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Zhou J, Guo L, Wang L, Li J, Liu Z, Sun J. The risk of muscle involvement in focal venous malformations in children. Phlebology 2024; 39:44-48. [PMID: 37859422 DOI: 10.1177/02683555231209081] [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: 10/21/2023]
Abstract
BACKGROUND Venous malformations (VMs) are the most common vascular malformations, which can be classified as focal, multifocal, or diffuse types. But the risk of focal venous malformations with muscle involvement is not well defined. METHODS This is a single-center, retrospective review of patients treated for focal VMs between February 2021 and February 2022. RESULTS We assessed 26 patients focal VMs with 47 lesions; 18 (69%) were unifocal, 3 (12%) were dual-focal, and 5 (19%) were multifocal type VMs, and 29 (62%) were intramuscular VMs. The lower limbs intramuscular VMs had a significantly elevated risk of focal VMs (relative risk [RR],1.7; 95% confidence interval [CI], 1.148-2.394). CONCLUSION Intramuscular involvement of the body should be considered in focal VMs. The lower limbs intramuscular VMs had a significantly elevated risk of focal VMs.
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Affiliation(s)
- Jie Zhou
- Department of Vascular anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Lei Guo
- Department of Vascular anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Liang Wang
- Department of Vascular anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Jing Li
- Department of Vascular anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Zhuang Liu
- Department of Vascular anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Jiali Sun
- Department of Vascular anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China
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2
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Jin CJ, Wang Q, Wang M, Chen Y, Yuan SM. Therapeutic evaluation and analysis of complications of ethanol sclerotherapy for intramuscular vascular malformations: a single-center retrospective study. Front Surg 2023; 10:1274313. [PMID: 37953821 PMCID: PMC10635452 DOI: 10.3389/fsurg.2023.1274313] [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: 08/08/2023] [Accepted: 09/19/2023] [Indexed: 11/14/2023] Open
Abstract
Background Intramuscular venous malformations (IMVMs) can cause pain and contracture deformity, leading to dysfunction of limbs. Ethanol sclerotherapy is one of the main treatments for IMVMs. This study aims to evaluate the efficacy and the complications associated with intravascular ethanol sclerotherapy for IMVMs and to provide a comprehensive summary of clinical experiences for future reference. Methods A retrospective analysis was conducted on a cohort of 118 patients diagnosed with IMVMs who were treated with ethanol sclerotherapy in our center between 2006 and 2021. The plastic surgeons utilized a standardized collection pro forma to record the clinical data. Furthermore, a follow-up period ranging from 6 months to 5 years was implemented to assess the relief of symptoms, the change of lesion size, and the recovery of functional outcomes. In addition, an analysis of long-term complications was conducted. Results The clinical symptoms of the patients in this group included pain, swelling, and limited movement. On average, 5.61 mL (range 2-14 mL) of ethanol was used during the sclerotherapy procedure. The intraoperative and early postoperative complications were successfully relieved by means of timely intervention, as observed during the follow-up period. Based on the MRI results, the sizes of the lesions in 19% of the cases were significantly decreased, while a slight decrease was observed in 39% of the cases. During the follow-up period, it was found that only eight out of the 118 patients included in this study experienced long-term complications related to sclerotherapy. Conclusions Although ethanol sclerotherapy has proven to be an effective first-line treatment for IMVMs, it is associated with a variety of adverse reactions and short- and long-term complications. Surgeons are required to perform operations prudently and provide timely medical intervention for postoperative complications.
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Affiliation(s)
- Cai-Jun Jin
- Department of Plastic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Qian Wang
- Department of Plastic Surgery, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Min Wang
- Department of Plastic Surgery, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Yong Chen
- Department of Plastic Surgery, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Si-Ming Yuan
- Department of Plastic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Department of Plastic Surgery, Jinling Hospital, Southern Medical University, Nanjing, China
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3
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Pavanello M, Piatelli G, Barretta I. Letter to the Editor regarding "Surgical considerations for spinal epidural hematoma evacuation in the setting of blue rubber bleb nevus syndrome in a child". Childs Nerv Syst 2023; 39:2265-2266. [PMID: 37357237 DOI: 10.1007/s00381-023-06034-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Marco Pavanello
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gianluca Piatelli
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Ida Barretta
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
- DINOGMI, Università degli Studi di Genova, Genoa, Italy.
