1
|
Ruthberg JS, Susarla SM, Bly RA. Head and Neck Vascular Anomalies in Children. Oral Maxillofac Surg Clin North Am 2024; 36:355-368. [PMID: 38632013 DOI: 10.1016/j.coms.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Craniomaxillofacial vascular anomalies encompass a diverse and complex set of pathologies that may have a profound impact on pediatric patients. They are subdivided into vascular tumors and vascular malformations depending on biological properties, clinical course, and distribution patterns. Given the complexity and potential for leading to significant functional morbidity and esthetic concerns, a multidisciplinary approach is generally necessary to optimize patient outcomes. This article reviews the etiology, clinical course, diagnosis, and current management practices related to vascular anomalies in the head and neck.
Collapse
Affiliation(s)
- Jeremy S Ruthberg
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, 1959 Northeast Pacific Street, UW Box 356515, Seattle, WA 98195, USA.
| | - Srinivas M Susarla
- Division of Craniofacial Plastic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, OB.9.520, Seattle, WA 98105, USA
| | - Randall A Bly
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, 1959 Northeast Pacific Street, UW Box 356515, Seattle, WA 98195, USA; Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, 1959 Northeast Pacific Street, UW Box 356515, Seattle, WA 98195, USA
| |
Collapse
|
2
|
Marcelin C, Dubois J, Kokta V, Giroux MF, Danino MA, Mottard S, Soulez G. Soft tissue vascular tumor-like lesions in adults: imaging and pathological analysis pitfalls per ISSVA classification. Insights Imaging 2024; 15:135. [PMID: 38853199 PMCID: PMC11162993 DOI: 10.1186/s13244-024-01712-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/01/2024] [Indexed: 06/11/2024] Open
Abstract
OBJECTIVES To compare the magnetic resonance imaging (MRI) and Doppler ultrasound (DUS) findings with the pathological findings of soft tissue vascular tumors (STVTs) according to the 2018 ISSVA (International Society for the Study of Vascular Anomalies) classification to differentiate vascular tumors from vascular malformations. METHODS This retrospective study included patients with STVTs who underwent contrast-enhanced MRI and pathological analysis at our hospital between 2010 and 2020. The presumptive diagnosis based on the on-site imaging and histological analysis was compared with imaging and histological analysis conducted off-site utilizing the ISSVA criteria. RESULTS This study included 31 patients with 31 vascular tumors located in the head and neck (n = 3), trunk (n = 2), and extremities (n = 26). The off-site pathological analysis confirmed benign vascular tumors in 54.8% of cases (non-involuting congenital hemangioma: 35.5%; epithelioid hemangioma: 13%; pyogenic granuloma: 3%; and spindle cell hemangioma: 3%). Based on the off-site histological analysis, 25.8% were reclassified as having a vascular malformation whereas three had other benign lesions. Only phleboliths were associated with a vascular malformation (p = 0.03). The concordance between off-site MRI and pathological findings was fair (k = 0.3902 (0.0531-0.7274)), whereas that between on-site and off-site pathological analyses was poor (k = -0.0949 (-0.4661 to 0.2763)). CONCLUSION Benign vascular tumors have non-specific imaging features on imaging with some overlap with atypical vascular malformations. Therefore, histological analysis is recommended. Imaging and pathological analyses should be performed in accordance with the ISSVA classification to minimize inter-observer discrepancies. CRITICAL RELEVANCE STATEMENT Imaging features of benign vascular tumors on MRI are non-specific, leading to discrepancies with pathological findings and potential overlap with atypical vascular malformations. Imaging and histological analyses should be performed in accordance with ISSVA guidelines to improve patient management. KEY POINTS The imaging features of benign vascular tumors are non-specific. Histological analysis is recommended for soft tissue vascular tumors in adults. Analyses of soft tissue vascular tumors should be performed in accordance with ISSVA guidelines.
Collapse
Affiliation(s)
- C Marcelin
- Department of Adult Diagnostic and Interventional Radiology, Hôpital Pellegrin place Amélie-Raba-Léon, 33076, Bordeaux, France.
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.
| | - J Dubois
- Department of Radiology, Radiation Oncology and Nuclear Medecine, Université de Montreal, Montreal, QC, Canada
- Department of Pediatric Radiology, CHU-Sainte Justine, Montréal, QC, Canada
| | - V Kokta
- Department of Pathology, CHU-Sainte Justine, Montréal, QC, Canada
| | - M F Giroux
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
- Department of Radiology, Radiation Oncology and Nuclear Medecine, Université de Montreal, Montreal, QC, Canada
| | - M A Danino
- Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - S Mottard
- Department of Surgery, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSS) de l'est de L'ile de Montréal, Montréal, QC, Canada
| | - G Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
- Department of Radiology, Radiation Oncology and Nuclear Medecine, Université de Montreal, Montreal, QC, Canada
| |
Collapse
|
3
|
Armstrong D, Owens R, Carlson T, Ching B. Retained foreign body misdiagnosed as a low flow vascular malformation: A case report. Radiol Case Rep 2024; 19:164-171. [PMID: 37954673 PMCID: PMC10637870 DOI: 10.1016/j.radcr.2023.10.007] [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: 08/21/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023] Open
Abstract
A 21-year-old woman presented with 1 year history of progressive dorsal right foot pain with no recollection of trauma. The physical exam did not reveal any unusual appearance to the plantar or dorsal skin surfaces. Specifically, no scars were seen. Foot radiographs were unremarkable. The presumed etiology after Doppler ultrasound (US) and MRI was a likely venous or venolymphatic malformation. She received 2 rounds of sclerotherapy 12 months apart with transient symptomatic clinical improvement. After the second sclerotherapy treatment, repeat MRI revealed dorsal extension of the lesion with skin involvement, prompting referral for surgical intervention. At surgery, a 3 cm wood splinter was found surrounded by granulation tissue. After showing the patient the resected splinter, she recalled stepping on a wooden broomstick that punctured the bottom of her foot in her childhood. She stated she also remembered pulling a splinter out of her foot. This case demonstrates the unusual and rare appearance of a chronic retained foreign body creating a cystic lesion in the foot presumed to be a low-flow vascular malformation on US and MRI.
