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Jung R, Trivedi CM. Congenital Vascular and Lymphatic Diseases. Circ Res 2024; 135:159-173. [PMID: 38900856 PMCID: PMC11192239 DOI: 10.1161/circresaha.124.323181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Over the past several centuries, the integration of contemporary medical techniques and innovative technologies, like genetic sequencing, have played a pivotal role in enhancing our comprehension of congenital vascular and lymphatic disorders. Nonetheless, the uncommon and complex characteristics of these disorders, especially considering their formation during the intrauterine stage, present significant obstacles in diagnosis and treatment. Here, we review the intricacies of these congenital abnormalities, offering an in-depth examination of key diagnostic approaches, genetic factors, and therapeutic methods.
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Affiliation(s)
- Roy Jung
- Division of Cardiovascular Medicine, UMass Chan Medical School, Worcester, MA 01605 USA
- Department of Medicine, UMass Chan Medical School, Worcester, MA 01605 USA
- Translational Science Program, Morningside Graduate School of Biomedical Sciences, UMass Chan Medical School, Worcester, MA 01605 USA
| | - Chinmay M. Trivedi
- Division of Cardiovascular Medicine, UMass Chan Medical School, Worcester, MA 01605 USA
- Department of Medicine, UMass Chan Medical School, Worcester, MA 01605 USA
- Translational Science Program, Morningside Graduate School of Biomedical Sciences, UMass Chan Medical School, Worcester, MA 01605 USA
- Department of Molecular, Cell, and Cancer Biology, UMass Chan Medical School; Worcester, MA 01605 USA
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2
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Xie MC, Wang FX, Xu J. Giant vascular malformations invading the skull: A case report. World J Clin Cases 2024; 12:2869-2875. [PMID: 38899294 PMCID: PMC11185347 DOI: 10.12998/wjcc.v12.i16.2869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Vascular malformations (VMs) arise as a result of errors in the process of angiogenesis and are usually present at birth, but may not become apparent until after birth. However, giant VMs of the head and face are uncommon, with few reported cases, and the prognosis for their surgical intervention is unclear. CASE SUMMARY A 12-year-old girl was admitted to the hospital with findings of an enlarged right temporal scalp. After admission, computed tomography (CT) angiography of cerebral ateries showed a right occlusal gap and a right temporal artery venous malformation. Furthermore, cerebral angiography showed a right temporal lobe VM with multiple vessels supplying blood. The patient underwent surgery to remove the malformed vessels and the eroded skull. Two hours after the surgery, the patient's right pupil was dilated, and an urgent CT scan of the skull showed a right subdural haematoma under the incision, which was urgently removed by a second operation. After surgery, we gave continuous antibiotic anti-infection treatment, and the patient recovered well and was discharged two weeks later. CONCLUSION Surgical removal of giant haemangiomas is risky and adequate preoperative (including interventional embolisation) and intraoperative preparations should be made.
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Affiliation(s)
- Ming-Chen Xie
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Fu-Xu Wang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Jian Xu
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
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Shiraishi M, Narushima M, Banda CH, Moriwaki Y, Fujisawa K, Nakajima M, Yamagata K, Kondo C, Okada Y, Mitsui K, Hashimoto K, Danno K, Hosomi K, Ishiura R, Kurita M, Okazaki M. Treatment Effectiveness and Recurrence of Extracranial Arteriovenous Malformations Following Surgical Operations: A 15-Year Retrospective Cohort Study. Ann Plast Surg 2024; 92:688-693. [PMID: 38747560 DOI: 10.1097/sap.0000000000003924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND At present, there is no golden standard for treatment of extracranial arteriovenous malformations (AVMs) and recurrence remains a major challenge with limited available evidence on the associated factors. This study aimed to evaluate the effectiveness of surgical treatment options, in terms of size reduction, symptoms, and early recurrence in patients treated surgically for AVMs. METHODS A retrospective cohort study was conducted to evaluate patients with AVMs following surgical treatment in 2 centers from 2005 to 2020. Posttreatment lesion size and symptoms, as well as recurrence, were assessed. Multiple regression analysis was performed to identify factors associated with recurrence. RESULTS Forty-four surgical treatment cases in 31 patients were assessed with a mean follow-up duration period of 67.9 ± 39.5 months. Treatment included total resection in 26 cases (59.1%) and partial resection 18 (40.9%), with free flap coverage used in 19 cases (43.2%). No acute exacerbation following treatment was observed in our cohort. Total resection significantly reduced posttreatment lesion size ( P < 0.001), symptoms ( P < 0.001), and recurrence (20.0%, P = 0.03). The recurrence rate was significantly higher after partial resection (73.7%, P = 0.03). Total resection was identified as an associated factor for significantly reduced AVM recurrence (odds ratio: 0.12; 95% confidence interval: 0.03, 0.52). However, the use of free flaps did not significantly reduce recurrence, post treatment size or improve AVM symptoms. CONCLUSIONS Total resection is the optimal treatment for AVMs. Free flaps are useful in covering large defects but the regulative effect of free flap remains controversial.
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Affiliation(s)
| | - Mitsunaga Narushima
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu
| | | | - Yuta Moriwaki
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kou Fujisawa
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Mayuri Nakajima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kosuke Yamagata
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu
| | - Chizuki Kondo
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu
| | | | - Kohei Mitsui
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu
| | - Kohei Hashimoto
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu
| | - Kanako Danno
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu
| | - Kento Hosomi
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu
| | | | | | - Mutsumi Okazaki
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Shabbir F, Rashid M, Khan MI, Sarwar SUR, Khan AH, Goher M. Our Experience in the Surgical Management of Arterio-Venous Malformations of the head and neck. JPRAS Open 2024; 40:59-67. [PMID: 38434943 PMCID: PMC10907505 DOI: 10.1016/j.jpra.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/07/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Vascular anomalies comprise a diverse group of abnormalities in blood vessel morphogenesis that usually occur prenatally. Arterio-venous malformations (AVMs) are rare congenital vascular lesions accounting for 1.5% of all vascular anomalies, with 50% of them occur in the oral and maxillo-facial regions. Treatment of large, complex vascular lesions is a serious challenge for patients and surgeons because it can cause disfigurement and massive haemorrhage, which may be spontaneous or the result of surgical intervention. Our study aimed to demonstrate surgical management of massive AVMs of the head and neck. Method This retrospective study shows the treatment outcomes of 28 patients with massive maxillo-facial vascular malformations, who presented to our department for treatment from 1 January 2015 to 31 July 2022. Results Twenty-eight patients with a mean age of 17.32 ± 12.21 years (women: 15, men: 13) were enrolled in the study. Diagnosis included extra cranial AVMs of the head and neck region. Treatment modalities, in isolation or combination, included angioembolisation procedure, sclerotherapy, and surgery. Conclusion Management of AVMs is challenging owing to the replacement of normal tissue by the diseased ones and the high rate of recurrence. Hence, multi-modal approaches are needed for the effective restoration of tissues.
