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Lagneaux E, Boon LM, Revencu N, Vikkula M, Hermans C. Direct oral anticoagulants and venous malformations: literature review and retrospective study of 29 patients. Res Pract Thromb Haemost 2024; 8:102400. [PMID: 38738172 PMCID: PMC11087699 DOI: 10.1016/j.rpth.2024.102400] [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: 03/12/2024] [Accepted: 03/27/2024] [Indexed: 05/14/2024] Open
Abstract
Background Venous malformations (VMs) are commonly associated with localized intravascular coagulopathy leading to elevated D-dimer and risks of hemorrhagic and thromboembolic events, particularly in extensive lesions. While low-molecular-weight heparin (LMWH) has been effective in managing coagulopathy and pain, direct oral anticoagulants (DOACs) emerge as a promising alternative. Objectives This study aims to evaluate the efficacy and safety of DOACs in treating VMs associated with localized intravascular coagulopathy, offering a comparative perspective to LMWH. Methods A retrospective study was conducted on 29 patients with VMs and secondary localized intravascular coagulopathy treated with DOACs between 2013 and 2023 in a single tertiary center specialized in vascular anomalies. Data were collected from February 24, 2023, to September 1, 2023. Results Patients' median age was 40 years (range, 22-76 years), with a female predominance of 66%. Descriptive statistical analysis showed that 85% of patients experienced pain improvement, and 86% showed a reduction in D-dimer by at least 25%, with a mean reduction of 57% (SD, ±32%; IQR, [38-81%]). Additionally, 37% of patients reported a bleeding event, mostly minor. Conclusion The study findings suggests that DOACs may serve as an alternative to LMWH for patients with VMs associated with pain management and reduced D-dimer, alongside a low observed risk of major bleeding. Tailored dosing considering the location of the malformation, bleeding and thrombotic tendencies, and laboratory abnormalities is recommended. Future studies with larger cohorts and extended follow-up are necessary for more conclusive evidence on DOACs' role in this patient population.
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Affiliation(s)
- Eugénie Lagneaux
- Division of Adult Hematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Laurence M. Boon
- Center for Vascular Anomalies, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), VASCERN VASCA European Reference Centre, Brussels, Belgium
- Division of Plastic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), VASCERN VASCA European Reference Centre, Brussels, Belgium
- Human Molecular Genetics, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Nicole Revencu
- Center for Vascular Anomalies, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), VASCERN VASCA European Reference Centre, Brussels, Belgium
- Department of Clinical Genetics, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Miikka Vikkula
- Center for Vascular Anomalies, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), VASCERN VASCA European Reference Centre, Brussels, Belgium
- Human Molecular Genetics, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Cedric Hermans
- Division of Adult Hematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
- Center for Vascular Anomalies, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), VASCERN VASCA European Reference Centre, Brussels, Belgium
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Cantarelli Rodrigues T, Serfaty A. MRI Assessment of Benign Tumor And Tumor-Like Synovial Diseases. Semin Roentgenol 2022; 57:191-200. [DOI: 10.1053/j.ro.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/11/2022]
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Diomeda F, Santaniello M, Bracciolini G, Ravelli A, Civino A. Intra-articular venous malformations of the knee: a diagnostic challenge. Pediatr Rheumatol Online J 2021; 19:153. [PMID: 34645460 PMCID: PMC8515759 DOI: 10.1186/s12969-021-00640-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/18/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Intra-articular venous malformations (IAVM) are rare benign vascular anomalies that usually affect young patients and most common locate in the knee. The terminology of these lesions is still ill-defined, as they are often termed in the literature as synovial hemangiomas. Early diagnosis can be difficult, because they usually present with nonspecific clinical manifestations that are similar those of other rheumatic diseases, especially juvenile idiopathic arthritis (JIA). CASE SERIES We conducted a retrospective analysis of five pediatric patients admitted to our units for recurrent swelling of the knee, and compared their characteristics with those of literature reports. The average age at first symptom and time from onset to diagnosis was 3.9 years (range 18 months-7 years) and 3.5 years (range 1-7 years), respectively. In our patients, an initial misdiagnosis of JIA, bleeding disorder or traumatic arthropathy was made. On MRI imaging, the features of the lesion were similar in all patients, and were marked by isointense-to-hypointense signal in T1-weighted images, and hyperintense signal in T2-weighted images. When performed, arthrocentesis led to aspiration of bloody fluid. The diagnosis was confirmed with a biopsy and histopathologic assessment in all patients. Open surgery enabled complete excision of the mass and was followed by stable remission over time in all cases. CONCLUSIONS Our report highlights the challenges that may be posed by the detection of knee IAVM and the frequent long delay between onset of symptoms and diagnosis. The key elements for early recognition include careful assessment of patient history, demonstration of bloody fluid on arthrocentesis, and proper interpretation of MRI scanning.