Collapse
Affiliation(s)
- Daniel Armstrong
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Robert Owens
- Department of Radiology, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI, 96859, USA
| | - Terri Carlson
- Department of Plastic and Reconstructive Surgery, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI, 96859, USA
| | - Brian Ching
- Department of Radiology, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI, 96859, USA
| |
Collapse
|
4
|
Fraissenon A, Fortin F, Durous V, Chauvel-Picard J, Gleizal A, Viremouneix L, Cabet S, Guibaud L. Percutaneous Sclerotherapy of Large Venous Malformations Using Consecutive Polidocanol and Bleomycin Foam: MR Imaging Volumetric and Quality-of-Life Assessment. J Vasc Interv Radiol 2024; 35:127-136.e1. [PMID: 37704038 DOI: 10.1016/j.jvir.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/23/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE To retrospectively evaluate sclerotherapy using consecutive polidocanol and bleomycin foam (CPBF) for large untreated venous malformations (VMs) and/or those resistant to prior treatment. MATERIALS AND METHODS This retrospective study included all patients treated with CPBF for untreated VMs larger than 10 mL and/or refractory to treatment between May 2016 and October 2019. Baseline and follow-up VM volumes were measured on fat-suppressed T2-weighted magnetic resonance (MR) imaging. Outcome was evaluated on postprocedural MR imaging volumetry and by a retrospective survey assessing clinical response and adverse events. Imaging response was considered good for volume reduction from 50% to 70% and excellent for volume reduction ≥70%. Symptoms and quality-of-life (QoL) scores were compared before and after CPBF sclerotherapy. RESULTS Forty-five patients (mean age, 16 years; range, 1-63 years; 25 males) with 57 VMs were analyzed and treated by 80 sclerotherapy. Sixty percent (27 of 45) of patients had undergone prior treatment for VM. Median VM volume was 36.7 mL (interquartile range, 84 mL) on pretherapy MR imaging. Good and excellent results after the last sclerotherapy were achieved in 36% (16 of 45) and 29% (13 of 45) of patients, respectively, corresponding to a decrease of >50% in 60% (34 of 57) of VMs. QoL score increased by at least 3 points, regardless of initial symptoms. Most patients did not desire additional sclerotherapy owing to near complete symptomatic relief, even for patients who did not achieve a good response. Swelling, pain, and motor impairment scores significantly improved after CPBF. Adverse events included fever (44%, 15 of 34) and nausea/vomiting (29%, 10 of 34). CONCLUSIONS CPBF sclerotherapy represents an effective therapy for large and/or refractory VMs with minimal adverse events.
Collapse
Affiliation(s)
- Antoine Fraissenon
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France; Service de Radiologie Mère-Enfant, Hôpital Nord, Saint Etienne, France
| | - Francis Fortin
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France; Département d'imagerie médicale, Hôpital Sainte-Justine, Montréal, Québec, Canada
| | - Vincent Durous
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France
| | - Julie Chauvel-Picard
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France; Service de chirurgie cranio-maxillo-faciale et plastique pédiatrique, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France
| | - Arnaud Gleizal
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France; Service de chirurgie cranio-maxillo-faciale et plastique pédiatrique, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France
| | - Loïc Viremouneix
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France
| | - Sara Cabet
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France
| | - Laurent Guibaud
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France.
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Xu Z, Yang Y, Ge C, Tai M, Chen T, Zhang Q, Li K, Yang X, Qin Z. Venous malformations of the lower limb with severe localized intravascular coagulopathy treated with radiofrequency ablation and resection. J Thromb Thrombolysis 2023:10.1007/s11239-023-02822-w. [PMID: 37184627 DOI: 10.1007/s11239-023-02822-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] [Accepted: 04/22/2023] [Indexed: 05/16/2023]
Abstract
Diffuse venous malformations (VMs) are relatively rare, especially the lesions locting special anatomical sites, and they are prone to casuse localized intravascular coagulopathy (LIC). Diffuse VMs can also cause bleeding and life-threatening disseminated intravascular coagulopathy (DIC) from trauma, surgery, and improper treatments. Thus, the treatment of diffuse VMs with LIC is quite tough. We report of a diffuse VMs with severe LIC that was treated with the combined use of minimally invasive treatment and open surgery.
Collapse
Affiliation(s)
- Zhenguo Xu
- Special Department of Vascular Anomalies, LinYi Tumor Hospital, Linyi, Shandong, 276000, P.R. China
| | - Yaowu Yang
- Department of Head and Neck Tumor Surgery, School of Stomatology, Air Force Military Medical University, Xi'an, Shanxi710000, P.R. China
| | - Chunxiao Ge
- Special Department of Vascular Anomalies, LinYi Tumor Hospital, Linyi, Shandong, 276000, P.R. China
| | - Maozhong Tai
- Special Department of Vascular Anomalies, LinYi Tumor Hospital, Linyi, Shandong, 276000, P.R. China
| | - Tao Chen
- Special Department of Vascular Anomalies, LinYi Tumor Hospital, Linyi, Shandong, 276000, P.R. China
| | - Qiuqi Zhang
- Department of Breast Diseases, LinYi Tumor Hospital, Ward 1, Linyi, Shandong, 276000, P.R. China
| | - Kelei Li
- Special Department of Vascular Anomalies, LinYi Tumor Hospital, Linyi, Shandong, 276000, P.R. China
| | - Xia Yang
- Department of Head and Neck Tumor Surgery, School of Stomatology, Air Force Military Medical University, Xi'an, Shanxi710000, P.R. China
| | - Zhongping Qin
- Special Department of Vascular Anomalies, LinYi Tumor Hospital, Linyi, Shandong, 276000, P.R. China.
| |
Collapse
|
7
|
Arasakumar DRB, Pang C, Evans N, Papadopoulou A, Khalifa M, Tsui J, Hamilton G, Brookes J, Lim CS. Efficacy and safety of foam sclerotherapy with sodium tetradecyl sulfate as preferred sclerosant of venous malformations based on experience from a single specialist center. J Vasc Surg Venous Lymphat Disord 2023; 11:379-388. [PMID: 36328136 DOI: 10.1016/j.jvsv.2022.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/13/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We have assessed the efficacy and safety of interventional therapy for venous malformations (VMs), with foam sclerotherapy as the treatment of choice according to our experience at a single specialist center. METHODS All the patients with VMs who had undergone interventional therapy (ie, embolo-sclerotherapy and/or open surgery) from January 1, 2015 to December 31, 2019 were identified through a prospective database. The VM types were classified according to the Puig classification. The outcome measures assessed included the efficacy and complications. The former was divided into four groups: no response, mild response, moderate response, and complete response. The complications were defined as any tissue or functional damage, distal embolization, or tissue reaction. The continuous variables were compared using the analysis of variance F test, and discrete variables were analyzed using the χ2 tests. P values < .05 were considered statistically significant. RESULTS A total of 207 patients were included. Puig type I lesions were significantly less likely to have received foam sclerotherapy using sodium tetradecyl sulfate (STS) 3% (P ≤ .001) and more likely to have been surgically excised (P ≤ .001). At the patient's first procedure during the study period, the volumes of foam STS 3% were significantly different across all types of VM (P ≤ .001). The patients with type I VMs had received a lower volume of STS 3% compared with those with type II and III VMs. The efficacy outcome categories were significantly different across all types of VMs (P ≤ .001). Overall, only 14 patients (6.8%) had reported no improvement in efficacy, and 38 patients (18%) had not attended follow-up. Therefore, 154 patients (74.8%) had experienced some form of efficacious outcome. Ten patients (4.8%) had developed complications such as hematoma, thrombophlebitis, and ulceration. The incidence of complications differed significantly across the categories (P = .030), with more complications reported for those with type I VMs. CONCLUSIONS We found that intervention with foam sclerotherapy using STS 3% is clinically effective and safe for patients with VMs and was most successful for those with Puig type I and II VMs.