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4
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Sun N, Liu R, Cheng G, Wu P, Yu F, Qing L, Zeng L, Pang X, Pan D, Xiao Y, Khan UZ, Tang J. The rare complication of vascular malformations of the limb after sclerotherapy: a report of 3 cases and brief literature review. BMC Pediatr 2023; 23:202. [PMID: 37106458 PMCID: PMC10142400 DOI: 10.1186/s12887-023-04018-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Vascular malformations are common but complicated types of disease in infants, with unclear causes and lack of effective prevention. The symptoms usually do not disappear and tend to progress without medical intervention. It is extremely necessary to choose correct treatment options for different types of vascular malformations. A large number of studies have confirmed that sclerotherapy has a tendency to become the first-line treatment in near future, but it is also associated with mild or severe complications. Furthermore, to our knowledge, the serious adverse event of progressive limb necrosis has not been systematically analyzed and reported in the literature. CASE PRESENTATION Three cases (two females and one male) were presented who were all diagnosed as vascular malformations and were treated by several sessions of interventional sclerotherapy. Their previous medical records showed the use of several sclerosants in different sessions including Polidocanol and Bleomycin. The sign of limb necrosis did not occur during the first sclerotherapy, but after the second and third sessions. Furthermore, the short-term symptomatic treatment could improve the necrosis syndrome, but could not change the outcome of amputation. CONCLUSION Sclerotherapy undoubtedly tends to be the first-line treatment in near future, but the adverse reactions still remain major challenges. Awareness of progressive limb necrosis after sclerotherapy and timely management by experts in centers of experience of this complication can avoid amputation.
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Affiliation(s)
- Nianzhe Sun
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Rui Liu
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Gechang Cheng
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Panfeng Wu
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Fang Yu
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Liming Qing
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Lei Zeng
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Xiaoyang Pang
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Ding Pan
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Yongbin Xiao
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Umar Zeb Khan
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Juyu Tang
- Department of Orthopedics Surgery, Hand & Microsurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China.
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China.
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Han T, Jiang S, Xiong J, Cui J, Shen W. 3D printing personalized guide plate in the management of recurrent intramuscular venous malformations: A single center experience. Phlebology 2023; 38:307-314. [DOI: 10.1177/02683555231162300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Objective This study aimed to investigate the feasibility and effectiveness of 3D printing personalized guide plate in the management of recurrent intramuscular venous malformations (IVM). Methods Fifteen patients with recurrent IVM were retrospectively assessed. 3D-slicer software was used to extract and reconstruct the imaging data from CT and/or MRI to highlight the morphology, size, and puncture depth of the lesion. With the guidance of personalized plate, complete excision of the IVM was adopted along the pre-marked (methylene blue, MB) margin. Results Personalized guide plate matched involved extremity well, and MB-puncture approach was consistent with preoperative design. All IVMs were removed radically in one single session. Complete pain relief was obtained in all cases postoperatively. Conclusion The application of 3D printing guide plate can be safe, effective, and reliable to confirming the precise margin of IVM, renders a promising technique with a high practical value in resection of recurrent lesion.
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Affiliation(s)
- Tao Han
- Department of Burns and Plastic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Shupei Jiang
- Department of Burns and Plastic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jiageng Xiong
- Department of Burns and Plastic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Cui
- Department of Burns and Plastic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Weimin Shen
- Department of Burns and Plastic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
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6
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Pessanha I, Delgado-Miguel C, Alves H, Triana P, Lopéz-Gutierrez JC. Venous malformations: what do phleboliths tell us in the pediatric population? Pediatr Surg Int 2022; 38:1501-1506. [PMID: 35852593 DOI: 10.1007/s00383-022-05181-4] [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] [Accepted: 07/07/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Phleboliths are often observed within Venous malformations (VM) and frequently indicated as cause of morbidity. The aim of this study is to investigate independent risk factors for phleboliths in a pediatric population and to determine if its presence influences clinical management. METHODS We retrospectively review data from patients diagnosed with VM in a vascular anomalies center during a 5-year period. Associations between phleboliths and potential risk factors were assessed. A multivariable analysis, was performed to assess the influence of phleboliths in the need for surgery. RESULTS We included 88 patients with a mean age of 10 years. Phleboliths were found in 33.0%. In univariate analysis, there were no significant differences between the two groups regarding age or gender, location, dimension or depth of the VM, pain and laboratory parameters. Multivariable analysis could not detect any independent risk factor for phleboliths. In contrast, multivariable logistic analysis revealed that when phleboliths were present, the need for surgical extirpation was more likely (p = 0.031). CONCLUSIONS This study showed that patients who have phleboliths within their VM seem to require surgery more frequently. This constitutes an entirely innovative thought that could raise awareness to a lower threshold for surgery in this group of patients.