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Affiliation(s)
- Farwa Shabbir
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
| | - Mamoon Rashid
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
| | - M. Ibrahim Khan
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
| | - Saad ur Rehman Sarwar
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
| | - Adeela Hussain Khan
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
| | - Maimoona Goher
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
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Fiore M, Bortoli M, Sambri A, Lotrecchiano L, Lovato L, Mirelli M, Neri I, De Paolis M, Piraccini BM, Gargiulo M. Soft Tissue Vascular Anomalies of the Extremities: A Proposed Diagnostic Approach. Life (Basel) 2024; 14:670. [PMID: 38929654 PMCID: PMC11204615 DOI: 10.3390/life14060670] [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: 03/22/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
This narrative review aims to summarise the classification of vascular anomalies, their clinical presentation, and their radiological features to propose a diagnostic algorithm to approach patients with suspected soft tissue vascular anomalies of the extremities. The management of vascular anomalies necessitates a multidisciplinary approach. Clinical presentation and physical examination are sufficient in most cases to achieve a correct diagnosis. This is especially true for small congenital lesions of the skin and subcutaneous tissue. Imaging is used for accurate characterization of these lesions, especially in cases of atypical or vague clinical presentation, and to assess extension in cases of lesions that are larger and localized in deeper tissues.
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Affiliation(s)
- Michele Fiore
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (M.B.); (M.D.P.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (B.M.P.); (M.G.)
| | - Marta Bortoli
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (M.B.); (M.D.P.)
| | - Andrea Sambri
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (M.B.); (M.D.P.)
| | - Ludovica Lotrecchiano
- Oncoematologic and Emergencies Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.L.); (L.L.)
| | - Luigi Lovato
- Oncoematologic and Emergencies Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.L.); (L.L.)
| | - Michele Mirelli
- IRCCS, Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Iria Neri
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Massimiliano De Paolis
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (M.B.); (M.D.P.)
| | - Bianca Maria Piraccini
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (B.M.P.); (M.G.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Mauro Gargiulo
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (B.M.P.); (M.G.)
- IRCCS, Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
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Mattheis S, Wanke I. Interdisciplinary Management of Vascular Anomalies in the Head and Neck. Laryngorhinootologie 2024; 103:S125-S147. [PMID: 38697145 DOI: 10.1055/a-2225-9932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Vascular anomalies in the head and neck area are usually rare diseases and pose a particular diagnostic and therapeutic challenge. They are divided into vascular tumours and vascular malformations. A distinction is made between benign tumours, such as infantile haemangioma, and rare malignant tumours, such as angiosarcoma. Vascular malformations are categorised as simple malformations, mixed malformations, large vessel anomalies and those associated with other anomalies. Treatment is interdisciplinary and various modalities are available. These include clinical observation, sclerotherapy, embolisation, ablative and coagulating procedures, surgical resection and systemic drug therapy. Treatment is challenging, as vascular anomalies in the head and neck region practically always affect function and aesthetics. A better understanding of the genetic and molecular biological basis of vascular anomalies has recently led to clinical research into targeted drug therapies. This article provides an up-to-date overview of the diagnosis, clinic and treatment of vascular anomalies in the head and neck region.
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Affiliation(s)
- Stefan Mattheis
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsmedizin Essen (Direktor: Prof. Dr. Stephan Lang)
| | - Isabel Wanke
- Zentrum für Neuroradiologie, Klinik Hirslanden, Zürich, Schweiz
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Rethinasamy R, Penubarthi LK, Gopalakishnan Srinivasan D, Alexander A. Tumescent solution: a game changer in excising refractory arteriovenous malformation. BMJ Case Rep 2024; 17:e257483. [PMID: 38684349 PMCID: PMC11146387 DOI: 10.1136/bcr-2023-257483] [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] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
Arteriovenous malformations of the head and neck are rare and inborn errors of vascular morphogenesis. They pose therapeutic challenges owing to their bleeding tendency and a high chance of recurrence. Treatment modalities include digital subtraction angiography with embolisation as a primary treatment or can be done preoperatively followed by surgical excision. We present a case of recurrent arteriovenous malformation of the postauricular region in an adolescent male who was taken up for upfront surgical excision with the help of a tumescent solution, thereby eliminating the need for embolisation and drastically reduced intraoperative blood loss.
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Affiliation(s)
- Ramkumar Rethinasamy
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Lokesh Kumar Penubarthi
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Arun Alexander
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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8
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Ethunandan M. Management of Midfacial and Skull Vault Osseous Vascular Lesions. Oral Maxillofac Surg Clin North Am 2024; 36:61-72. [PMID: 37821289 DOI: 10.1016/j.coms.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
There continuous to be widespread misuse of nomenclature used to described vascular anomalies, This is even more pronounced in the case of intra-osseous lesions. Bone involvement is more common with vascular malformations and extremely rare in haemangiomas. An accurate diagnosis is mandatory for tailored management and often based on a thorough history, clinical examination, and cross-sectional imaging. Surgery remains the main stay for the management of symptomatic venous malformations. Embolisation with or without surgery is the main stay for arteriovenous malformations. Virtual surgical planning, with surgical guides and patient specific implants help achieve predictably excellent results.
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Affiliation(s)
- Madan Ethunandan
- Oral & Maxillofacial Surgery, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK; Oral & Maxillofacial Surgery, Sri Ramchandra Institute of Higher Education and Research, Prour, Chennai, 600116, India.
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Seebauer CT, Wiens B, Hintschich CA, Platz Batista da Silva N, Evert K, Haubner F, Kapp FG, Wendl C, Renner K, Bohr C, Kühnel T, Vielsmeier V. Targeting the microenvironment in the treatment of arteriovenous malformations. Angiogenesis 2024; 27:91-103. [PMID: 37733132 PMCID: PMC10881762 DOI: 10.1007/s10456-023-09896-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
Extracranial arteriovenous malformations (AVMs) are regarded as rare diseases and are prone to complications such as pain, bleeding, relentless growth, and high volume of shunted blood. Due to the high vascular pressure endothelial cells of AVMs are exposed to mechanical stress. To control symptoms and lesion growth pharmacological treatment strategies are urgently needed in addition to surgery and interventional radiology. AVM cells were isolated from three patients and exposed to cyclic mechanical stretching for 24 h. Thalidomide and bevacizumab, both VEGF inhibitors, were tested for their ability to prevent the formation of circular networks and proliferation of CD31+ endothelial AVM cells. Furthermore, the effect of thalidomide and bevacizumab on stretched endothelial AVM cells was evaluated. In response to mechanical stress, VEGF gene and protein expression increased in patient AVM endothelial cells. Thalidomide and bevacizumab reduced endothelial AVM cell proliferation. Bevacizumab inhibited circular network formation of endothelial AVM cells and lowered VEGF gene and protein expression, even though the cells were exposed to mechanical stress. With promising in vitro results, bevacizumab was used to treat three patients with unresectable AVMs or to prevent regrowth after incomplete resection. Bevacizumab controlled bleeding, pulsation, and pain over the follow up of eight months with no patient-reported side effects. Overall, mechanical stress increases VEGF expression in the microenvironment of AVM cells. The monoclonal VEGF antibody bevacizumab alleviates this effect, prevents circular network formation and proliferation of AVM endothelial cells in vitro. The clinical application of bevacizumab in AVM treatment demonstrates effective symptom control with no side effects.