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Affiliation(s)
- Federico Diomeda
- Dipartimento di Scienze Biomediche e Oncologia Umana, Università degli Studi di Bari Aldo Moro, Bari, Italy
- UOSD Reumatologia e Immunologia Pediatrica, Ospedale Vito Fazzi, Lecce, Italy
| | - Maria Santaniello
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Giulia Bracciolini
- UOC Pediatria e Emergenza Pediatrica, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Angelo Ravelli
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Adele Civino
- UOSD Reumatologia e Immunologia Pediatrica, Ospedale Vito Fazzi, Lecce, Italy.
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4
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Jones KM, Corey KC, Garza-Mayers AC, Spencer SA, Mulliken JB, Chewning RH, Liang MG. Classification of lower extremity venous malformations and risk of knee involvement: A retrospective cohort study. J Am Acad Dermatol 2021; 85:1480-1485. [PMID: 33421482 DOI: 10.1016/j.jaad.2020.12.054] [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: 05/12/2020] [Revised: 11/10/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Venous malformation (VM) is the most common vascular anomaly in the lower extremity. VMs can be classified as focal, multifocal, or diffuse types. Intraarticular VM (IA-VM) of the knee portends morbidity. Association of the lower extremity VM type with IA-VM is not well defined. OBJECTIVE To classify a large cohort of lower extremity, nonsyndromic VMs by type and determine associations with IA-VM. METHODS Retrospective cohort study. RESULTS We assessed 156 patients with nonsyndromic, lower extremity VM; 71 (46%) were focal and 85 (54%) were diffuse type VM, and 97 (62%) were IA-VM. Of diffuse VMs, 26 (31%) were Bockenheimer and 59 (69%) were localized subtypes. Pure VM had a significantly elevated risk of IA-VM (relative risk [RR], 2.34; 95% confidence interval [CI], 1.42-3.89). IA-VM was more common in diffuse (73%) versus focal (49%) types. Risk of IA-VM in diffuse type VM was significantly elevated (RR, 1.48; 95% CI, 1.13-1.94). One hundred percent of diffuse Bockenheimer type VM had IA-VM, and this subtype had the highest risk (RR, 1.83; 95% CI, 1.56-2.14) of IA-VM. LIMITATIONS Retrospective, single-institution study. CONCLUSIONS Intraarticular involvement of the knee should be considered in all lower extremity VMs. Pure VM and the Bockenheimer diffuse VM subtype had the highest risk of IA-VM.
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Affiliation(s)
- Krystal M Jones
- Dermatology Program, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kristen C Corey
- Dermatology Program, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Samantha A Spencer
- Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - John B Mulliken
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rush H Chewning
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marilyn G Liang
- Dermatology Program, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
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Abstract
Vascular anomalies impact the musculoskeletal system dependent on the tissue involved (skin, subcutis, muscle, cartilage, or bone), the extent of involvement, and the type of anomalous vessels (arteries, capillaries, veins, or lymphatics). These malformations can cause a multitude of musculoskeletal problems for the patient. Leg-length discrepancy, intra-articular involvement, muscular lesions, and primary or secondary scoliosis are amongst the issues that patients face. All of these problems can cause pain, deformity, and a range of functional limitations. Surgical and nonsurgical treatment plans have a role in patient care. Patients with vascular anomalies may also suffer from life-threatening cardiovascular and hematologic abnormalities. For those patients who undergo surgery, the thromboembolic risk is elevated, wound breakdown and infection are much more common, and bleeding risk continues well into the postoperative course. Because of the complex nature of these disorders, the clinician must have a full understanding of the types of lesions, their natural history, appropriate diagnostic studies, associated medical problems, indications for treatment, and treatment options. For severe malformations, especially syndromes such as CLOVES and Klippel- Trenaunay syndrome, interdisciplinary team management is essential for the best outcomes.