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Affiliation(s)
- Inês Pessanha
- Department of Paediatric Surgery, Paediatric Hospital, Centro Hospitalar E Universitário de Coimbra, R. Dr. Afonso Romão, 3000-602, Coimbra, Portugal.
| | | | - Hélio Alves
- Department of Biomedicine, Unit of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paloma Triana
- Department of Plastic Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
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Kang M, Connor DE, Parsi K. Treatment of venous malformations with tumescent-assisted sclero-embolic and ablative lasers (SEALs): Safe and effective long-term outcomes. Phlebology 2022; 37:367-380. [DOI: 10.1177/02683555221080045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Perivascular infiltration of tumescent anaesthesia (TA) is an essential element of endovenous thermal ablative procedures employed to treat superficial venous disease. In addition to anaesthesia, TA is administered to achieve vessel wall approximation and to protect surrounding structures from thermal damage. However, its role in the treatment of venous malformations (VMs) has not been established. Objectives To assess the safety and efficacy of tumescent-assisted thermal and chemical ablative methods in the treatment of VMs. Methods Adult and paediatric patients presenting with VMs were treated using a combination of endovenous laser ablation, foam embolo-sclerotherapy and liquid embolisation using n-BCA. All procedures were ultrasound-guided. Treatment outcomes were assessed in early and late follow-ups. To assess the efficacy of TA in achieving vessel wall approximation, cross-sectional lesional diameters were measured by ultrasound, before and after the administration of TA during endovenous procedures. Results In a 12 month period, 22 patients recruited in the study presented with 27 VMs which included 23 extra-truncular lesions (16 subcutaneous and seven intramuscular) and four truncular anomalies. On average the subcutaneous lesions measured 5.5 mm (1.9–24.5 mm) in diameter, intramuscular lesions measured 9.2 mm (5.9–15.1 mm) and truncular anomalies measured 4.9 mm (1.2–12 mm) in diameter. Perivascular infiltration of TA resulted in a significant reduction in vessel calibre (90% reduction on average). Intramuscular VMs were less compressible with TA (69.2% reduction) compared to subcutaneous lesions (98% reduction). Truncular anomalies such as the embryonic marginal vein achieved complete approximation (100% reduction). Procedures were safely tolerated with no major complications such as thromboembolism, stroke, nerve damage or tissue necrosis. Most patients had significant clinical as well as ultrasonographic improvement. Conclusion Tumescent-assisted endovenous laser ablation and foam sclerotherapy provides safe and effective outcomes in patients with a variety of VMs.
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Affiliation(s)
- Mina Kang
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent’s Centre for Applied Medical Research, Darlinghurst, NSW, Australia
- Department of Dermatology, St Vincent’s Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - David E Connor
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent’s Centre for Applied Medical Research, Darlinghurst, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Kurosh Parsi
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent’s Centre for Applied Medical Research, Darlinghurst, NSW, Australia
- Department of Dermatology, St Vincent’s Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
- Australian Vascular Anomalies Centre, Sydney, NSW, Australia
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8
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Abstract
BACKGROUND Intramuscular venous malformations, often erroneously called "intramuscular hemangiomas," present to pediatric orthopaedic surgeons either as a differential diagnosis of tumor or as a cause of muscle pain. Treatment options include injection sclerotherapy or surgery. There is some literature to indicate that sclerotherapy can reduce pain, but little evidence on the effectiveness of surgery. The primary aim of this study was to evaluate the efficacy of surgical resection for intramuscular venous malformations, with a secondary aim to evaluate the natural history and presentation of intramuscular venous malformations to improve clinician understanding of this condition. METHODS A retrospective chart analysis was performed of cases identified from a vascular anomalies database from January 2004 and December 2018. Primary outcome was change in preoperative and postoperative pain. Natural history of the lesion was assessed, including age when the lesion was first noticed, when it became painful, and when it required treatment. RESULTS Fifty-four cases were identified in the study period of which 40 underwent surgery. Pain improved in 36 of 39 patients (92.3%) who had pain before surgery and 29 (74.4%) were pain free after surgery. All 13 patients who required whole muscle excision to resect the lesion experienced an improvement in pain and 10 (76.9%) were pain free. A history of previous intervention, with surgery or sclerotherapy showed a trend towards less successful surgical outcomes. Patients presented across a wide age range from infancy to adulthood, but the most common presentation was pain with exercise between 9 and 16 years of age, with presence of a mass in about half of cases. CONCLUSIONS Surgery, when performed by a surgeon with appropriate experience, is an effective first-line treatment for painful intramuscular venous malformations, offering pain relief in the majority of cases. Magnetic resonance imaging and ultrasound are diagnostic in most cases. The majority of lesions are resectable, meaning they can be removed with a margin leaving a functional limb. Sometimes resection of a whole muscle is required. LEVEL OF EVIDENCE Level IV-case series.