Collapse
Affiliation(s)
| | - Calver Pang
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Nicholas Evans
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Anthie Papadopoulou
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Mohamed Khalifa
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Janice Tsui
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - George Hamilton
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Jocelyn Brookes
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Department of Interventional Radiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Chung Sim Lim
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, London, United Kingdom.
| |
Collapse
|
8
|
Altenbernd J, Kutta F, Forsting M, Theysohn J, Rohde S. Results of interventional treatment of peripheral slow-flow malformations. CVIR Endovasc 2023; 6:5. [PMID: 36763217 PMCID: PMC9918669 DOI: 10.1186/s42155-023-00352-3] [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: 10/20/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND In recent years sclerotherapy has increasingly become the treatment of choice for peripheral slow-flow malformations. However, the long-term effectiveness of sclerotherapy is still a matter of debate, especially when it comes to new sclerosing agents like polidocanol. This study aims at gathering further information concerning its long-term effectiveness and safety. RESULTS Most patients reported a reduction of symptoms which include pain (57,7%), swelling (65,4%) and functional impairment (60%). Cosmetic complaints were less likely to be reduced by sclerotherapy (44,4%). In most cases a relief of symptoms was stable for many years, especially after several consecutive treatment sessions. Complication rates were comparably low, with only 2 patients requiring additional treatment at hospital and no lasting damages. (…) (7) Most patients (70,9%) were at least partially satisfied with the treatment. Satisfaction was closely linked to a partial or complete relief of symptoms (p = 0.001). CONCLUSION Sclerotherapy is a promising way of treating slow-flow-malformations. Polidocanol has proved to be a save sclerosing agent. The reduction of major symptoms was substantial in most cases and lasted for many years.
Collapse
Affiliation(s)
- Jens Altenbernd
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 22, 45122, Essen, Germany.
| | - Felix Kutta
- grid.410718.b0000 0001 0262 7331Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 22, 45122 Essen, Germany
| | - Michael Forsting
- grid.410718.b0000 0001 0262 7331Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 22, 45122 Essen, Germany
| | - Jens Theysohn
- grid.410718.b0000 0001 0262 7331Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 22, 45122 Essen, Germany
| | - Stefan Rohde
- Radiology and Neuroradiology, Klinikum Dortmund gGmbH, Dortmund, Germany
| |
Collapse
|
9
|
Schmidt VF, Masthoff M, Goldann C, Brill R, Sporns PB, Segger L, Schulze-Zachau V, Takes M, Köhler M, Deniz S, Öcal O, Mansour N, Ümütlü MR, Shemwetta MD, Baraka BM, Mbuguje EM, Naif AA, Ukweh O, Seidensticker M, Ricke J, Gebauer B, Wohlgemuth WA, Wildgruber M. Multicentered analysis of percutaneous sclerotherapies in venous malformations of the face. Front Med (Lausanne) 2022; 9:1066412. [PMID: 36582288 PMCID: PMC9792481 DOI: 10.3389/fmed.2022.1066412] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives To evaluate the safety and outcome of image-guided sclerotherapy for treating venous malformations (VMs) of the face. Materials and methods A multicenter cohort of 68 patients with VMs primarily affecting the face was retrospectively investigated. In total, 142 image-guided sclerotherapies were performed using gelified ethanol and/or polidocanol. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Sub-analyses of complication rates depending on type and injected volume of the sclerosant as well as of pediatric versus adult patient groups were conducted. Results Mean number of procedures per patient was 2.1 (±1.7) and mean follow-up consisted of 8.7 months (±6.8 months). Clinical response (n = 58) revealed a partial relief of symptoms in 70.7% (41/58), 13/58 patients (22.4%) presented symptom-free while only 4/58 patients (6.9%) reported no improvement. Post-treatment imaging (n = 52) revealed an overall objective response rate of 86.5% (45/52). The total complication rate was 10.6% (15/142) including 4.2% (7/142) major complications, mostly (14/15, 93.3%) resolved by conservative means. In one case, a mild facial palsy persisted over time. The complication rate in the gelified ethanol subgroup was significantly higher compared to polidocanol and to the combination of both sclerosants (23.5 vs. 6.0 vs. 8.3%, p = 0.01). No significant differences in complications between the pediatric and the adult subgroup were observed (12.1 vs. 9.2%, p = 0.57). Clinical response did not correlate with lesion size reduction on magnetic resonance imaging (MRI). Conclusion Image-guided sclerotherapy is effective for treating VMs of the face. Clinical response is not necessarily associated with size reduction on imaging. Despite the complex anatomy of this location, the procedures are safe for both adults and children.
Collapse
Affiliation(s)
- Vanessa F. Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany,*Correspondence: Vanessa F. Schmidt,
| | - Max Masthoff
- Clinic for Radiology, Münster University Hospital, Münster, Germany
| | - Constantin Goldann
- Clinic and Policlinic of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Peter B. Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Segger
- Department of Radiology, Charité – University Medicine Berlin, Berlin, Germany
| | - Victor Schulze-Zachau
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Martin Takes
- Department of Interventional Radiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Michael Köhler
- Clinic for Radiology, Münster University Hospital, Münster, Germany
| | - Sinan Deniz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nabeel Mansour
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Mwivano Dunstan Shemwetta
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Balowa Musa Baraka
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eric M. Mbuguje
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Azza A. Naif
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ofonime Ukweh
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania,Department of Radiology, University of Calabar, Calabar, Nigeria
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité – University Medicine Berlin, Berlin, Germany
| | - Walter A. Wohlgemuth
- Clinic and Policlinic of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
10
|
Ganesan A, Hegde AI, Ghosh TS, Chaudhry K. Venolymphatic malformation of tongue: a prompt life saving intervention. BMJ Case Rep 2022; 15:e252437. [PMID: 36450418 PMCID: PMC9717346 DOI: 10.1136/bcr-2022-252437] [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: 12/02/2022] Open
Abstract
Venolymphatic malformations (VLMs) of the head and neck can have varied clinical presentation with associated complications. Timely diagnosis and treatment is warranted to curb the morbidity and obtain satisfactory outcomes. We present the case of a male patient in his early 20s with VLM of the tongue who received precise interventions which were executed with active contributions from a team of anaesthesiologists, interventional radiologists, oral and maxillofacial surgeons and intensivists. We highlight the importance of an immediate, comprehensive and multimodal treatment approach for VLMs of the maxillofacial region.