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Affiliation(s)
- Caroline T Seebauer
- Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Benedikt Wiens
- Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Constantin A Hintschich
- Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | | | - Katja Evert
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, Ludwig Maximilian University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Friedrich G Kapp
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, University of Freiburg, Heiliggeiststr. 1, 79106, Freiburg im Breisgau, Germany
| | - Christina Wendl
- Institute of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Kathrin Renner
- Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christopher Bohr
- Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Thomas Kühnel
- Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Veronika Vielsmeier
- Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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Mehlhorn I, Heichel J, Wohlgemuth W, Skalej M, Izaguirre V, Dießel L, Kisser U, Viestenz A, Wienrich R. [Interdisciplinary management of a combined vascular malformation of the orbit]. DIE OPHTHALMOLOGIE 2024; 121:68-71. [PMID: 37624390 DOI: 10.1007/s00347-023-01900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Ivana Mehlhorn
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland.
| | - Jens Heichel
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Walter Wohlgemuth
- Klinik und Poliklinik für Radiologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Martin Skalej
- Klinik und Poliklinik für Radiologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Victor Izaguirre
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Linda Dießel
- Institut für Pathologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Ulrich Kisser
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Arne Viestenz
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Ricarda Wienrich
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
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11
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Wong KPL, Tan TWX, Chan LWM, Mahadev A, Cheng MHW. Wide Resection for Pediatric Extremity Vascular Malformation-A Tertiary Hospital's Experience. J Pediatr Orthop 2024; 44:55-60. [PMID: 37807610 DOI: 10.1097/bpo.0000000000002546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND Vascular malformations of the extremities (VM) are common benign lesions that tend to grow throughout the patient's lifetime. They can cause various issues like pain, swelling, and even limb length discrepancies. Sclerotherapy was the preferred treatment choice in previous studies. However, sclerotherapy and many other treatments have the potential to result in higher recurrence rates. Surgical treatment has been shown to be effective and safe in many cases. Hence, this study aims to evaluate the suitability of wide resection surgery for VM to reduce recurrence. METHODS Fort-seven VM cases that underwent wide resection were identified retrospectively in the institution of study. Demographics, depth of malformation, whether malformations were local or diffuse, location and size of malformations, and histology records were taken note of. Records of recurrence and postoperative function were also gathered. We utilized self-reported questionnaires, QuickDASH and Lower Extremity Functional Scale, to determine patients' postsurgical physical function. RESULTS Out of 47 cases that underwent wide resection, we found a recurrence rate of 2.1%. No patients sustained any loss of function postsurgery, with few patients experiencing minor complications like tenderness, hypertrophic scars/keloids, as well as numbness. Good functionality posttreatment was also seen through self-reported questionnaires, with an average score of 2.12 for QuickDASH and 99.96% for LEFS. CONCLUSION Where margins can be obtained without functional impairment, surgical-wide resection for VM is a viable treatment option to minimize recurrence. LEVEL OF EVIDENCE Level-IV.
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12
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Zhang Z, Ni X, Guo S, Zuo C, Cheng C. 68 Ga-FAPI-04 Detected Hepatic Arteriovenous Malformation in a Patient With IgA Nephropathy. Clin Nucl Med 2023; 48:1096-1098. [PMID: 37883057 PMCID: PMC10662614 DOI: 10.1097/rlu.0000000000004887] [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] [Received: 06/27/2023] [Revised: 07/21/2023] [Indexed: 10/27/2023]
Abstract
ABSTRACT A 51-year-old woman with a history of IgA nephropathy was found to have a mass in the right lobe of the liver by abdominal ultrasound. The PET/CT scan revealed elevated 68 Ga-FAPI-04 uptake in the aforementioned lesion, indicating the potential presence of liver cancer. However, subsequent histopathological analysis confirmed it to be an arteriovenous malformation. This case illustrates that 68 Ga-FAPI-04 uptake can occur in arteriovenous malformation and is a benign cause of 68 Ga-FAPI-04 uptake.
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Affiliation(s)
- Zeyu Zhang
- From the Departments of Nuclear Medicine
| | | | - Shiwei Guo
- Hepatobiliary Pancreatic Surgery, Changhai Hospital, Military Medical University, Shanghai, China
| | | | - Chao Cheng
- From the Departments of Nuclear Medicine
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Al-Smadi MW, Fazekas LA, Aslan S, Bernat B, Beqain A, Al-Khafaji MQM, Priksz D, Orlik B, Nemeth N. A Microsurgical Arteriovenous Malformation Model on Saphenous Vessels in the Rat. Biomedicines 2023; 11:2970. [PMID: 38001970 PMCID: PMC10669800 DOI: 10.3390/biomedicines11112970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Arteriovenous malformation (AVM) is an anomaly of blood vessel formation. Numerous models have been established to understand the nature of AVM. These models have limitations in terms of the diameter of the vessels used and the impact on the circulatory system. Our goal was to establish an AVM model that does not cause prompt and significant hemodynamic and cardiac alterations but is feasible for follow-up of the AVM's progression. Sixteen female rats were randomly divided into sham-operated and AVM groups. In the AVM group, the saphenous vein and artery were interconnected using microsurgical techniques. The animals were followed up for 12 weeks. Anastomosis patency and the structural and hemodynamic changes of the heart were monitored. The hearts and vessels were histologically analyzed. During the follow-up period, shunts remained unobstructed. Systolic, diastolic, mean arterial pressure, and heart rate values slightly and non-significantly decreased in the AVM group. Echocardiogram results indicated minor systolic function impact, with slight and insignificant changes in aortic pressure and blood velocity, and minimal left ventricular wall enlargement. The small-caliber saphenous AVM model does not cause acute hemodynamic changes. Moderate but progressive alterations and venous dilatation confirmed AVM-like features. The model seems to be suitable for studying further the progression, enlargement, or destabilization of AVM.
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Affiliation(s)
- Mohammad Walid Al-Smadi
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond ut 22, 4032 Debrecen, Hungary; (M.W.A.-S.); (L.A.F.); (S.A.); (A.B.); (M.Q.M.A.-K.)
- Kalman Laki Doctoral School, University of Debrecen, 4032 Debrecen, Hungary
| | - Laszlo Adam Fazekas
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond ut 22, 4032 Debrecen, Hungary; (M.W.A.-S.); (L.A.F.); (S.A.); (A.B.); (M.Q.M.A.-K.)
| | - Siran Aslan
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond ut 22, 4032 Debrecen, Hungary; (M.W.A.-S.); (L.A.F.); (S.A.); (A.B.); (M.Q.M.A.-K.)
| | - Brigitta Bernat
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, 4032 Debrecen, Hungary; (B.B.); (D.P.)
| | - Anas Beqain
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond ut 22, 4032 Debrecen, Hungary; (M.W.A.-S.); (L.A.F.); (S.A.); (A.B.); (M.Q.M.A.-K.)
| | - Mustafa Qais Muhsin Al-Khafaji
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond ut 22, 4032 Debrecen, Hungary; (M.W.A.-S.); (L.A.F.); (S.A.); (A.B.); (M.Q.M.A.-K.)
| | - Daniel Priksz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, 4032 Debrecen, Hungary; (B.B.); (D.P.)
| | - Brigitta Orlik
- Department of Pathology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, 4032 Debrecen, Hungary;
| | - Norbert Nemeth
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond ut 22, 4032 Debrecen, Hungary; (M.W.A.-S.); (L.A.F.); (S.A.); (A.B.); (M.Q.M.A.-K.)