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Abstract
Vascular anomalies, comprised of vascular tumors and malformations, are frequently associated with coagulopathy. Recognition of and familiarity with these vascular anomaly-associated hematologic abnormalities prior to surgery or interventional procedures is essential for pre-operative pre-operative planning. Complicated coagulopathies present within the framework of either Kasabach-Merritt phenomenon (KMP) or localized intravascular coagulopathy (LIC), and their management benefits from the expertise of a hematologist for optimal intra- and peri‑operative care. Furthermore, with the recent broadening of understanding of vascular anomalies and the addition of new classification sub-groups, distinctions of these two classic coagulopathy phenotypes have been recognized. This review summarizes the main features of these coagulopathies, described according to their vascular anomaly type, highlighting clinical aspects relevant to surgical management.
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Affiliation(s)
- Kiersten W Ricci
- Hemangioma and Vascular Malformation Center, Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7015, Cincinnati 45229, OH, United States.
| | - Leonardo R Brandão
- The Hospital for Sick Children, Division of Haematology-Oncology, Toronto, Ontario, Canada
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Weitz-Tuoretmaa A, Keski-Nisula L, Rautio R, Laranne J. Quality of life and clinical results after endovascular sclerotherapy: A comparison between intra- and extramuscular low-flow venous malformations. Phlebology 2020; 36:226-232. [PMID: 32996841 DOI: 10.1177/0268355520962920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Based on clinical observations we hypothesized that patients with intramuscular venous malformations (VMs) did worse or needed more sclerotherapy sessions than patients with extramuscular VMs. PURPOSE To evaluate the difference in treatment and quality of life (QOL) results after Polidocanol sclerotherapy of intra- and extramuscular low-flow VMs. MATERIAL AND METHODS Forty-one patients with a VM were treated with Polidocanol in two university hospitals. The results were retrospectively analyzed. Pre- and post-treatment magnetic resonance imaging (MRI) scans were compared. All patients completed a self-evaluating form on symptoms as well as a QOL questionnaire. The results were compared between two groups: intra- and extramuscular VM's. RESULTS No statistically significant differences between intra- and extramuscular groups concerning QOL and specific dimensions pain, functional problems or cosmetic appearance were found. Radiological changes in MRI examinations did not correlate with any of the subjective symptoms. 56% of the patients benefitted from the treatment according to patient self-evaluation. CONCLUSION In this material intramuscular VM's responded to the treatment comparably to extramuscular malformations. Post-treatment MRI findings do not correlate with subjective symptoms or QOL results and thus, a routine post-treatment examination seems to be unwarranted. Subjective symptoms and QOL results are the most important parameters in evaluating the effectiveness of sclerotherapy.