Collapse
Affiliation(s)
- Aparna Ganesan
- Oral & Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
| | - Adarsh Ishwar Hegde
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Tushar Suvra Ghosh
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Kirti Chaudhry
- Additional Professor, Oral & Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
| |
Collapse
|
11
|
Nichat V, Shenouda N, Koujak K, Zwicker K, Barrowman N, Bijelic V, Shapira-Zaltsberg G. Clinical and Radiological Correlation of Low Flow Vascular Malformation Treated With Percutaneous Sclerotherapy. Can Assoc Radiol J 2022; 74:415-421. [PMID: 36167492 DOI: 10.1177/08465371221128696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To retrospectively correlate imaging findings post-sclerotherapy of low-flow vascular malformations with clinical outcome. Materials and Methods: We retrospectively evaluated 81 pediatric patients who had sclerotherapy in our department over a 14-year period. Patients with a diagnosis of low-flow vascular malformation, pre and post-treatment ultrasound (US) and clinical follow-up evaluation were included in the study. Exclusion criteria were coexisting high-flow vascular malformations, history of additional surgical or medical treatment to their malformation and large infiltrative lesions difficult to measure on US. Pre and post-treatment sonographic volumes of the malformation were assessed. Changes in volume were categorized into 6- increased volume, stable and volume decrease of 1-25%/26-50%/51-75%/75-100%. Clinical outcomes were categorized into 4 - worse, no change, improved and symptom free. In cases where pre-treatment MRI was available, the estimated malformation volumes in both modalities were correlated using Spearman's rank correlation. The change in sonographic volume was correlated with clinical outcome using Spearman's rank correlation. P-values < .05 were considered significant. Results: Twenty-nine patients were included in the study; 13 with venous malformation (VM), and 16 with lymphatic malformation (LM). Nineteen patients had both pre-treatment US and MRI, showing correlation in volume between the 2 modalities (P < .001). Post-treatment change in volume correlated with clinical outcome for combined venous and LMs (rho = .44, P = .02). No correlation was found when venous (rho = .48, P = .09) and lymphatic (rho = .33, P = .21) malformations were considered separately. Conclusion: Ultrasound can potentially be used as an objective tool in evaluating sclerotherapy treatment response of low-flow vascular malformations in the pediatric population.
Collapse
Affiliation(s)
- Vaibhav Nichat
- Department of Medical Imaging, 27338CHEO, Ottawa, ON, Canada.,University of Ottawa, ON, Canada
| | - Nazih Shenouda
- Department of Medical Imaging, 27338CHEO, Ottawa, ON, Canada.,University of Ottawa, ON, Canada
| | - Khaldoun Koujak
- Department of Medical Imaging, 27338CHEO, Ottawa, ON, Canada.,University of Ottawa, ON, Canada
| | - Kelley Zwicker
- University of Ottawa, ON, Canada.,Department of Pediatrics, 27338CHEO, Ottawa, ON, Canada
| | | | - Vid Bijelic
- Research Institute, 27338CHEO, Ottawa, ON, Canada
| | - Gali Shapira-Zaltsberg
- Department of Medical Imaging, 27338CHEO, Ottawa, ON, Canada.,University of Ottawa, ON, Canada
| |
Collapse
|
12
|
Müller-Wille R, Wildgruber M, Wohlgemuth WA. Interventionelle Behandlungsoptionen bei vaskulären Malformationen. PHLEBOLOGIE 2022. [DOI: 10.1055/a-1808-2566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Klassifikation von vaskulären Malformationen Während Hämangiome zu den vaskulären Tumoren zählen, sind vaskuläre Malformationen angeboren und bilden sich von selbst nicht zurück. Sie werden nach der ISSVA-Klassifikation unterschieden.
Indikation zur Therapie Ziele der Therapie von Gefäßmalformationen sind die Linderung der Symptome, der Organerhalt und die Verhinderung von Krankheitsprogress und Komplikationen.
Nichtinvasive Therapieoptionen Die Kompressionstherapie sowie physiotherapeutische Maßnahmen zählen zu den wichtigsten konservativen Therapieoptionen.
Invasive Therapieoptionen Die chirurgische Resektion, die oberflächliche Lasertherapie und die interventionelle Therapie stellen die invasiven Therapieoptionen dar. Für die Behandlung symptomatischer Gefäßmalformationen stehen mittlerweile zahlreiche minimalinvasive interventionelle Verfahren zur Verfügung. Slow-Flow-Malformationen können relativ komplikationsarm mittels perkutaner Sklerotherapie behandelt werden, die zu einem zeitversetzten entzündlichen Verschluss der Läsion führt. Dysplastische Venen wie die Marginalvene können mittels endoluminaler Verfahren erfolgreich verödet werden. Die zumeist Katheter-gesteuerten Embolisationsverfahren mittels Flüssigembolisaten, Plugs und Coils erlauben den Verschluss von Fast-Flow-Gefäßmalformationen.
Collapse
Affiliation(s)
| | - Moritz Wildgruber
- Klinik und Poliklinik für Radiologie, Klinikum der Ludwig-Maximilians-Universität München
| | | |
Collapse
|
13
|
Yu MW, Han YY, Wang Q, Wang M, Chen Y, Yuan SM. Treatment outcomes and effects of ethanol sclerotherapy on systemic coagulation profile of patients with venous malformation. Ann Vasc Surg 2022; 85:268-275. [PMID: 35395373 DOI: 10.1016/j.avsg.2022.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Venous malformations (VMs) and sclerotherapy may disrupt the normal systemic coagulation profile in individuals. This study investigated a correlation between the clinical efficacy of sclerotherapy in the treatment of VMs and the changes in coagulation indexes to provide data that will inform future application of this therapy. METHODS From September 2019 to September 2020, 61 patients were enrolled in this study to receive sclerotherapy with absolute alcohol. The clinical outcomes and the coagulation profile were assessed. RESULTS Sclerotherapy induced increasing in fibrin (original) degradation products (FDP), D-dimer (D-D). The changes in FDP and D-D level pre- and post-treatment were positively correlated with treatment outcomes. Moreover, repeated treatment with absolute alcohol may restore normal levels of FDP and D-D. CONCLUSIONS Upregulation of FDP and D-D levels after sclerotherapy results in good therapeutic outcomes. Therefore, monitoring changes in FDP and D-D levels in patients with VMs undergoing sclerotherapy may reflect the effects of sclerotherapy.
Collapse
Affiliation(s)
- Ming-Wei Yu
- Department of Plastic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yu-Yu Han
- Department of Plastic Surgery, Jinling Hospital, Jiangsu, China
| | - Qian Wang
- Department of Plastic Surgery, Jinling Hospital, Jiangsu, China
| | - Min Wang
- Department of Plastic Surgery, Jinling Hospital, Jiangsu, China
| | - Yong Chen
- Department of Plastic Surgery, Jinling Hospital, Jiangsu, China
| | - Si-Ming Yuan
- Department of Plastic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Plastic Surgery, Jinling Hospital, Jiangsu, China; Department of Plastic Surgery, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China.
| |
Collapse
|
14
|
Schmidt VF, Olivieri M, Häberle B, Masthoff M, Deniz S, Sporns PB, Wohlgemuth WA, Wildgruber M. Interventional Treatment Options in Children with Extracranial Vascular Malformations. Hamostaseologie 2022; 42:131-141. [PMID: 35263769 DOI: 10.1055/a-1728-5686] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Extracranial vascular malformations vary greatly and belong to the complex field of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic system. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) represents an important guidance for selecting appropriate therapy. Although many of the principles of endovascular treatment, including image-guided sclerotherapy and embolization, are similar in adult and pediatric practice, there are some distinct differences regarding the treatment of vascular malformations of children. Thus, it is crucial to involve longer-term plan about managing these chronic diseases and their impact on a growing child. This review provides a detailed overview over the clinical presentation of venous, lymphatic, and arteriovenous malformations in children and emphasizes the specifics of their interventional treatment options, including distinct pediatric dose limitations and procedure-related side effects.