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14
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Utami AM, Halfwerk JBG, de Boer OJ, Mackaaij C, Pabittei DR, van der Horst CMAM, Meijer-Jorna LB, van der Wal AC. Relative expression of hormone receptors by endothelial and smooth muscle cells in proliferative and non-proliferative areas of congenital arteriovenous malformations. Eur J Med Res 2023; 28:449. [PMID: 37864259 PMCID: PMC10588228 DOI: 10.1186/s40001-023-01436-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/07/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Episodic growth due to microvascular proliferations (MVP) has been reported in congenital arteriovenous malformations (AVM), which are normally quiescent lesions composed of mature malformed vessels. Since AVM also may worsen under conditions of hormonal dysregulation, we hypothesized that hormonal influences may stimulate this process of vasoproliferative growth through potential interactions with hormone receptors (HR). METHODS 13 Cases of AVM tissue with histologically documented vasoproliferative growth were analyzed quantitatively for the presence and tissue localization of estrogen receptor (ER), progesterone receptor (PGR), growth hormone receptor (GHR) and follicle-stimulating hormone receptor (FSHR) in relation to resident cells of interest (endothelial cells (EC), smooth muscle cells (SMC) and mast cells (MC)) by applying multiplex immunohistochemistry (IHC) staining. Expression patterns in lesions with MVP and mature vessels were quantified and compared. Available fresh frozen tissues of 3 AVM samples were used to confirm the presence of HR using Reverse-Transcriptase quantitative Polymerase Chain Reaction (RT-qPCR). RESULTS All four HR studied were expressed in all cases within EC and SMC in areas of MVP and mature vessels, but not in normal skin tissue. ER, GHR, and FSHR showed more expression in EC of MVP and in SMC of mature vessels. RT-qPCR confirmed presence of all 4 HR in both areas. CONCLUSION Expression of ER, PGR, GHR, and FSHR in vasoproliferative areas of congenital AVM could explain onset of sudden symptomatic growth, as has observed in a subpopulation of patients. These findings may have implications for eventual anti-hormonal targeted therapy in the lesions involved.
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Affiliation(s)
- A M Utami
- Department of Pathology, Amsterdam University Medical Center-Location AMC, University of Amsterdam, Amsterdam, The Netherlands.
- Department of Anatomical Pathology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - J B G Halfwerk
- Department of Pathology, Amsterdam University Medical Center-Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - O J de Boer
- Department of Pathology, Amsterdam University Medical Center-Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C Mackaaij
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D R Pabittei
- Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - C M A M van der Horst
- Department of Plastic Surgery, Amsterdam University Medical Center-Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - L B Meijer-Jorna
- Symbiant Pathology Expert Center, NWZ- Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - A C van der Wal
- Department of Pathology, Amsterdam University Medical Center-Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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15
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Fan X, Gao X, Deng Y, Ma B, Liu J, Zhang Z, Zhang D, Yang Y, Wang C, He B, Nie Q, Ye Z, Liu P, Wen J. Untargeted plasma metabolome identifies biomarkers in patients with extracranial arteriovenous malformations. Front Physiol 2023; 14:1207390. [PMID: 37727659 PMCID: PMC10505742 DOI: 10.3389/fphys.2023.1207390] [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: 04/17/2023] [Accepted: 08/09/2023] [Indexed: 09/21/2023] Open
Abstract
Objective: This study aimed to investigate the plasma metabolic profile of patients with extracranial arteriovenous malformations (AVM). Method: Plasma samples were collected from 32 AVM patients and 30 healthy controls (HC). Ultra-high performance liquid chromatography-mass spectrometry (UHPLC-MS) was employed to analyze the metabolic profiles of both groups. Metabolic pathway enrichment analysis was performed through Kyoto Encyclopedia of Genes and Genomes (KEGG) database and MetaboAnalyst. Additionally, machine learning algorithms such as Least Absolute Shrinkage and Selection Operator (LASSO) and random forest (RF) were conducted to screen characteristic metabolites. The effectiveness of the serum biomarkers for AVM was evaluated using a receiver-operating characteristics (ROC) curve. Result: In total, 184 differential metabolites were screened in this study, with 110 metabolites in positive ion mode and 74 metabolites in negative mode. Lipids and lipid-like molecules were the predominant metabolites detected in both positive and negative ion modes. Several significant metabolic pathways were enriched in AVMs, including lipid metabolism, amino acid metabolism, carbohydrate metabolism, and protein translation. Through machine learning algorithms, nine metabolites were identify as characteristic metabolites, including hydroxy-proline, L-2-Amino-4-methylenepentanedioic acid, piperettine, 20-hydroxy-PGF2a, 2,2,4,4-tetramethyl-6-(1-oxobutyl)-1,3,5-cyclohexanetrione, DL-tryptophan, 9-oxoODE, alpha-Linolenic acid, and dihydrojasmonic acid. Conclusion: Patients with extracranial AVMs exhibited significantly altered metabolic patterns compared to healthy controls, which could be identified using plasma metabolomics. These findings suggest that metabolomic profiling can aid in the understanding of AVM pathophysiology and potentially inform clinical diagnosis and treatment.
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Affiliation(s)
- Xueqiang Fan
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Xixi Gao
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Yisen Deng
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Bo Ma
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jingwen Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhaohua Zhang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Dingkai Zhang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Yuguang Yang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Cheng Wang
- Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Bin He
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Qiangqiang Nie
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhidong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Peng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Jianyan Wen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
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Tuleja A, Bernhard S, Hamvas G, Andreoti TA, Rössler J, Boon L, Vikkula M, Kammer R, Haupt F, Döring Y, Baumgartner I. Clinical phenotype of adolescent and adult patients with extracranial vascular malformation. J Vasc Surg Venous Lymphat Disord 2023; 11:1034-1044.e3. [PMID: 37030445 DOI: 10.1016/j.jvsv.2023.03.012] [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: 10/14/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVE In recent years, genotypic characterization of congenital vascular malformations (CVMs) has gained attention; however, the spectrum of clinical phenotype remains difficult to attribute to a genetic cause and is rarely described in the adult population. The aim of this study is to describe a consecutive series of adolescent and adult patients in a tertiary center, where a multimodal phenotypic approach was used for diagnosis. METHODS We analyzed clinical findings, imaging, and laboratory results at initial presentation, and set a diagnosis according to the International Society for the Study of Vascular Anomalies (ISSVA) classification for all consecutively registered patients older than 14 years of age who were referred to the Center for Vascular Malformations at the University Hospital of Bern between 2008 and 2021. RESULTS A total of 457 patients were included for analysis (mean age, 35 years; females, 56%). Simple CVMs were the most common (n = 361; 79%), followed by CVMs associated with other anomalies (n = 70; 15%), and combined CVMs (n = 26; 6%). Venous malformations (n = 238) were the most common CVMs overall (52%), and the most common simple CVMs (66%). Pain was the most frequently reported symptom in all patients (simple, combined, and vascular malformation with other anomalies). Pain intensity was more pronounced in simple venous and arteriovenous malformations. Clinical problems were related to the type of CVM diagnosed, with bleeding and skin ulceration in arteriovenous malformations, localized intravascular coagulopathy in venous malformations, and infectious complications in lymphatic malformations. Limb length difference occurred more often in patients with CVMs associated with other anomalies as compared with simple or combined CVM (22.9 vs 2.3%; P < .001). Soft tissue overgrowth was seen in one-quarter of all patients independent of the ISSVA group. CONCLUSIONS In our adult and adolescent population with peripheral vascular malformations, simple venous malformations predominated, with pain as the most common clinical symptom. In one-quarter of cases, patients with vascular malformations presented with associated anomalies on tissue growth. The differentiation of clinical presentation with or without accompanying growth abnormalities need to be added to the ISSVA classification. Phenotypic characterization considering vascular and non-vascular features remains the cornerstone of diagnosis in adult as well as pediatric patients.