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Affiliation(s)
| | - Leo Keski-Nisula
- Department of Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Riitta Rautio
- Department of Interventional Radiology, Turku University Hospital, Turku, Finland
| | - Jussi Laranne
- Department of Otorhinolaryngology, Kokkola Central Hospital, Kokkola, Finland
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11
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Laurian C, Cerceau P, Paraskevas N, Massoni C, Marteau V, Wassef M, Houdart E, Bisdorff A. Intramuscular venous malformations of the calf: Surgical treatment outcomes of 57 patients. Phlebology 2020; 35:597-604. [PMID: 32375603 DOI: 10.1177/0268355520920811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To report the outcomes of surgical treatment of calf intramuscular venous malformations (IMVMs) on pain, functional limitation, and quality of life. METHODS We retrospectively reviewed 57 consecutive patients who had surgery for IMVM of the posterior compartment of the leg between 2010 and 2015. Treatments were all done at a single institution. RESULTS Patients presented with pain (52), muscle contracture (14), or pulmonary embolism (4). Muscle involvement included the soleus muscle (n = 28, 49%), the gastrocnemius muscle (n = 25, 43%), and deep muscles (n = 4, 7%). Complete excision was possible in 52 patients (91%) and partial excision in 5 (9%). Thirty-five of 46 patients who had an MRI follow-up at six months had no residual venous malformation. At the final follow-up (mean 39 months), 32 of 40 patients seen had no residual pain and 37 had no residual functional impairment. CONCLUSION In cases where IMVM is located in one muscle in the leg, we demonstrated that surgery yielded improvement in pain, function, and quality of life.
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Affiliation(s)
- Claude Laurian
- Department of Vascular Surgery, Saint Joseph Hospital, Paris, France
| | - Pierre Cerceau
- Department of Vascular Surgery, Bichat Hospital, Paris, France
| | | | | | | | - Michel Wassef
- Department of Pathology, Lariboisiere Hospitals, Paris, France
| | - Emmanuel Houdart
- Department of Neuroradiology, Lariboisère Hospital, Paris, France
| | - Annouk Bisdorff
- Department of Neuroradiology, Lariboisère Hospital, Paris, France
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12
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Restrepo R, Pevsner R, Pelaez L, Plut D, Lee EY. Three Distinct Vascular Anomalies Involving Skeletal Muscle: Simplifying the Approach for the General Radiologist. Radiol Clin North Am 2020; 58:603-618. [PMID: 32276706 DOI: 10.1016/j.rcl.2020.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Venous malformations and hemangiomas of the skeletal muscle are separate entities with different clinical presentation, histology, and imaging findings. Recent advances in the field of vascular anomalies and current efforts in the unification of terminology by the International Society for the Study of Vascular Anomalies are pivotal in understanding and differentiating intramuscular venous malformations and intramuscular capillary-type hemangioma. Fibroadipose vascular anomaly is another recently defined vascular anomaly affecting the skeletal muscle, with a distinct clinical presentation, histology, and imaging appearance. These 3 distinct vascular anomalies are reviewed and their histologic features, clinical presentation, imaging appearance, and treatment are discussed.
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Affiliation(s)
- Ricardo Restrepo
- Department of Pediatric Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA
| | - Rachel Pevsner
- Department of Pediatric Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA
| | - Liset Pelaez
- Department of Pathology, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA
| | - Domen Plut
- Department of Pediatric Radiology, Clinical Radiology Institute, University Medical Centre, Ljubljana, Zaloska cesta 7, Ljubljana 1000, Slovenia
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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13
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Carabin J, Bouhamama A, Vaz G, Cuinet M, Ricoeur A, Thibaut A, Beji H, Mastier C, Pilleul F. Percutaneous Cryoablation of Symptomatic Intramuscular Venous Malformation. J Vasc Interv Radiol 2020; 31:558-563.e3. [PMID: 32113799 DOI: 10.1016/j.jvir.2019.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/04/2019] [Accepted: 10/08/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of cryoablation for venous malformations. MATERIALS AND METHODS A total of 12 patients with symptomatic intramuscular venous malformations who underwent percutaneous cryoablation between February 2015 and December 2018 were retrospectively studied. The mean age was 42 y (range, 19-58 y). Pain was reported by 11 patients (92%) and swelling by 1 (8%). Pain was assessed with a visual analog scale (VAS) before and after cryoablation. Lesion size was followed with magnetic resonance (MR) imaging at baseline and at 3-mo follow-up. Median initial VAS score was 7 (range, 0-8), and median initial lesion size was 32.5 mm (range, 11-150 mm). RESULTS The median VAS score at 3 mo was 0 (range, 0-4), and the median lesion size at 3 mo was 0 mm (range, 0-142 mm). Eleven of 12 patients reported an improvement in their pain. MR imaging control showed a treatment scar with no residual lesion in 5 patients and decreased lesion size in 4. No major complications were reported. One minor hematoma and 1 small myositis were noted as defined by Society of Interventional Radiology criteria. CONCLUSIONS Percutaneous cryoablation is effective and safe for treatment of symptomatic intramuscular venous malformations, with improvement of symptoms.