Collapse
Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany
| | - Martin Olivieri
- Paediatric Thrombosis and Haemostasis Unit, Dr. von Hauner Children's Hospital Munich, Ludwig Maximilian University, Munich, Germany
| | - Beate Häberle
- Department for Pediatric Surgery, Ludwig Maximilian University Hospital, Munich, München, Germany
| | - Max Masthoff
- Clinic of Radiology, University Hospital Muenster, Muenster, Germany
| | - Sinan Deniz
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany
| | - Peter B Sporns
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Diagnostic Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany
| |
Collapse
|
15
|
Larson AS, Brinjikji W, Anderson KR, Tollefson M, Michelle Silvera V, Guerin JB. Imaging of benign cervicofacial vascular anomalies and associated syndromes. Interv Neuroradiol 2021; 28:364-374. [PMID: 34397285 DOI: 10.1177/15910199211034989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Cervicofacial vascular anomalies can result in morbidity, pain, and cosmetic concerns in affected individuals. Each anomaly has its own unique natural history, treatment, and associations with underlying genetic syndromes. For optimal patient care, it is important for the neuroradiologist to accurately recognize and characterize these entities to ensure appropriate treatment and management. In this review, we discuss the general characteristics, classifications, and imaging features associated with the most common vascular anomalies such as hemangiomas, arteriovenous malformations and fistulas, capillary malformations, venous malformations, and lymphatic malformations in the context of associated syndromes. Additionally, we discuss novel imaging techniques that aid in identifying these vascular anomalies.
Collapse
Affiliation(s)
| | - Waleed Brinjikji
- Department of Radiology, 6915Mayo Clinic, USA.,Department of Neurosurgery, 6915Mayo Clinic, USA
| | | | - Megha Tollefson
- Department of Dermatology, 6915Mayo Clinic, USA.,Department of Pediatric & Adolescent Medicine, 6915Mayo Clinic, USA
| | | | | |
Collapse
|
16
|
Tai MZ, Wang YP, Chen T, Li KL, Xu ZG, Ge CX, Qin ZP, Zheng JW. Venous malformations with severe localized intravascular coagulopathy treated with microwave ablation. Vascular 2021; 30:779-786. [PMID: 34144653 DOI: 10.1177/17085381211026829] [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: 01/19/2023]
Abstract
OBJECTIVES To evaluate the safety and feasibility of microwave ablation for treating venous malformations (VMs) with severe localized intravascular coagulopathy (LIC). PATIENTS AND METHODS Data for patients with the diagnosis of VMs coupled with severe LIC who underwent color Doppler-guided microwave dynamic ablation between January 2017 and June 2019 were retrospectively reviewed and analyzed. All patients had previously received sclerotherapy or other treatments with poor outcomes and gradual aggravation of coagulation abnormalities. Microwave treatment with "dynamic ablation" was performed with real-time color Doppler monitoring and was repeated if necessary after 3 months. Low-molecular-weight heparin (LMWH) was used to control consumptive coagulopathy. The therapeutic efficacy including coagulation function and lesion size was evaluated using the four-level scale developed by Achauer. RESULTS Among 15 patients with extensive diffuse or multiple VMs, 10 patients presented with lesions in a single lower extremity, one in both lower extremities and the perineum, one in both upper extremities and the trunk, and three with multiple lesions. The patients underwent a total of 74 microwave ablation sessions, with an average of 4.9 sessions per person. Coagulation abnormalities were temporarily aggravated in 59 sessions within the first seven days post-ablation but improved to grade II (fair) a week later. From six months to three years after the ablation, the lesions improved to grade IV (excellent) in one patient, grade III (good) in six patients, and grade II (fair) in eight patients. Moreover, the coagulation function improved to grade IV in four patients, grade III in eight patients, and grade II in three patients, resulting in an efficiency rate of 80% (12/15). Post-ablation complications included fever, hemoglobinuria, and elevations in aspartate aminotransferase, lactate dehydrogenase, and alanine aminotransferase. The patients with fever and hemoglobinuria recovered after specific therapeutic measures, but elevations in aspartate aminotransferase, lactate dehydrogenase, and alanine aminotransferase recovered spontaneously without further interventions. CONCLUSIONS Ablation coupled with anticoagulation can effectively treat VMs in patients with severe LIC and improve the long-term coagulation function.
Collapse
Affiliation(s)
- Mao-Zhong Tai
- Special Department of Vascular Anomalies, Linyi Cancer Hospital, Linyi, China
| | - Yu-Ping Wang
- Special Department of Vascular Anomalies, Linyi Cancer Hospital, Linyi, China
| | - Tao Chen
- Special Department of Vascular Anomalies, Linyi Cancer Hospital, Linyi, China
| | - Ke-Lei Li
- Special Department of Vascular Anomalies, Linyi Cancer Hospital, Linyi, China
| | - Zhen-Guo Xu
- Special Department of Vascular Anomalies, Linyi Cancer Hospital, Linyi, China
| | - Chun-Xiao Ge
- Special Department of Vascular Anomalies, Linyi Cancer Hospital, Linyi, China
| | - Zhong-Ping Qin
- Special Department of Vascular Anomalies, Linyi Cancer Hospital, Linyi, China
| | - Jia-Wei Zheng
- Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
17
|
Narsinh KH, Gautam A, Baker A, Cooke DL, Dowd CF. Vascular anomalies: Classification and management. HANDBOOK OF CLINICAL NEUROLOGY 2021; 176:345-360. [PMID: 33272404 DOI: 10.1016/b978-0-444-64034-5.00003-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Vascular anomalies are broadly classified into two major categories: vascular tumors and vascular malformations. Most vascular anomalies are caused by sporadic mosaic gene mutations, and recent genetic studies have advanced our understanding of the molecular pathways involved in their pathogenesis. These findings have suggested new therapeutic approaches to vascular anomalies, focusing on their pathogenetic mechanism. This chapter seeks to integrate an improved molecular understanding within the updated classification system of the International Society for Study of Vascular Anomalies. We emphasize the genetic, radiologic, and interventional aspects of diagnosis and management in hopes of allowing improved multidisciplinary collaboration surrounding these complex and interesting anomalies.