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Affiliation(s)
- Aleksandra Tuleja
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Sarah Bernhard
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland
| | - Györgyi Hamvas
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland
| | - Themis-Areti Andreoti
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Inselspital - University Hospital of Bern, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Jochen Rössler
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Inselspital - University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Laurence Boon
- Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Saint Luc University Hospital, Brussels, Belgium
| | - Miikka Vikkula
- Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Saint Luc University Hospital, Brussels, Belgium; Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
| | - Rafael Kammer
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland
| | - Fabian Haupt
- Department of Radiology, Inselspital, Bern University, Hospital, Bern, Switzerland
| | - Yvonne Döring
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland; Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland; Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich (LMU), Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland
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17
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Israrahmed A, Singh V, Prasad SN, Singh AK, Bhatnagar A, Singh A, Phadke RV. Management of scalp arteriovenous malformations: a rising trend towards percutaneous direct puncture embolization technique-our experience. Acta Radiol 2023; 64:2431-2438. [PMID: 37192645 DOI: 10.1177/02841851231174458] [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: 05/18/2023]
Abstract
BACKGROUND Scalp arteriovenous malformations (AVMs), or cirsoid aneurysms of the scalp, usually present with troublesome symptoms and cosmetic disfigurement. Endovascular/percutaneous embolization has evolved as a sole treatment method or adjunct to surgical excision in the management of scalp AVMs with an excellent outcome. PURPOSE To discuss minimally invasive techniques for treating scalp AVMs as well as to highlight the role of embolization before surgery. MATERIAL AND METHODS This is a retrospective study of 50 patients with scalp AVM who underwent embolization (percutaneous/endovascular) during 2010-2019 at a tertiary care center. n-butyl cyanoacrylate (n-BCA) was used as an embolizing agent in all the cases and the patients were followed up at three- and six-month intervals with Doppler evaluation. RESULTS A total of 50 patients were included in the study. The occipital region was the most common location; 82% were Schobinger class II lesions and 18% were class III lesions. Thirteen patients had small-sized AVMs and 37 patients had large-sized AVMs. Post-embolization surgery was performed in 36 patients. Of the patients, 28 underwent percutaneous embolization, 20 underwent endovascular embolization, and two underwent both to achieve complete embolization of the lesion. The number of percutaneous procedures increased in the latter half of the study period as the safety and efficacy of the technique were established. No major complications were seen in this study. CONCLUSION Embolization of scalp AVMs is a safe and effective technique and can be used in isolation for small lesions and as an adjunct procedure to surgery for large-sized lesions.
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Affiliation(s)
- Amrin Israrahmed
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Vivek Singh
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Surya Nandan Prasad
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, India
| | - Anil Kumar Singh
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ankur Bhatnagar
- Department of Plastic Surgery and Burns, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anupama Singh
- Department of Plastic Surgery and Burns, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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18
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Leyman B, Govaerts D, Dormaar JT, Meeus J, Bila M, Coropciuc R, Willaert R, Politis C. A 16-year retrospective study of vascular anomalies in the head and neck region. Head Face Med 2023; 19:32. [PMID: 37528467 PMCID: PMC10391867 DOI: 10.1186/s13005-023-00376-z] [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: 01/08/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
Depending on the diagnostic modality, the classification of vascular anomalies varies and so does the nomenclature. The 'International Society for the Study of Vascular Anomalies' (ISSVA) is the most widely accepted classification in the literature and is mainly based on the radiologic and clinical presentation. The aim of this article is to review the clinical practice of diagnosis and treatment of vascular anomalies in the head and neck region in a university hospital, with special focus on the nomenclature. All patients with a vascular anomaly presenting to the department of oral and maxillofacial surgery were reviewed in a retrospective manner. Nomenclature, diagnostic process, lesion characteristics, treatment and outcome were examined. The lesions were (re)classified according to the ISSVA classification. A total of 185 patients were identified, of which 12.4% (n = 23) had a congenital anomaly. After reclassification, the most common lesions were venous malformations (n = 47, 25.4%), followed by lobular capillary hemangiomas (n = 17, 9.2%). A group of 39 anomalies could not be further specified. One hundred and one patients (54,6%) received treatment, of which 93 were treated surgically (92,1% of treated patients). Endovascular treatment was considered in 41 patients but applied in only eight. This strict selection led to a low a complication rate. We provide an overview of the clinical practice in the management of vascular anomalies in a university hospital. The histology report is a source of miscommunication because clinicians use the ISSVA classification, while pathologists use the WHO classification. Every professional involved should be aware of the differences in classification and nomenclature.
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Affiliation(s)
- Bernard Leyman
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
| | - Dries Govaerts
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Jakob Titiaan Dormaar
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
- Present Address: Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
| | - Jan Meeus
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Michel Bila
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Ruxandra Coropciuc
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Robin Willaert
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
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Sudduth CL, Smits PJ, Vivero MP, Cheng YS, Ad M, Konczyk DJ, Bischoff J, Warman ML, Greene AK. Arteriovenous malformation Map2k1 mutation affects vasculogenesis. Sci Rep 2023; 13:11074. [PMID: 37422456 PMCID: PMC10329712 DOI: 10.1038/s41598-023-35301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/16/2023] [Indexed: 07/10/2023] Open
Abstract
Somatic activating MAP2K1 mutations in endothelial cells (ECs) cause extracranial arteriovenous malformation (AVM). We previously reported the generation of a mouse line allowing inducible expression of constitutively active MAP2K1 (p.K57N) from the Rosa locus (R26GT-Map2k1-GFP/+) and showed, using Tg-Cdh5CreER, that EC expression of mutant MAP2K1 is sufficient for the development of vascular malformations in the brain, ear, and intestines. To gain further insight into the mechanism by which mutant MAP2K1 drives AVM development, we induced MAP2K1 (p.K57N) expression in ECs of postnatal-day-1 pups (P1) and investigated the changes in gene expression in P9 brain ECs by RNA-seq. We found that over-expression of MAP2K1 altered the transcript abundance of > 1600 genes. Several genes had > 20-fold changes between MAP2K1 expressing and wild-type ECs; the highest were Col15a1 (39-fold) and Itgb3 (24-fold). Increased expression of COL15A1 in R26GT-Map2k1-GFP/+; Tg-Cdh5CreER+/- brain ECs was validated by immunostaining. Ontology showed that differentially expressed genes were involved in processes important for vasculogenesis (e.g., cell migration, adhesion, extracellular matrix organization, tube formation, angiogenesis). Understanding how these genes and pathways contribute to AVM formation will help identify targets for therapeutic intervention.
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Affiliation(s)
- Christopher L Sudduth
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Patrick J Smits
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Matthew P Vivero
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Yu Sheng Cheng
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Michal Ad
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Dennis J Konczyk
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Joyce Bischoff
- Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew L Warman
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Arin K Greene
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.