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Affiliation(s)
- Samantha A Spencer
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, United States.
| | - Joel I Sorger
- Department of Orthopedics, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, United States
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Han YY, Sun LM, Yuan SM. Localized intravascular coagulation in venous malformations: A system review. Phlebology 2020; 36:38-42. [PMID: 32731789 DOI: 10.1177/0268355520946211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Venous malformation is one of the slow-flow vascular malformations. Dysfunction of coagulation often occurs in most venous malformations, especially the diffuse and multifocal lesions, referred to as localized intravascular coagulopathy. It is characterized by the elevation of D-dimers and fibrin degradation products, low levels of fibrinogen, FV, FVIII, FXIII, and antithrombin III, and sometimes minor-to-moderate thrombocytopenia. Here we reviewed the clinical manifestations, pathogenesis, diagnosis, and treatment of localized intravascular coagulopathy in venous malformations.
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Affiliation(s)
- Yu-Yu Han
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Southeast University, Jiangsu, China
| | - Li-Ming Sun
- Department of Plastic Surgery, Jinling Hospital, Nanjing, School of Clinical Medicine, Bengbu Medical College, Jiangsu, China
| | - Si-Ming Yuan
- Department of Plastic Surgery, Jinling Hospital, School of Medicine, Southeast University, Jiangsu, China
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Mattila KA, Aronniemi J, Salminen P, Rintala RJ, Kyrklund K. Intra-articular venous malformation of the knee in children: magnetic resonance imaging findings and significance of synovial involvement. Pediatr Radiol 2020; 50:509-515. [PMID: 31853571 PMCID: PMC7067728 DOI: 10.1007/s00247-019-04580-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/02/2019] [Accepted: 11/14/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Intra-articular venous malformations of the knee are an uncommon cause of unilateral knee pain in children. Timely diagnosis is important because lesions with intrasynovial involvement can lead to joint space hemorrhage and secondary cartilage damage. OBJECTIVE To describe our tertiary center's experience of diagnostics and typical magnetic resonance imaging (MRI) findings. MATERIALS AND METHODS A retrospective review of all patients ≤16 years of age managed for intra-articular venous malformations of the knee at our institution between 2002 and 2018. RESULTS Of 14 patients (8 male), the mean age at presentation was 6 years (range: 0-14 years). The most common clinical findings were unilateral knee pain (93%), joint swelling (79%), quadriceps atrophy (50%) and a limited range of motion (29%). Cutaneous manifestations were present in four patients (29%). Contrast-enhanced MRI was available in all cases. After initial MRI, a vascular anomaly etiology had been identified in 11 cases (79%), and correctly reported as a venous malformation in 6 (55%). Three patients received entirely different diagnoses (arthritis, tumor or pigmented villonodular synovitis). Three of seven patients with intrasynovial lesions had established chondropathy at diagnosis. Two patients with lesions of the suprapatellar fat pad had intrasynovial involvement that was not visualised on MRI. CONCLUSION Although MRI usually permits the diagnosis, clinical awareness of these lesions is important for optimal imaging, accurate interpretation and timely diagnosis. Involvement of the intrasynovial cavity carries a risk of hemarthrosis and progressive chondropathy that may be underestimated by MRI.