Collapse
Affiliation(s)
- Kazim H Narsinh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Ayushi Gautam
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Amanda Baker
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Christopher F Dowd
- Departments of Radiology and Biomedical Imaging, Neurological Surgery, Neurology, and Anesthesia and Perioperative Care, University of California San Francisco, School of Medicine, San Francisco, CA, United States.
| |
Collapse
|
18
|
Budge EJ, Khalil Allam MA, Mechie I, Scully M, Agu O, Lim CS. Venous malformations: Coagulopathy control and treatment methods. Phlebology 2020; 36:361-374. [PMID: 33283636 DOI: 10.1177/0268355520972918] [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: 01/19/2023]
Abstract
Venous malformations (VMs) are ectatic channels which arise as a result of vascular dysmorphogenesis, commonly caused by activating mutations in the endothelial tyrosine kinase receptor (TIE2)/phosphatidylinositol 3-kinase (PI3Kinase) pathway. With a prevalence of 1% in the general population, and a diverse clinical presentation depending on site, size and tissue involvement, their treatment requires a personalised and multidisciplinary approach. Larger lesions are complicated by local intravascular coagulopathy (LIC) causing haemorrhagic and/or thrombotic complications which can progress to disseminated intravascular coagulopathy (DIC). METHODS We performed a literature review using a PubMed® search and identified 15 articles to include. References of these texts were examined to further expand the literature review.Principle findings: Several treatment options have been explored, including compression, sclerotherapy, laser therapy, cryoablation and surgery in addition to the management of LIC with low-molecular-weight-heparin (LMWH) and other anticoagulants. Targeted molecular therapies acting on the phosphatidylinositol 3-kinase (PI3Kinase)/Protein Kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway are newly emerging. CONCLUSION Despite a wealth of literature, larger, multi-centric, randomised and prospective trails are required to offer further clarification on the therapeutic management of coagulopathy control and to provide symptomatic benefit to patients with VMs. There should be efforts to provide long term follow up and to use standardised risk stratification tools and quality of life (QOL) questionnaires to aid comparison of agents and treatment protocols.
Collapse
Affiliation(s)
- Eleanor J Budge
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK
| | | | - Imogen Mechie
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Marie Scully
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK.,Research Department of Surgical Biotechnology, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
| | - Obi Agu
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK.,Research Department of Surgical Biotechnology, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
| | - Chung Sim Lim
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK.,Research Department of Surgical Biotechnology, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
| |
Collapse
|
19
|
Höhn F, Hammer S, Fellner C, Zeman F, Uller W, Brill R, Guntau M, Wildgruber M, Wohlgemuth WA. 3T MRI of Peripheral Vascular Malformations: Characteristics and Comparison of Two Fat-Saturated sequences: Short Tau Inversion Recovery Versus Three-Dimensional High-Resolution Volume Interpolated Gradient Recalled Echo. ROFO-FORTSCHR RONTG 2020; 193:446-458. [PMID: 33003248 DOI: 10.1055/a-1253-8422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess morphological and hemodynamic characteristics of peripheral vascular malformations on 3 T magnetic resonance imaging (MRI) including qualitative comparison of two fat-saturated sequences: short tau inversion recovery (STIR) and three-dimensional high-resolution volume interpolated gradient recalled echo (GRE). MATERIALS AND METHODS During 9 months, 100 patients with suspected or known vascular malformations were prospectively assessed on a 3 T scanner using T2-weighted STIR and turbo spin echo (TSE), T1-weighted TSE, time-resolved contrast-enhanced magnetic resonance angiography (MRA) with interleaved stochastic trajectories (TWIST) and T1-weighted volume interpolated breath-hold examination (VIBE) after contrast enhancement. The analysis included signal behavior and morphologic and hemodynamic characteristics. Additionally, the image quality of the fat-saturated sequences was evaluated by 2 radiologists. RESULTS 86 patients (14 dropouts; 57 female, 29 male; mean age 26.8 years, age range 1-56) were analyzed. 22 had high-flow and 64 low-flow malformations, including 14 with a lymphatic component. In 21 of 22 patients with high-flow malformations, typical characteristics (flow voids, hyperdynamic arteriovenous fistula, dilated main/feeder-arteries and draining veins) were documented. Patients with low-flow malformations had phleboliths in 35 cases, fluid-fluid levels in 47 and dilated draining veins in 23. Lymphatic malformations showed peripheral contrast enhancement of cyst walls in the volume interpolated GRE. The comparison of fat-saturated sequences showed significantly better results of the volume interpolated GRE in all categories except the presence of artifacts which were significantly reduced in the STIR (p < 0.05). CONCLUSION 3 T MRI with MRA provides detailed morphological and hemodynamic information of different types of peripheral vascular malformations. Contrast-enhanced high-resolution volume interpolated GRE proved superior to STIR in differentiating morphologic features and to be diagnostic in the differentiation of lymphatic parts and joint involvement. KEY POINTS · 3 T MRI with MRA offers detailed information about vascular malformations.. · Fat-saturated MRI provides especially information about morphological characteristics, extent and tissue involvement.. · Volume interpolated GRE proved superior in almost all categories compared to STIR.. · Volume interpolated GRE showed more artifacts.. · Volume interpolated GRE additionally allows differentiation of lymphatic parts and evaluation of joint involvement.. CITATION FORMAT · Höhn F, Hammer S, Fellner C et al. 3T MRI of Peripheral Vascular Malformations: Characteristics and Comparison of Two Fat-Saturated sequences: Short Tau Inversion Recovery Versus Three-Dimensional High-Resolution Volume Interpolated Gradient Recalled Echo. Fortschr Röntgenstr 2021; 193: 446 - 458.
Collapse
Affiliation(s)
- Florentine Höhn
- Clinic and Policlinic of Nuclear Medicine, University Hospital Würzburg, Germany
| | - Simone Hammer
- Department of Radiology, University Hospital Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, University Hospital Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Hospital Regensburg, Germany
| | - Wibke Uller
- Department of Radiology, University Hospital Regensburg, Germany
| | - Richard Brill
- University Clinic and Policlinic of Radiology, Martin Luther University Hospital Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Guntau
- University Clinic and Policlinic of Radiology, Martin Luther University Hospital Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Clinical Radiology, University Hospital Münster, Germany
| | - Walter A Wohlgemuth
- University Clinic and Policlinic of Radiology, Martin Luther University Hospital Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
20
|
Sun LM, Xu MN, Xu Y, Wang M, Yuan SM. Imaging assessment and treatment of soft-tissue venous malformations: Retrospective case series study of 126 cases. Dermatol Ther 2020; 33:e14238. [PMID: 32856347 DOI: 10.1111/dth.14238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/21/2020] [Indexed: 01/10/2023]
Abstract
Venous malformations (VMs) are common slow-flow vascular malformations, which affect almost anywhere of the body. From January 2010 to October 2019, 126 patients with VMs who had complete imaging and follow-up data were enrolled into this study, including 75 males. The initial treatment age ranged from 5 to 72 years. The role of imaging results on the choice of treatment measures and the application were summarized. In this study, we retrospectively analyzed the imaging examinations, treatment measures, and follow-up results of the patients with VMs in our clinic. In this series, imaging examinations included ultrasound, magnetic resonance imaging, computed tomography (CT) scan and enhanced scan, percutaneous sinus angiography and three-dimensional CT imaging, plain film, CT venography, CT angiography, and digital subtraction angiography. Treatment measures included surgical excision (n = 20), sclerotherapy (n = 86, including absolute ethanol [n = 75], polidocanol [n = 8], and pingyangmycin [n = 3]), and combination treatment with intralesional copper wire retention and sclerotherapy(n = 20). After treatment, most of the lesions shrunk obviously or disappeared, and the symptoms were largely relieved. Comprehensive and accurate imaging assessment of VMs is necessary for selecting appropriate treatment. Individual strategy and sequential treatment can achieve effective results and avoid potential complications.