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20
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Orly J, Bisdorff A, Fraissenon A, Joly A, Boulouis G, Guibaud L, Tavernier E, Mallet S, Marcelin C, Miquel J, Martin L, Droitcourt C, Gusdorf L, Abasq C, Dadban A, Chiaverini C, Vabres P, Herbreteau D, Boccara O, Wassef M, Maruani A. Intramuscular capillary-type hemangioma: Diagnosis, treatment, and outcomes. A French multicentric retrospective study of 66 cases. Eur J Radiol 2023; 165:110962. [PMID: 37423018 DOI: 10.1016/j.ejrad.2023.110962] [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: 03/09/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Intramuscular capillary-type hemangiomas (ICTHs) are rare entities, belonging to the group of intramuscular "hemangiomas." The diagnosis remains challenging. We aimed to assess the diagnostic criteria, treatments and outcomes of ICTHs. METHODS This retrospective study collected all cases of ICTH followed up in 9 French hospital centers, reviewed by an adjudication expert group. RESULTS Among 133 patients screened, 66 with ICTH were included. The median age of patients at diagnosis was 28.0 years, interquartile range (21.0---36.0). The lesion, mainly presenting as a gradually increasing mass (83.9%), was painless (88.9%) and was located in the head and neck (42.4%). MRI (available in all cases) mainly revealed a well-delineated lesion, isointense to the muscle on T1-weighted images, with enhancement after contrast injection; hyperintense on T2-weighted images; and containing flow voids. Among the 66 cases, 59 exhibited typical ICTH features and 7 shared some imaging features with arteriovenous malformations. These latter were larger than typical ICTHs and more painful and appeared on imaging as less well delimited and more heterogeneous tissue masses, with larger tortuous afferent arteries, earlier draining vein opacification and mild arteriovenous shunting. We propose to name these lesions arteriovenous malformation (AVM)-like ICTH. Pathological reports were similar in typical and AVM-like ICTH, showing capillary proliferation with mainly small-size vessels, negative for GLUT-1 and positive for ERG, AML, CD31 and CD34, with low Ki67 proliferation index (<10%), and adipose tissue. The most frequent treatment for ICTH was complete surgical resection (17/47, 36.2%), preceded in some cases by embolization, which led to complete remission. CONCLUSIONS ICTH can be diagnosed on MRI when it is typical. Biopsy or angiography are required for atypical forms.
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Affiliation(s)
- Jordan Orly
- CHRU Tours, Department of Dermatology, Unit of Pediatric Dermatology, Tours, France; Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Tours), Tours, France
| | - Annouk Bisdorff
- Reference Center for Vascular Anomalies FAVA-multi, University Hospital of Lariboisière, Coordinator of the Constitutive Center for Superficial Arteriovenous Malformations in Children and Adults, AP-HP, Department of Neuroradiology, Paris, France
| | - 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; CREATIS, UMR 5220, U1294 Lyon, France
| | - Aline Joly
- Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Tours), Tours, France; CHRU Tours, Department of Maxillo-facial Surgery, Tours, France
| | - Grégoire Boulouis
- Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Tours), Tours, France; CHRU Tours, Department of Neuroradiology and Interventional Radiology, Tours, 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
| | - Elsa Tavernier
- University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France; CHRU Tours, Clinical Investigation Center INSERM 1415, Tours, France
| | - Stéphanie Mallet
- University Hospital Center of Marseille, Department of Dermatology, Marseille, France
| | - Clément Marcelin
- University Hospital Center of Bordeaux, Department of Radiology, Bordeaux, France
| | - Juliette Miquel
- University Hospital Center of La Réunion, Department of Pediatric Dermatology, Saint-Pierre, La Réunion, France
| | - Ludovic Martin
- University Hospital Center of Angers, Department of Dermatology, Angers, France
| | | | - Laurence Gusdorf
- University Hospital Center of Reims, Department of Dermatology, Reims, France
| | - Claire Abasq
- University Hospital Center of Brest, Department of Dermatology, Brest, France
| | - Ali Dadban
- University Hospital Center of Amiens, Department of Dermatology, Amiens, France
| | | | - Pierre Vabres
- University of Bourgogne, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Dijon, France
| | - Denis Herbreteau
- Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Tours), Tours, France; CHRU Tours, Department of Neuroradiology and Interventional Radiology, Tours, France
| | - Olivia Boccara
- Department of Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Necker), University Hospital Necker-Enfants Malades, Paris, France
| | - Michel Wassef
- University Hospital of Lariboisière, AP-HP, Department of Pathology, Paris, France
| | - Annabel Maruani
- CHRU Tours, Department of Dermatology, Unit of Pediatric Dermatology, Tours, France; Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Tours), Tours, France; University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France.
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21
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Sylvester B, Sundaram N, Marica S, Cagir B, Ronsivalle J. Lower-Extremity Arteriovenous Malformation Masquerading as Peripheral Artery Disease. Cureus 2023; 15:e41431. [PMID: 37546090 PMCID: PMC10404121 DOI: 10.7759/cureus.41431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
An arteriovenous malformation (AVM) refers to an anomalous, direct connection between an artery and a vein. Typically, these two vessels are interposed by high-resistance capillary beds, the absence of which results in a high-flow system from an artery into a vein. Venous vessel walls are not designed to handle such high-pressure blood flow, and their vessel wall structure becomes permanently altered and weakened. For this reason, AVMs are at an increased risk for hemorrhages and ruptures. AVMs present with a spectrum of symptoms, ranging from skin discoloration, ischemia in distal tissues, and heart failure from arteriovenous shunting. Here, we present a case of a patient who underwent amputation of his second left toe, initially thought to be a result of peripheral arterial disease (PAD) due to his extensive smoking history. Further imaging findings revealed a rare lower-extremity AVM as the source of his ischemia, not PAD. Ultimately, the treatment of the vascular anomaly and resolution of the patient's symptoms were achieved via transarterial embolization. This case emphasizes the importance of looking beyond PAD as the cause of distal lower-extremity ischemia and provides insights into an uncommon and often missed diagnosis of extracranial AVMs.
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Affiliation(s)
- Briana Sylvester
- School of Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
| | | | - Silviu Marica
- Vascular Surgery, Guthrie Clinic/Guthrie Robert Packer Hospital, Sayre, USA
| | - Burt Cagir
- Colorectal Surgery, Guthrie Robert Packer Hospital, Sayre, USA
| | - Joseph Ronsivalle
- Interventional Radiology, Guthrie Robert Packer Hospital, Sayre, USA
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22
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Tanoue S, Tanaka N, Koganemaru M, Kuhara A, Kugiyama T, Sawano M, Abe T. Head and Neck Arteriovenous Malformations: Clinical Manifestations and Endovascular Treatments. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:23-35. [PMID: 37485489 PMCID: PMC10359175 DOI: 10.22575/interventionalradiology.2022-0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/01/2022] [Indexed: 07/25/2023]
Abstract
Arteriovenous malformations (AVMs) are vascular malformations that present high-flow direct communication between the arteries and veins, not involving the capillary beds. They can be progressive and lead to various manifestations, including abnormal skin or mucosal findings, ischemia, hemorrhage, and high-output heart failure in severe cases. AVMs often involve the head and neck region. Head and neck AVMs can present region-specific clinical manifestations, angioarchitecture, and complications, especially in cosmetic appearance and ingestion, respiratory, and neuronal functions. Therefore, when planning endovascular treatment of head and neck AVMs, physicians should consider not only the treatment strategy but also the preservation of the cosmetic appearance and critical functions. Knowledge of the functional vascular anatomy as well as treatment techniques should facilitate a successful management. This review summarizes AVMs' clinical manifestations, imaging findings, treatment strategy, and complications.
