present a case of FAVA found in a 23-year-old male patient who presented with chronic wrist pain associated with a mass, and we identified an associated somatic activating mutation (H1047R) in PIK3CA. We briefly review the relevant literature surrounding the identification and histology of FAVA, the known mutational spectrum, downstream signaling pathways, and relevant treatment modalities. Our case highlights the association between FAVA and somatic mosaic activating PIK3CA mutations.
Collapse
Affiliation(s)
- Jordan H. Driskill
- Medical Scientist Training Program, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Helena Hwang
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Alexandra K. Callan
- Department of Orthopaedic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Dwight Oliver
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| |
Collapse
|
10
|
Strübing F, Sadick M, Porubsky S, Harhaus L, Bigdeli A, Kneser U. Fibroadipose Vascular Anomaly of the Upper Extremity: Case Report of Extensive Resection and Secondary Tendon Transfer. Ann Plast Surg 2021; 87:e92-e96. [PMID: 33833153 DOI: 10.1097/sap.0000000000002792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Alomari and colleagues described in 2014 for the first time a distinct combination of vascular malformation, fibrofatty muscular infiltration and contracture which was termed fibroadipose vascular anomaly (FAVA) (J Pediatr Orthoped 34, 109-117 (2014). So far only few publications (J Pediatr Orthoped (2014) 34, 109-117; J Hand Surg (2020). 45, 68.e1, 68.e13; Ann Vasc Dis (2014) 7, 316-319; Pediatr Radiol 46, 1179-1186 (2016)) concerning this newly described disease have been published, covering only a limited number of cases. We present a case of a 19-year-old male patient suffering from a FAVA of the proximal forearm with a severe contracture of the infiltrated flexor musculature. Upon surgery, we observed infiltration of the ulnar nerve. We were able to successfully resect the vascular malformation. Secondary tendon transfer was performed after extensive resection of the flexor musculature.FAVA presents a differential diagnosis in patients with solid growth of the upper or lower extremity and contracture of the involved extremity. We conclude that patients suffering from FAVA of the upper extremity should be referred to a center specialized in oncologic extremity surgery and reconstructive hand and microsurgery.
Collapse
Affiliation(s)
- Felix Strübing
- From the Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg
| | - Maliha Sadick
- Institute for Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim
| | - Stefan Porubsky
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Leila Harhaus
- From the Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg
| | - Amir Bigdeli
- From the Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg
| | - Ulrich Kneser
- From the Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg
| |
Collapse
|
11
|
Abstract
Vascular anomalies are composed of tumors and malformations and with overlapping histologies, thus are often misdiagnosed or labeled with imprecise terminology. Lesions are common and usually diagnosed during infancy or childhood; the estimated prevalence is 4.5%. Vascular tumors rapidly enlarge postnatally and demonstrate endothelial proliferation. Malformations are errors in vascular development with stable endothelial turnover; they are typically named based on the primary vessel that is malformed (capillary, arterial, venous, lymphatic). This article reviews the pathologic and molecular genetic characteristics for select recently described vascular anomalies.
Collapse
Affiliation(s)
- Alyaa Al-Ibraheemi
- Department of Pathology, Boston Children's Hospital, 300 Longwood Avenue, BCH 3027, Boston, MA 02115, USA.
| |
Collapse
|
12
|
Khera PS, Garg PK, Babu S, Elhence P, Tiwari S, NK S. Fibro Adipose Vascular Anomaly: A Rare and Often Misdiagnosed Entity. Indian J Radiol Imaging 2021; 31:776-781. [PMID: 34790337 PMCID: PMC8590565 DOI: 10.1055/s-0041-1736399] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Fibro adipose vascular anomaly (FAVA) is a rare type of vascular malformation with distinct clinical features. The authors here discussed the clinical, imaging, differential diagnosis, histopathological features, and treatment options of FAVA along with an illustrative case. It is important to know about this uncommon entity as this can be misdiagnosed due to the overlapping clinical features with other common entities. It is a benign condition with no proven malignant potential. There are no guidelines regarding the best treatment option.
Collapse
Affiliation(s)
- Pushpinder S. Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan K. Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Santhosh Babu
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shyamkumar NK
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| |
Collapse
|
13
|
Management of Fibro-adipose Vascular Anomalies (FAVA) in Paediatric Practice. JPRAS Open 2021; 29:71-81. [PMID: 34189232 PMCID: PMC8220101 DOI: 10.1016/j.jpra.2021.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/07/2021] [Indexed: 02/05/2023] Open
Abstract
Fibro-adipose vascular anomaly (FAVA) is a discrete type of vascular anomaly. We describe our experience managing FAVA at a tertiary level paediatric hospital and offer a treatment algorithm. Methods A retrospective review of 27 patients with proven FAVA was undertaken. All patients had undergone MRI and USS evaluation. Patient demographics, presenting concerns, treatment methods, and outcomes were recorded and evaluation with the paediatric outcomes data collection instrument (PODCI) completed a minimum of 12 months after definitive treatment. Results Mean age at presentation was 8.9 years (range: 9 m-17.4 y) and mean post-treatment follow-up was 7.4 y (range: 2 y-11.6 y). Twenty of 27 lesions affected the lower limb. Severe neurogenic-type pain was present in 23 cases and contractures across joints in 11 cases. Sclerotherapy with sodium tetradecyl sulphate was used in 11 cases, with no improvement in symptoms. Cryoablation provided pain relief in 3/4 cases, but contracture subsequently increased in one patient and pain recurred in another.Fourteen cases underwent surgery (four surgical excisions alone, 10 in combination with other procedures). Three patients required four further surgical procedures that include one amputation for intractable pain and poor function.PODCI evaluations suggest overall good function, with surgical management and interventional radiology that provide comparable results. Surgery did correct deformity. Conclusion If conservative measures or cryoablation fail to achieve symptomatic control, surgical excision should be considered, combined with adjunctive procedures, to correct contractures and balance muscle forces.Relief of pain may compensate for the loss of muscle mass and overall improves function. Multidisciplinary team working is essential.
