Efficacy and safety of DSA-guided percutaneous sclerotherapy for venous malformations of penile region in children

Effect of interventional embolization based on absolute ethanol for peripheral arteriovenous malformations

BACKGROUND

Interventional embolization schedules based on absolute ethanol are usually used for peripheral arteriovenous malformations (PAVMs), and clinicians often choose the scheme according to the classification.

AIM

To evaluate different interventional embolization schedules based on absolute ethanol for PAVMs.

METHODS

A retrospective study was performed of 165 patients with PAVMs treated with interventional embolization based on absolute ethanol in Henan Provincial People's Hospital from January 2018 to May 2021. PAVMs were classified as type II (n = 67), type III (n = 81) and type IV (n = 17) according to the Yakes classification system, including 123 maxillofacial, 13 trunk and 29 limbs. Effectiveness of embolization was based on PAVM devascularization on angiography: 100% (total), 90%~99% (near-total), 70%~90% (substantial), 30%~70% (partial) and 0%~30% (failure).

RESULTS

PAVMs were classified as type II (n = 67), type III (n = 81) and type IV (n = 17) according to the Yakes classification system, including 123 maxillofacial (74.55%), 13 trunk (7.88%) and 29 limbs (17.58%). There are statistical differences in the angiographic outcomes among different Yakes classification and between different methods (P < 0.05), and there was a statistical difference in the failure rates among different Yakes classification (P < 0.05).

CONCLUSIONS

PAVMs occur maxillofacial usually, and Type II can achieve better effect by spring coil and absolute ethanol, while Type III and Type IV have no ideal effect by Pingyangmycin + iodized oil + PVA + absolute ethanol and spring coil + absolute ethanol, respectively. Both the two happen to be complications, and wound accounts the highest.

Comparative analysis of the efficacy and safety of different methods for injecting polidocanol in the treatment of venous malformations

OBJECTIVE

To compare and analyze the efficacy and safety of different methods for injecting polidocanol in the treatment of venous malformations.

METHODS

The medical records of patients with venous malformations in our hospital from April 2021 to April 2023 were analyzed retrospectively, and they were divided into control group (n = 38) and observation group (n = 20) according to different treatment methods. Control group was injected with polidocanol under ultrasound guidance, while observation group was injected with polidocanol under digital subtraction angiography (DSA) monitoring. Therapeutic effects of observation group and control group after 3-6 months of treatment were compared and analyzed, and complications that can be used to reflect the safety of treatment in two groups were collected and recorded.

RESULTS

After treatment, the total effective rates of observation group and control group were 97.37% (37/38) and 75.00% (15/20) respectively, with significant differences (both p < .05). After 3-6 months of treatment, 13 complications occurred in observation group, while 16 occurred in control group. The number of complications in observation group was 6, with an incidence rate of 15.78%; while that in control group was 9, with an incidence rate of 45.00%, with a significant difference (p < .05). There were no significant differences among other baseline data, age and complications between two groups (all p > .05).

CONCLUSION

Injection of polidocanol in patients with venous malformations under DSA monitoring was more effective and safer.

Intralesional injection of bleomycin in the management of low flow vascular malformations: Results and factors affecting the outcome

OBJECTIVE

Ethanol has been a commonly used sclerosant for low-flow vascular malformations, but it carries a high risk of complications. Bleomycin has been recently introduced as a potentially effective treatment. The aim of this study was to evaluate the safety and efficacy of bleomycin intralesional injection for the treatment of low-flow vascular malformations and determine the different factors affecting the outcome.

PATIENTS AND METHODS

A total of fifty patients with low-flow vascular malformations were enrolled in the study between April 2020 and March 2022. All patients underwent preoperative duplex ultrasound and magnetic resonance angiography. The procedure was performed under ultrasound and fluoroscopic guidance. All patients were assessed for the objective improvement, ultrasound assessment, and patient-reported outcome.

RESULTS

The overall rate of objective improvement was 79.53% (78.05% in venous and 87.5% in lymphatic malformations), whereas 81.25% of the patients showed a degree of size reduction or complete obliteration on postoperative ultrasound. The patient-reported outcome analysis showed a statistically significant improvement in the mean score for the pain, overall symptoms, and self-confidence. On regression analysis, the only factor associated with poor objective outcome was diffuse lesions (ill-defined or extending in more than one body region or one compartment). No major complications were recorded.

CONCLUSIONS

Bleomycin intralesional injection is a safe and effective treatment for low-flow vascular malformations.

Surgical Management of Arteriovenous Malformation of the Penis in an Adolescent Boy: A Case Report and Review of the Literature

Arteriovenous malformations (AVMs) are common benign lesions, present at birth. Although they may occur anywhere in the body, usually they are found on the head, the neck, and the extremities. AVMs of the glans penis are very rare. Only a few have been reported in the literature, and thus, a definitive treatment does not exist. We herein report our experience of treating an AVM of the glans penis with surgical excision and plastic reconstruction of the glans, with the application of transplant tissue from the inner skin of the prepuce.

The rare complication of vascular malformations of the limb after sclerotherapy: a report of 3 cases and brief literature review

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.

Venous malformation of the penis treated with a combined Nd:YAG laser and sclerotherapy technique

Venous malformations are the commonest vascular anomalies and can be found everywhere in the body. Those of the external genitalia are quite rare. Although they can be small, they may give rise to psychological discomfort and functional impairment and their management can be delicate and challenging. We present a case of a large and infiltrating venous malformation of the glans penis successfully treated with a combined strategy using sclerotherapy and Nd:YAG laser.

Aspectos prácticos en la patología venosa del pene

El objetivo del presente artículo es mostrar una serie de alteraciones peneanas que, aunque frecuentes en la consulta de medicina sexual, son minimizadas, la mayoría de las veces por desconocimiento de los terapeutas, aunque para los pacientes que las padecen sean genuinas tragedias personales. Hemos revisado la literatura disponible sobre un grupo de seis patologías venosas especificas del pene que configuran el grupo más representativo. Se incluyen las frecuentes e indolentes venas superficiales tortuosas, los cirsoceles o flebectasias, las fugas venosas dorsales, que suelen ser una patología congénita, las deformantes malformaciones venosas del glande, la desconcertante y enigmática enfermedad de Mondor, y las fístulas arteriovenosas, con su riesgo de priapismo de alto flujo implícito. Todas se consideran alteraciones patológicas que requieren intervenciones menores en su tratamiento, excepto ciertos casos de fugas venosas y de fístulas, cuyo manejo es invasivo, y que, en conjunto, buscan una mejor comprensión de los hallazgos cotidianos en este órgano.