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Affiliation(s)
- Shuichi Tanoue
- Department of Radiology, Kurume University School of Medicine, Japan
| | - Norimitsu Tanaka
- Department of Radiology, Kurume University School of Medicine, Japan
| | | | - Asako Kuhara
- Department of Radiology, Kurume University School of Medicine, Japan
| | - Tomoko Kugiyama
- Department of Radiology, Kurume University School of Medicine, Japan
| | - Miyuki Sawano
- Department of Radiology, Kurume University School of Medicine, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Japan
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23
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Osuga K, Yamamoto K, Higashihara H, Juri H, Yamamoto K, Higashiyama A, Matsutani H, Sugimoto A, Toda S, Fujitani T. Endovascular and Percutaneous Embolotherapy for the Body and Extremity Arteriovenous Malformations. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:36-48. [PMID: 37485480 PMCID: PMC10359173 DOI: 10.22575/interventionalradiology.2022-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/24/2022] [Indexed: 07/25/2023]
Abstract
Arteriovenous malformations (AVMs) consist of abnormal communications between the arteries and veins. They can involve any part of the body and extremity and grow in proportion to age and in response to hormonal influence or trauma. When symptoms progress from Schöbinger clinical stage II to III, transcatheter and/or direct puncture embolization are less-invasive and repeatable options for symptom palliation. The goal of embolization is to obliterate the AV shunt, and the choice of lesion access and embolic agents is based on the individual anatomy and flow. Embolization can be technically challenging due to complex vascular anatomy and morbidity risks. Therefore, a multidisciplinary management is essential for the diagnosis and therapeutic intervention of AVMs.
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Affiliation(s)
- Keigo Osuga
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Kazuhiro Yamamoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Hiroki Higashihara
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan
| | - Hiroshi Juri
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Kiyohito Yamamoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Akira Higashiyama
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Hiroki Matsutani
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Asami Sugimoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Sou Toda
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Tomohiro Fujitani
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
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24
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Jia H, Chen Y, Yang X, Lee Y, Zou Y, Zhou J, Jin Y, Hua C, Lin X. Treatment of Challenging Extracranial Arteriovenous Malformations: A Single-Center Experience and Literature Review. Ann Plast Surg 2023; 90:S177-S182. [PMID: 36752531 DOI: 10.1097/sap.0000000000003375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ABSTRACT Extracranial arteriovenous malformation (AVM) is a high-flow congenital vascular malformation, where direct communication between the arteries and veins impedes perfusion of capillary beds and causes disfigurement of the affected tissue. Surgery and endovascular therapy are currently the main treatment for extracranial AVMs. Nevertheless, management of complex cases is sometimes challenging because of severe complications such as refractory ulceration, life-threatening bleeding, and even cardiac insufficiency. Here, we reviewed the development and potential treatment for extracranial AVMs and shared our single-center experiences of diagnosis and treatment of this challenging disease.
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Affiliation(s)
- Hechen Jia
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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25
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Talafha M, Al Sharie S, Abu-Hamdiyah OJ, Araydah M, Al-Husinat L, Varrassi G. A Rare Case of Scalp Arteriovenous Malformation in an Adolescent Patient. Cureus 2023; 15:e37952. [PMID: 37223134 PMCID: PMC10202684 DOI: 10.7759/cureus.37952] [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: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
Scalp arteriovenous malformations (AVMs) are rare lesions that arise due to a pathological fistulous connection between scalp arterial feeders and draining veins without the involvement of capillary beds. Here, we report a case of a 17-year-old male who presented with an enlarging, pulsatile, mass in the scalp of the parietal region with mild headaches and was diagnosed with a scalp AVM that was treated successfully with endovascular trans-arterial embolization. Scalp AVMs are uncommon extracranial vascular abnormalities that neurosurgeons hardly ever see. To precisely define the angiographic architecture of an AVM and to organize further management, digital subtraction angiography is crucial.
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Affiliation(s)
- Muna Talafha
- Medicine, Burnett School of Biomedical Sciences, University of Central Florida (UCF) College of Medicine, Orlando, USA
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26
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Katsushima C, Yamanaka H, Tsuge I, Saito S, Morimoto N. Free superficial circumflex iliac artery perforator flow‐through flap transfer for reconstruction after excision of arteriovenous malformations of the hand: A case report. Microsurgery 2023. [DOI: 10.1002/micr.31045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/05/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Chihiro Katsushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine Kyoto University Kyoto Japan
| | - Hiroki Yamanaka
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine Kyoto University Kyoto Japan
| | - Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine Kyoto University Kyoto Japan
| | - Susumu Saito
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine Kyoto University Kyoto Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine Kyoto University Kyoto Japan
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27
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Orly J, Bisdorff A, Joly A, Edee AE, Tavernier E, Herbreteau D, Boccara O, Wassef M, Maruani A. Characteristics, Natural Course and Treatment of Intramuscular Capillary-type Haemangioma: A Systematic Literature Review. Acta Derm Venereol 2023; 103:adv00893. [PMID: 36939537 PMCID: PMC10041649 DOI: 10.2340/actadv.v103.4432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/29/2022] [Indexed: 03/21/2023] Open
Abstract
Intramuscular capillary-type haemangiomas (ICTH) are rare vascular anomalies that can easily be misdiagnosed as other entities. A systematic review was performed of all cases of ICTH in the literature since its first description in 1972. An adjudication committee reviewed cases to include only ICTHs. Among 1,143 reports screened, 43 were included, involving 75 patients. The most frequent differential diagnosis was intramuscular venous malformations. The mean age of patients at diagnosis was 21.2 years. ICTH was mainly described as a gradually increasing mass (81.8%), painless (73.9%), that could occur anywhere in the body but most frequently on the head and neck (44.0%). Magnetic resonance imaging (MRI) was mainly used for diagnosis (69.1%) and displayed specific features. The most frequent treatment was complete surgical removal (73.9%), which could be preceded by embolization, and led to complete remission without recurrence in all but 1 case.
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Affiliation(s)
- Jordan Orly
- CHRU Tours, Department of Dermatology, Unit of Pediatric dermatology, Tours, France; Reference center for genodermatoses and rare skin diseases (MAGEC-Tours), Tours.