Collapse
Affiliation(s)
- Li-Ming Sun
- Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Bengbu Medical College, Nanjing, Jiangsu, China
| | - Meng-Nan Xu
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Yuan Xu
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Min Wang
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Si-Ming Yuan
- Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Bengbu Medical College, Nanjing, Jiangsu, China.,Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| |
Collapse
|
21
|
Yang X, Chen H, Gu H, Jin Y, Hu L, Hua C, Wang Y, Sun Y, Yu W, Lin X. Interim results of bleomycin-polidocanol foam sclerotherapy as a highly efficient technique for venous malformations. J Vasc Surg Venous Lymphat Disord 2020; 8:1066-1073. [PMID: 32284311 DOI: 10.1016/j.jvsv.2019.11.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/03/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study was to retrospectively review the clinical and radiographic outcomes of patients with venous malformations (VMs) treated with bleomycin-polidocanol foam (BPF) sclerotherapy. METHODS The Institutional Review Board waived ethical approval for this retrospective review in which 55 patients (31 female and 24 male patients; mean age, 18.8 years; range, 2-60 years) were treated with BPF sclerotherapy. The stability (half-life) of BPF compared with polidocanol foam was studied. Standard sclerotherapy techniques were used. A total of 111 sclerotherapy sessions were performed, with a mean of 2.0 treatments per patient (range, 1-6). An average of 10 mL of BPF was used per procedure, with the total amount ranging from 2.5 to 30 mL. Symptoms before and after treatment, follow-up time, complications, and volume reduction on magnetic resonance imaging were recorded. RESULTS The median half-lives of the BPF and polidocanol foam were 238.25 ± 3.86 seconds and 194.33 ± 3.5 seconds, respectively. A t-test indicated significant differences between the groups (P < .01). The mean follow-up was 14 months (range, 6-24 months). All 55 patients (100%) reported improvement in symptoms. The total excellent and good response rate was 94.6%. An excellent response was achieved in 32 cases (58.2% [32/55]), a good response in 20 cases (36.4% [20/55]), and a poor response in 3 cases (5.4% [3/55]). Postprocedural magnetic resonance imaging demonstrated volume reduction of treated lesions in 54 of 55 patients (98%), with a mean lesion volume reduction of 84.6%. Postprocedure complications were minor in 13 of 111 procedures (12%) that were performed on 10 of 55 patients (18.2%), and no major complications occurred. CONCLUSIONS BPF sclerotherapy of VMs is safe and effective. BPF sclerotherapy can be a promising first-line treatment of VMs.
Collapse
Affiliation(s)
- Xi Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunbo Jin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Hu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Hua
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yungying Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenxin Yu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
22
|
Management of massive venous malformations by percutaneous injection of bleomycin combined with fibrin glue in the head and neck. J Craniomaxillofac Surg 2020; 48:488-493. [PMID: 32222354 DOI: 10.1016/j.jcms.2020.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/20/2019] [Accepted: 02/10/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the effectiveness of percutaneous injection of bleomycin combined with fibrin glue in treating massive venous malformations (MVMs) in the head and neck region. MATERIALS AND METHODS A retrospective case series analysis of 22 patients who underwent percutaneous sclerotherapy between June 2015 and December 2018 was performed. All the patients were examined by comparing the size of the venous malformations (VMs) and their responses to treatment including complications in the follow-up. RESULTS The follow-up period ranged from 6 to 24 months. Ten patients (10/22) were completely cured and 10 patients (10/22) exhibited excellent size reduction of their VMs. Two patients (2/22) exhibited reasonable size reduction and were recommended to undergo a second sclerotherapy procedure. However, both patients were satisfied with the outcomes and refused subsequent treatment. Neither systemic nor local complications occurred in this study. All the patients were satisfied with their significant size reductions and symptom improvements without recurrences during follow-up. CONCLUSION Percutaneous injection of bleomycin combined with fibrin glue is a promising treatment option that yielded excellent size reduction with a low risk of complications on MVMs in the head and neck region.
Collapse
|
23
|
Sclerotherapy for Venous Malformations of the Pharynx or the Tongue Base Without Tracheostomy: Treatment Protocol With Intubation and Outcomes. J Craniofac Surg 2020; 31:702-706. [PMID: 32149978 DOI: 10.1097/scs.0000000000006230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Venous malformations (VMs) occurring in the tongue base or pharynx are rare, but can cause airway obstruction. Considering the potential issues or morbidity related to surgical resection in the tongue or pharynx region, sclerotherapy is often preferred. We perform sclerotherapy for such lesions without conducting tracheotomy, but keep patients intubated for a certain period. Outcomes of sclerotherapy, and benefits and cautions related with our protocol were investigated.Our subjects were 10 cases in 9 patients who underwent sclerotherapy for VMs of the tongue base (6 patients) or pharynx (3 patients) from 2008 to 2017. One patient underwent treatment sessions twice. The sclerosants used were absolute ethanol (ET) (3 cases), 5% ethanolamine oleate (EO) (4 cases), or both ET and 5%EO (3 cases).In 5 of 9 patients, postoperative MRI was performed, which revealed lesion volume reduction by 12% to 47%. The intubation period varied according to the sclerosant used: ET, 5 to 11 days; 5% EO, 2 to 12 days; and combination of ET and 5% EO, 8 days. Postoperative complications included fever of unknown (n = 2), acute psychosis (n = 3), vocal cord paralysis (n = 2), and bradycardia induced from the use of a sedative agent (n = 1). One patient complained of mild transient swallowing difficulty that lasted for a month postoperatively.Although our method mandatorily requires careful postoperative management in an ICU, including sedation with anesthetic agents and artificial respiration by intubation for a certain period of time, no serious complications or post-therapeutic morbidities occurred.