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Affiliation(s)
- Katariina A. Mattila
- grid.15485.3d0000 0000 9950 5666Department of Pediatric Surgery, Children’s Hospital, Helsinki University Hospital and University of Helsinki, P.O. Box 347, 00029 HUS, Helsinki, Finland
| | - Johanna Aronniemi
- grid.15485.3d0000 0000 9950 5666Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland ,grid.15485.3d0000 0000 9950 5666 VASCERN VASCA European Reference Center, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Salminen
- grid.15485.3d0000 0000 9950 5666Department of Pediatric Surgery, Children’s Hospital, Helsinki University Hospital and University of Helsinki, P.O. Box 347, 00029 HUS, Helsinki, Finland ,grid.15485.3d0000 0000 9950 5666 VASCERN VASCA European Reference Center, Helsinki University Hospital, Helsinki, Finland
| | - Risto J. Rintala
- grid.15485.3d0000 0000 9950 5666Department of Pediatric Surgery, Children’s Hospital, Helsinki University Hospital and University of Helsinki, P.O. Box 347, 00029 HUS, Helsinki, Finland
| | - Kristiina Kyrklund
- grid.15485.3d0000 0000 9950 5666Department of Pediatric Surgery, Children’s Hospital, Helsinki University Hospital and University of Helsinki, P.O. Box 347, 00029 HUS, Helsinki, Finland ,grid.15485.3d0000 0000 9950 5666 VASCERN VASCA European Reference Center, Helsinki University Hospital, Helsinki, Finland
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8
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Gnannt R, Guggenberger R, Mueller DA, Neuhaus K, Aufdenblatten C, Theiler M, Kellenberger CJ, Pfammatter T. MR Features of Juxta-Articular Venous Malformations of the Knee to Predict the Clinical Outcome of Sclerotherapy. J Vasc Interv Radiol 2019; 31:551-557. [PMID: 31882302 DOI: 10.1016/j.jvir.2019.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/17/2019] [Accepted: 11/13/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To analyze and correlate preinterventional magnetic resonance (MR) imaging findings with clinical symptoms after percutaneous sclerotherapy of venous malformations (VMs) adjacent to the knee. MATERIALS AND METHODS Twenty-five patients (mean age, 24 y; range, 7-55 y; 11 female) with 26 VMs adjacent to the knee undergoing sclerotherapy (direct puncture, diagnostic angiography, sclerosant injection) were identified, and MR imaging findings were analyzed. The VM involved the synovium of the knee joint in 19 of 26 cases (76%). These lesions were associated with joint effusion (3 of 19; 16%), hemarthrosis (4 of 19; 21%), or synovial thickening (16 of 19; 84%). Follow-up ended 6-8 weeks after the first or second sclerotherapy session if complete pain relief was achieved or 3 months after the third sclerotherapy session. Treatment outcomes were categorized as symptom improvement (complete or partial pain relief) or poor response (unchanged or increased pain). RESULTS Forty-nine percutaneous sclerotherapy sessions were performed. Despite the absence of signs of knee osteoarthritis, patients with a VM involving the synovium (8 of 14; 57%) showed a poor response to sclerotherapy (1 of 8 [13%] pain-free after 1 sclerotherapy session). Among patients with VMs with no associated joint alteration and no synovial involvement (6 of 14; 43%), 5 of 6 (83%) showed improvement of symptoms after 1 sclerotherapy session (P < .05). CONCLUSIONS Juxta-articular VMs of the knee are frequently associated with hemarthrosis and synovial thickening. Patients with signs of osteoarthritis and synovial involvement of the VM on presclerotherapy MR imaging deserve special consideration, as these findings predict worse clinical symptoms after sclerotherapy.
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Affiliation(s)
- Ralph Gnannt
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland; Department of Diagnostic Imaging, University Children's Hospital Zurich, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland.
| | - Roman Guggenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel A Mueller
- Department of Orthopaedics, Der Balgrist-Universitätsklinik, Zurich, Switzerland
| | - Kathrin Neuhaus
- Division of Plastic and Reconstructive Surgery and Department of Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland
| | - Christoph Aufdenblatten
- Departments of Orthopaedics and Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland
| | - Martin Theiler
- Division of Pediatric Dermatology, University Children's Hospital Zurich, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland
| | - Christian J Kellenberger
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland
| | - Thomas Pfammatter
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Hu L, Chen H, Yang X, Wang Y, Gu H, Liu M, Lin X. Risk factors associated with pain in patients with venous malformations of the extremities. Vasc Med 2018; 24:56-62. [PMID: 30340449 DOI: 10.1177/1358863x18802007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pain is a common symptom and the major complaint in patients with venous malformations of the extremities, which may lead to joint dysfunction and even walking disabilities. Therefore, this study aimed to investigate determined independent risk factors for pain in these patients. We retrospectively collected data for 168 patients with venous malformations of the extremities from January 16, 2013 to August 13, 2015. They were categorized into painful and painless groups according to the symptom and pain scores. Associations between pain and candidate factors were determined using univariate and multivariate analyses. A total of 125 (74.4%) patients with an average pain score of 4.4 were included in the painful group. In univariate analysis, age, lesion size, tissue involvement, and phleboliths were associated with pain. In the multivariate analysis, only type-II tissue involvement (adjusted odds ratio 4.57; p = 0.001) and phleboliths (adjusted odds ratio 2.44; p = 0.039) were identified as the independent risk factors. In conclusion, this study revealed that prevalence of pain in patients with venous malformations of the extremities was high. Patients who presented with type-II tissue involvement and phleboliths are more likely to suffer from pain.