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Affiliation(s)
- Jonathan Carabin
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France.
| | - Amine Bouhamama
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Gualter Vaz
- Department of Orthopedic Surgery, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Marie Cuinet
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Alexis Ricoeur
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Antoine Thibaut
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Hedi Beji
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Charles Mastier
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Frank Pilleul
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
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Ryu JY, Eo PS, Lee JS, Lee JW, Lee SJ, Lee JM, Lee SY, Huh S, Kim JY, Chung HY. Surgical approach for venous malformation in the head and neck. Arch Craniofac Surg 2019; 20:304-309. [PMID: 31658794 PMCID: PMC6822077 DOI: 10.7181/acfs.2019.00416] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 10/14/2019] [Indexed: 12/14/2022] Open
Abstract
Background Treatment for venous malformations of the head and neck includes sclerotherapy, surgical resection, or a combination of both. Surgical resection can remove or reduce the volume of vascular lesions; however, surgery can cause postoperative scarring and potential surgical complications. This study sought to determine the effectiveness of surgery for the treatment of venous malformations of the head and neck. Methods A retrospective review of the medical records of patients who received surgeries for venous malformations of the head and neck from January 2011 to July 2019 was performed. Using clinical photographs, preoperative and postoperative Doppler ultrasonography, outpatient clinic records, and operation records, the postoperative result and complications were evaluated for each case. Results Among patients who visited our vascular anomalies clinic, 43 patients (ratio of male to female= 24:19) received surgeries for venous malformations of the head and neck. Twenty-nine patients had undergone surgery only, five patients received sclerotherapy after surgery, and nine patients received surgery after preoperative sclerotherapy. In postoperative evaluations, the result was excellent in 24 patients, good in 18 patients, and poor in one patient. Four patients experienced a recurrence of lesions with lagophthalmos, drooping of the corner of the mouth, partial wound necrosis, and scar widening found in one patient each. Conclusion Because the head and neck region is the most exposed area in the body, more active implementation of surgical treatments with or without sclerotherapy is essential to reduce the functional and cosmetic impairments associated with venous malformations.
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Affiliation(s)
- Jeong Yeop Ryu
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Pil Seon Eo
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jeong Woo Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seok Jong Lee
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong Min Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Yub Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Huh
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Yun Chung
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Affiliation(s)
- Meerim Park
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, Goyang, Korea
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Padia R, Bly R, Bull C, Geddis AE, Perkins J. Medical Management of Vascular Anomalies. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2018; 4:221-236. [PMID: 30505648 PMCID: PMC6261360 DOI: 10.1007/s40746-018-0130-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW This chapter will summarize the most recent literature regarding the current state of medical treatment for vascular anomalies. RECENT FINDINGS Research into the biology of these anomalies has strengthened our understanding of each anomaly and has helped to pave the way for more tailored treatment options involving molecular and/or genetic targets. SUMMARY While there is still a role for surgical intervention, medical therapies that target the etiology of vascular anomalies may represent an alternative or adjunctive approach in the management of these lesions.
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Affiliation(s)
- Reema Padia
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
| | - Randall Bly
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
| | - Catherine Bull
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
| | - Amy E. Geddis
- Cancer and Blood Disorders Clinic, Seattle Children's Hospital, Seattle, Washington, United States
| | - Jonathan Perkins
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
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Intramuscular Venous Malformations of the Upper and Lower Limbs: Indications and Outcomes of Sclerotherapy. Cardiovasc Intervent Radiol 2018; 41:1505-1512. [PMID: 29850938 DOI: 10.1007/s00270-018-1997-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/21/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Multiple treatment options have been described for intramuscular venous malformations (VMs) of the limbs. At the current time, there are no clear management guidelines. The aim was to evaluate efficacy and safety of sclerotherapy in this type of VMs. MATERIALS AND METHODS This is a single-center, retrospective review of patients treated for extremity intramuscular VMs between January 2013 and June 2017. The primary outcomes were the improvement of symptoms self-assessed by questionnaires, and the reduction in VM size measured by magnetic resonance (MRI). RESULTS Sclerotherapy was performed in 81 patients with extremity intramuscular VMs. The sclerosing agent was ethanol in 46 cases (56.8%), polidocanol in 27 cases (33.3%), a combination of both in 8 cases (9.9%). The mean follow-up was 26 months (range 3-52). Overall quality of life was improved in 62 patients (76.5%). The postoperative MRI showed a minimum change of VM size in 68 patients (83.9%). A major complication (peripheral nerve injury) was observed in 1 case (1.2% of patients, 0.5% of procedures). Minor complications occurred in 9 cases (11.1% of patients, 4.1% of procedures). CONCLUSIONS Sclerotherapy is a low-invasive, effective and safe treatment for intramuscular VMs of the extremities. It induces a significant improvement in symptoms, also when the VM size is unchanged. LEVEL OF EVIDENCE Level 4, Case Series.