Collapse
|
24
|
Xu M, Wang M, Cheng Y, Ni X, Xu Y, Wang Q, Yuan S. Diagnosis and treatment of intermuscular venous malformations: A retrospective study in one center. Phlebology 2019; 35:384-393. [PMID: 31663826 DOI: 10.1177/0268355519885216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Intermuscular venous malformations are common vascular malformation, do not have typical symptoms, and are difficult to diagnose. This article is a retrospective analysis of the diagnostic and therapeutic measures of intermuscular venous malformations. METHODS From January 2013 to June 2018, 21 patients were included in this study. The clinical presentations, managements, and follow-up results were retrospectively analyzed. The indications and potential risks of different treatments were summarized. RESULTS The complaints of patients with intermuscular venous malformations included local pain, swelling, discomfort, or aggravation after activity. Ultrasound, phlebography, magnetic resonance imaging, percutaneous sinus angiography, and three-dimensional computed tomography imaging were performed. The patients received surgical excision, sclerotherapy, or the combinational therapy of intralesional copper wires retention and ethanol injection and were followed for six months to five years. All patients' symptoms were relieved largely. The lesions evaluated by magnetic resonance imaging decreased apparently or disappeared. CONCLUSIONS Imaging examinations are necessary in the diagnosis of intermuscular venous malformations and can guide the choice of treatment. Individualized treatment for intermuscular venous malformations should be made to achieve good effect and avoid adverse effects.
Collapse
Affiliation(s)
- Mengnan Xu
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Min Wang
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Yenwen Cheng
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Xiaodong Ni
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Yuan Xu
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Qian Wang
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Siming Yuan
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| |
Collapse
|
25
|
Legiehn GM. Sclerotherapy with Adjunctive Stasis of Efflux (STASE) in Venous Malformations: Techniques and Strategies. Tech Vasc Interv Radiol 2019; 22:100630. [PMID: 31864535 DOI: 10.1016/j.tvir.2019.100630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Venous malformations are very commonly encountered in interventional radiologic practice. Indications for therapy are clearly defined based on the lesion's impact on patient's quality of life. Screening laboratory coagulation studies in patients with historical or lesion morphologic risk factors often reveal abnormal coagulation parameters consistent with localized intravascular coagulation or more severe coagulopathic states. These may require chronic or periprocedural medical management to avoid potentially life-threatening disseminated intravascular coagulation or other thromboembolic phenomena. Once a multidisciplinary decision to treat a venous malformation is made, one must decide between percutaneous and/or surgical techniques. Sclerotherapy with adjunctive stasis of efflux (STASE) techniques have become the mainstay of therapy for most venous malformations as they are well-tolerated and effective. STASE techniques work primarily by (i) the administration of sclerosant(s) exerting an inhibitory and/or endotheliocidal effect on venous malformation endothelium leading to thrombosis, involution, and fibrosis, and secondarily via adjunctive outflow occlusion using any combination of local compression, balloons, gelatin, coils, laser, radiofrequency, or adhesives to improve sclerosant penetration and dwell-time in the lesion. Adhesives alone can fill the lesion to facilitate surgical resection in some cases. Common sclerosants in modern practice include sodium tetradecyl sulfate, bleomycin, polidocanol, ethanol, and hypertonic saline. Most agents can be given directly in unmodified or "neat" form or can be mixed with a gas to form a sclerofoam or embolic such as gelatin to form a sclerogel. Choice and method of sclerosant delivery in each patient is based on the intraluminal lesion volume, architecture, vital structure proximity, agent toxicity, viscosity, and level of experience of the interventional radiologist with that particular agent. Multi-session STASE therapy usually reduces symptoms of chronic pain or mass with low risk of known complications of skin or nerve impairment, compartment syndrome, hemoglobinuria, deep venous thrombosis, or pulmonary phenomena.
Collapse
Affiliation(s)
- Gerald M Legiehn
- Division of Interventional Radiology, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
26
|
Khaitovich B, Kalderon E, Komisar O, Eifer M, Raskin D, Rimon U. Venous Malformations Sclerotherapy: Outcomes, Patient Satisfaction and Predictors of Treatment Success. Cardiovasc Intervent Radiol 2019; 42:1695-1701. [DOI: 10.1007/s00270-019-02338-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022]
|
27
|
Lee J. Commentary to: Efficacy of Percutaneous Sclerotherapy in Low Flow Venous Malformations - A Single Center Series. Neurointervention 2019; 14:61-62. [PMID: 30827066 PMCID: PMC6433190 DOI: 10.5469/neuroint.2019.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jongmin Lee
- Department of Radiology, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea
| |
Collapse
|
28
|
Hage AN, Chick JFB, Srinivasa RN, Bundy JJ, Chauhan NR, Acord M, Gemmete JJ. Treatment of Venous Malformations: The Data, Where We Are, and How It Is Done. Tech Vasc Interv Radiol 2018; 21:45-54. [DOI: 10.1053/j.tvir.2018.03.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
29
|
Kangas J, Nätynki M, Eklund L. Development of Molecular Therapies for Venous Malformations. Basic Clin Pharmacol Toxicol 2018; 123 Suppl 5:6-19. [DOI: 10.1111/bcpt.13027] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 04/09/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Jaakko Kangas
- Life Science Center of Tsukuba Advanced Research Alliance; University of Tsukuba; Tsukuba Japan
| | - Marjut Nätynki
- Oulu Center for Cell-Matrix Research; Faculty of Biochemistry and Molecular Medicine; Biocenter Oulu University of Oulu; Oulu Finland
| | - Lauri Eklund
- Oulu Center for Cell-Matrix Research; Faculty of Biochemistry and Molecular Medicine; Biocenter Oulu University of Oulu; Oulu Finland
| |
Collapse
|
30
|
Razek AAKA, Ashmalla GA. Prediction of venous malformations with localized intravascular coagulopathy with diffusion-weighted magnetic resonance imaging. Phlebology 2018; 34:156-161. [DOI: 10.1177/0268355518773528] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Venous malformations may be complicated by localized intravascular coagulopathy which is a serious condition with hematological sequel. Prediction of localized intravascular coagulopathy is mandatory for prompt anticoagulation therapy. Laboratory and routine magnetic resonance imaging can predict localized intravascular coagulopathy in venous malformations; however, the results are variable. Purpose To predict venous malformations with localized intravascular coagulopathy with diffusion-weighted magnetic resonance imaging. Material and methods A retrospective analysis was performed on 55 patients (34 male, 21 female aged 14–64 years: mean 39 years) with venous malformations that underwent diffusion-weighted magnetic resonance imaging. The apparent diffusion coefficient value of venous malformations was calculated. Results The mean apparent diffusion coefficient value of venous malformations with localized intravascular coagulopathy (n = 26) (1.28 ± 0.18 × 10−3 mm2/s) was significantly different ( P = 0.001) from venous malformations without localized intravascular coagulopathy (n = 29) (1.60 ± 0.18 × 10−3 mm2/s). When apparent diffusion coefficient value of 1.454 × 10−3 mm2/s was used as a threshold value for the prediction of venous malformations with localized intravascular coagulopathy, the best result was obtained with an accuracy of 83.6%, sensitivity of 84.6%, specificity of 82.8%, and area under the curve of 0.895. The apparent diffusion coefficient value of venous malformations was correlated with D-dimer level ( r = −0.59, P = 0.006) and fibrinogen level ( r = 0.73, P = 0.001). Conclusion The apparent diffusion coefficient value is a non-invasive imaging parameter that can be used to predict venous malformations with localized intravascular coagulopathy.
Collapse
Affiliation(s)
- Ahmed AKA Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Germeen A Ashmalla
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
| |
Collapse
|