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Affiliation(s)
- Li Hu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongying Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Liu
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Arteriovenous Malformations: Syndrome Identification and Vascular Management. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:67. [PMID: 30019284 DOI: 10.1007/s11936-018-0662-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Vascular malformations represent a poorly understood set of conditions that create considerable diagnostic and therapeutic confusion. Historically, extensive surgical resections yielded poor results. More recently, the treatment paradigm has shifted to endovascular therapy such that embolization and sclerotherapy are now considered the first line of treatment. Although there is still a role for traditional surgical techniques, it is now most commonly integrated with endovascular therapies in a hybrid fashion. The goal of this review is to provide a greater understanding of the diagnosis and treatment of vascular malformations. RECENT FINDINGS Vascular malformations can be high-flow (arteriovenous shunting) or low-flow (venous or lymphatic). Clinical presentation and treatment is different for each. Treatment of high-flow lesions must be directed at reducing or eliminating the nidus, usually via super-selective catheterization and embolization. Low-flow lesions are usually treated by direct injection of sclerosing agents under fluoroscopic or ultrasound guidance. The cornerstone of managing patients with vascular malformations is making the proper diagnosis, which is often challenging. Even after a diagnosis is made, therapy itself may be challenging and generate frustration among patients and providers. Frequently, the treatment of vascular malformations is characterized by only slow and incremental improvements without complete lesion eradication. By combining a thorough understanding of the vascular malformation disease process with an array of endovascular techniques, vascular interventionalists may contribute greatly to the care of these patients.
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Uller W, El-sobky S, Alomari AI, Fishman SJ, Spencer SA, Taghinia AH, Chaudry G. Preoperative Embolization of Venous Malformations Using n-Butyl Cyanoacrylate. Vasc Endovascular Surg 2018; 52:269-274. [DOI: 10.1177/1538574418762192] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: The purpose of this study was to evaluate the safety and efficacy of preoperative percutaneous n-butyl cyanoacrylate (nBCA) embolization of venous malformations in children. Material and Methods: Clinical data were retrospectively reviewed in children who underwent embolization using nBCA followed by resection of venous malformations. Results: A total of 17 embolizations were performed in 14 patients (9 females, mean age: 5.5 years; median age: 3 years; range 0.1-16 years). The venous malformations involved the lower extremity and the knee joint (n = 7), the trunk (n = 4), head and neck (n = 2), and hand (n = 1). n-Butyl cyanoacrylate was diluted with iodized oil at a ratio of 1:3 to 1:5. The mean and median volume of nBCA per procedure were 2.1 and 2 mL, respectively (range: 0.5-8 mL). There were no complications associated with the procedures. The mean and median time between final embolization and resection were 3.6 and 2 days, respectively. All children underwent successful resection of the symptomatic lesions. The estimated mean and median blood loss were 75 and 50 mL, respectively (range: 5-350 mL). The postprocedure course was uneventful, the days to discharge ranged between 1 and 6 days (mean 3 days). Conclusion: Initial results suggest that preoperative percutaneous n-butyl cyanoacrylate embolization of venous malformations is safe and effective in children, with the potential for minimizing blood loss and inpatient stay.
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Affiliation(s)
- Wibke Uller
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Vascular and Interventional Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sherif El-sobky
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Vascular and Interventional Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Ahmad I. Alomari
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Vascular and Interventional Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Steven J. Fishman
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Samantha A. Spencer
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Orthopaedics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Amir H. Taghinia
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Plastic Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Gulraiz Chaudry
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Vascular and Interventional Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
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