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Abstract
BACKGROUND Vascular malformations isolated to skeletal muscles are rare and often debilitating due to pain and very challenging to treat. Multi-modal management options include compression garments, medical therapy, sclerotherapy, and surgical resection. METHODS A retrospective review of patients who underwent sclerotherapy for intramuscular venous malformations (IVM) between 2008 and 2016 was performed. Demographics, indications, and clinical follow-up were analyzed. RESULTS Twenty patients underwent sclerotherapy for IVM. Six males and 14 females underwent 58 procedures. All patients presented with pain and were treated initially with compression garments. Median age at first treatment was 13years (+/- 5.06years). Initial protocol consisted of 2 sclerotherapy procedures with sodium tetradecyl sulfate (STS) within a 2-3month interval. Median volume of the lesion was 40cm3 (+/- 28.7), mostly located in the lower extremities (15/20). Median number of treatments was 2 (+/- 1.95). Treatment prior to puberty resulted in a median symptom-free time of 4years (+/- 2.18), while after puberty resulted in a symptom-free time of 2years (+/- 2.28). Two patients had an underlying coagulopathy and were admitted for observation and peri-procedural Lovenox. No procedure related complications were noted with a median follow-up of 4years (+/- 2.27). CONCLUSION IVMs are rare but can be incapacitating secondary to pain. Sclerotherapy is a useful minimally invasive procedure generally requiring at least two consecutive treatments. Treatment of patients prior to puberty appears to provide a more durable result, and surgical resection may be avoided. TYPE OF STUDY retrospective. LEVEL OF EVIDENCE IV.
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Abstract
INTRODUCTION Intramuscular hemangioma (IMH) is a rare congenital soft tissue tumor. Here, we report a case of IMH patient who had undergone several surgeries and other treatments that were all ineffective before he visited us. CLINICAL FINDINGS This IMH patient was a 16-yearold male who was born with a tumor of unknown size in his right hand and forearm. On physical examination, the tumor and skin flap complex was seen with a size of 14 cm_12 cm in his right hand, and the multiple postoperative scars were shown on his right hand and forearm. The patient was not able to raise his right shoulder, and the ranges of motion of his right elbow, wrist, and finger were almost zero degrees. INTERVENTIONS Considering that the tumor had been surgically excised for several times and the multiple recurrences had affected adversely his daily life, an amputation of his right hand, forearm, and the part of his right arm was performed. DIAGNOSES The pathological examination confirmed the diagnosis of IMH. OUTCOMES After the amputation surgery, the patient gained a functional recovery and the tumor did not recur during the 2 years after the surgery. CONCLUSION A treatment of choice should be personalized according to an IMH patient's overall situation. For an IMH patient like our case with a history of multiple tumor recurrences, we suggest that an amputation surgery should be performed as early as possible to avoid the repeated, but ineffective surgical excisions and the unnecessary sufferings.
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Affiliation(s)
- Hui Lu
- Department of Hand Surgery, the First Affiliated Hospital, College of Medcine, Zhejiang University
| | - Qiang Chen
- Department of Hand Surgery, Zhejiang Province People's Hospital, Hangzhou, Zhejiang Province, P. R. China
| | - Hu Yang
- Department of Hand Surgery, the First Affiliated Hospital, College of Medcine, Zhejiang University
| | - Hui Shen
- Department of Hand Surgery, the First Affiliated Hospital, College of Medcine, Zhejiang University
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