Collapse
|
14
|
Gibson CR, Barnacle AM. Vascular anomalies: special considerations in children. CVIR Endovasc 2020; 3:60. [PMID: 32886264 PMCID: PMC7474047 DOI: 10.1186/s42155-020-00153-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022] Open
Abstract
The diagnosis and treatment of vascular anomalies are a large part of the caseload for paediatric interventional radiologists. Although many of the principles of sclerotherapy and embolisation are the same in adult and paediatric practice, there are some key differences in the approach for children, including some longer term thinking about managing these chronic diseases and their impact on a growing child. Vascular tumours are not often seen in adult IR practice and the rarest can be life threatening; knowledge of the commonest types and the role IR can play in their management can be instrumental in ensuring that children get appropriate treatment in a timely manner. Vascular anomalies also encompass some conditions associated with complex overgrowth, a subject that often causes confusion and uncertainty for interventional radiologists. This paper presents a simplified and practical approach to this spectrum of disease.
Collapse
Affiliation(s)
- Craig R Gibson
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Alex M Barnacle
- Department of Radiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
| |
Collapse
|
15
|
Abstract
Vascular anomalies impact the musculoskeletal system dependent on the tissue involved (skin, subcutis, muscle, cartilage, or bone), the extent of involvement, and the type of anomalous vessels (arteries, capillaries, veins, or lymphatics). These malformations can cause a multitude of musculoskeletal problems for the patient. Leg-length discrepancy, intra-articular involvement, muscular lesions, and primary or secondary scoliosis are amongst the issues that patients face. All of these problems can cause pain, deformity, and a range of functional limitations. Surgical and nonsurgical treatment plans have a role in patient care. Patients with vascular anomalies may also suffer from life-threatening cardiovascular and hematologic abnormalities. For those patients who undergo surgery, the thromboembolic risk is elevated, wound breakdown and infection are much more common, and bleeding risk continues well into the postoperative course. Because of the complex nature of these disorders, the clinician must have a full understanding of the types of lesions, their natural history, appropriate diagnostic studies, associated medical problems, indications for treatment, and treatment options. For severe malformations, especially syndromes such as CLOVES and Klippel- Trenaunay syndrome, interdisciplinary team management is essential for the best outcomes.
Collapse
Affiliation(s)
- Samantha A Spencer
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, United States.
| | - Joel I Sorger
- Department of Orthopedics, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, United States
| |
Collapse
|
16
|
Ferreira J, López Gutiérrez JC, Carneiro A, Sousa PP, Braga S, Simões JC, Carrilho C, Mesquita A. Lower Extremity Fibro-Adipose Vascular Anomaly-Case Report. Ann Vasc Surg 2020; 66:671.e15-671.e18. [PMID: 32018020 DOI: 10.1016/j.avsg.2020.01.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/28/2019] [Accepted: 01/08/2020] [Indexed: 01/19/2023]
Abstract
Fibro-adipose vascular anomaly (FAVA) is a painful complex vascular malformation, characterized by muscle fibrofatty infiltration, usually in lower limb, associated with contracture of the ipsilateral extremity. This article describes the first case of FAVA reported in Portugal successfully treated with surgery. A 9-year-old female was admitted complaining of a painful mass in the right leg. The MRI scan showed the presence of a 5 × 4 × 4 cm mass in the right leg consistent with FAVA located in the peroneus longus muscle. The patient underwent resection of the involved muscle. She had 6 months of follow-up without any relevant clinical event. The authors also highlight the difference between FAVA and venous malformation. Early surgery is a treatment option that can prevent long-term consequences, as contracture and movement limitation.
Collapse
Affiliation(s)
- Joana Ferreira
- Life and Health Science Research Institute (ICVS), School of Health Science, University of Minho, Serviço de Cirurgia Vascular e Centro Académico do Hospital da Senhora da Oliveira Guimarães, Portugal.
| | | | | | - Pedro Pinto Sousa
- Life and Health Science Research Institute (ICVS), School of Health Science, University of Minho, Serviço de Cirurgia Vascular e Centro Académico do Hospital da Senhora da Oliveira Guimarães, Portugal
| | - Sandrina Braga
- Life and Health Science Research Institute (ICVS), School of Health Science, University of Minho, Serviço de Cirurgia Vascular e Centro Académico do Hospital da Senhora da Oliveira Guimarães, Portugal
| | - João Correia Simões
- Life and Health Science Research Institute (ICVS), School of Health Science, University of Minho, Serviço de Cirurgia Vascular e Centro Académico do Hospital da Senhora da Oliveira Guimarães, Portugal
| | - Celso Carrilho
- Life and Health Science Research Institute (ICVS), School of Health Science, University of Minho, Serviço de Cirurgia Vascular e Centro Académico do Hospital da Senhora da Oliveira Guimarães, Portugal
| | - Amílcar Mesquita
- Life and Health Science Research Institute (ICVS), School of Health Science, University of Minho, Serviço de Cirurgia Vascular e Centro Académico do Hospital da Senhora da Oliveira Guimarães, Portugal
| |
Collapse
|