| | - Annouk Bisdorff
- 3Reference center for vascular anomalies FAVA-multi, University Hospital of Lariboisière; Coordinator of the constitutive center for superficial arteriovenous malformations in children and adults; AP-HP, Department of Neuroradiology, Paris, France
| | - Aline Joly
- Reference center for genodermatoses and rare skin diseases (MAGEC-Tours), Tours, France; Reference center for vascular anomalies FAVA-multi, University Hospital of Lariboisière; Coordinator of the constitutive center for superficial arteriovenous malformations in children and adults; AP-HP, Department of Neuroradiology, Paris, France; CHRU Tours, Department of Maxillo-facial surgery, Tours, France
| | - Afi-Emiliène Edee
- Reference center for genodermatoses and rare skin diseases (MAGEC-Tours), Tours, France
| | - Elsa Tavernier
- University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France; CHRU Tours, Clinical Investigation Center INSERM 1415, Tours, France
| | | | - Olivia Boccara
- Department of Dermatology and Reference center for genodermatoses and rare skin diseases (MAGEC-Necker), University Hospital Necker-Enfants Malades, Paris, France
| | - Michel Wassef
- Department of Pathology, University Hospital of Lariboisière, AP-HP, Paris, France
| | - Annabel Maruani
- CHRU Tours, Department of Dermatology, Unit of Pediatric dermatology, Tours, France; Reference center for genodermatoses and rare skin diseases (MAGEC-Tours), Tours, France; University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France
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28
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Berger S, Andersen R, Smaastuen MC, Rosseland LA, Dorenberg E. Long-term changes of health-related quality of life in patients with peripheral vascular malformations - a prospective observational study. J Plast Reconstr Aesthet Surg 2023; 77:46-53. [PMID: 36549122 DOI: 10.1016/j.bjps.2022.10.024] [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: 05/20/2022] [Revised: 08/30/2022] [Accepted: 10/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this observational study was to assess health-related quality of life (HRQOL) changes in patients with vascular malformations, over a period of almost eight years, and to assess clinical and demographic characteristics possibly associated with HRQOL changes. METHODS Eighty out of 111 patients who were included in a previously published comparative HRQOL study accepted inclusion in this follow-up study. HRQOL at baseline and follow-up was assessed with the Short-Form 36-item questionnaire (SF-36). Median observation time was 7.9 years. Linear mixed models and linear regression models were applied to assess HRQOL change and possible associations with demographic and clinical variables. RESULTS The median age of the patient cohort at baseline evaluation (n = 111) was 27.0 years. Ninety-six out of 111 (86.5%) patients were diagnosed with venous malformations. Significantly higher SF-36 scores at follow-up were found for the physical domains Role limitations due to (RLDT) physical problems (difference=13.5; 95% CI [1.6, 25.3]) and Bodily pain (difference=11.3; 95% CI [3.8, 18.8]). No deterioration of HRQOL was found in any domain. In multivariate analyses, female gender, muscle/bone involvement, and higher age were associated with a positive relative change in SF-36 in the domains Physical functioning, RLDT physical problems, and RLDT emotional problems, respectively. Invasive treatment was not associated with long-term HRQOL change. CONCLUSIONS Over a period of almost eight years, significant improvement of SF-36 scores was observed in the physical domains RLDT physical problems and bodily pain. Female gender, muscle/bone involvement, and higher age were associated with HRQOL improvement in certain domains.
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Affiliation(s)
- Sigurd Berger
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway.
| | - Rune Andersen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Milada Cvancarova Smaastuen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway
| | - Leiv Arne Rosseland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway
| | - Eric Dorenberg
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
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29
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Mataro I, Di Franco L, Cavaliere A, Razzano S, Schonauer F, D'Andrea F, d'Alessio R. Extensive severe intraorbital arteriovenous malformations: report of a rare laser complication and successful management. J Wound Care 2023; 32:S4-S8. [PMID: 36630192 DOI: 10.12968/jowc.2023.32.sup1.s4] [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: 01/12/2023]
Abstract
Arteriovenous malformations (AVMs) are rare congenital errors of vascular morphogenesis, characterised by abnormal direct communications between arteries and veins, bypassing the normal capillary bed. Apart from the central nervous system, typical locations include the head and neck, and less frequently limbs, trunk or internal organs. AVMs of the head and neck often become clinically evident and symptomatic only in later childhood and are characterised by a history of variable growth, sometimes leading to large, deforming, pulsating masses with a propensity to massive haemorrhage. Therapeutic strategy is based on selective embolisation, surgical excision, or a combination of both. Radical surgical excision of local AVMs is the only effective treatment but it may be mutilating, especially for AVMs of the head and neck. Laser therapy represents a good option to treat the cutaneous aspects of AVMs nevertheless, its efficacy is limited. To the date, pharmacological therapy for AVMs is still on debate due to its controversial outcomes as it seems not as effective as other treatments and usually requires a longer course of application. However, pharmacological therapy could be useful in selected patients and for AVMs nonresponsive to traditional treatment, allowing them to obtain acceptable results without serious complications. This paper reports the case of a serious laser complication of extensive intraorbital AVM successfully treated by local reconstruction and topical pharmacological treatment.
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Affiliation(s)
- Ilaria Mataro
- Plastic and Reconstructive Surgery and Burn Unit, Hospital 'A. Cardarelli', Naples, Italy
| | - Livia Di Franco
- Resident Doctor in General Surgery, Federico II University Hospital, Via Pansini 5, Naples, Italy
| | - Annachiara Cavaliere
- Department of Plastic and Reconstructive Surgery, Federico II University Hospital, Via Pansini 5, Naples, Italy
| | - Sergio Razzano
- Plastic and Reconstructive Surgery and Burn Unit, Hospital 'A. Cardarelli', Naples, Italy
| | - Fabrizio Schonauer
- Department of Plastic and Reconstructive Surgery, Federico II University Hospital, Via Pansini 5, Naples, Italy
| | - Francesco D'Andrea
- Department of Plastic and Reconstructive Surgery, Federico II University Hospital, Via Pansini 5, Naples, Italy
| | - Roberto d'Alessio
- Plastic and Reconstructive Surgery and Burn Unit, Hospital 'A. Cardarelli', Naples, Italy
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30
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Schmidt VF, Masthoff M, Vielsmeier V, Seebauer CT, Cangir Ö, Meyer L, Mükke A, Lang W, Schmid A, Sporns PB, Brill R, Wohlgemuth WA, da Silva NPB, Seidensticker M, Schinner R, Küppers J, Häberle B, Haubner F, Ricke J, Zenker M, Kimm MA, Wildgruber M. Clinical Outcome and Quality of Life of Multimodal Treatment of Extracranial Arteriovenous Malformations: The APOLLON Study Protocol. Cardiovasc Intervent Radiol 2023; 46:142-151. [PMID: 36261507 PMCID: PMC9810564 DOI: 10.1007/s00270-022-03296-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/30/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Arteriovenous malformations (AVMs) as rare diseases are diagnostically and therapeutically challenging. Due to the limited evidence regarding treatment outcome, prospective data are needed on how different treatment regimens affect outcome. The aims of this prospective trial are to determine effectiveness, safety, and clinical outcome of multimodal treatment in patients with extracranial AVMs. MATERIALS AND METHODS After clinical and magnetic resonance imaging (MRI)-based diagnosis and informed consent, 146 patients (> 4 years and < 70 years) undergoing multimodal therapy in tertiary care vascular anomalies centers will be included in this prospective observational trial. Treatment options include conservative management, medical therapy, minimally invasive image-guided procedures (embolization, sclerotherapy) and surgery as well as combinations of the latter. The primary outcome is the patient-reported QoL 6 months after completion of treatment using the short form-36 health survey version 2 (SF-36v2) and the corresponding short form-10 health survey (SF-10) for children. In addition, clinical presentation (physician-reported signs), MRI imaging (radiological assessment of devascularization), recurrence rate, and therapeutic safety will be analyzed. Further follow-up will be performed after 12, 24, and 36 months. Moreover, liquid biopsies are being obtained from peripheral blood at multiple time points to investigate potential biomarkers for therapy response and disease progression. DISCUSSION The APOLLON trial is a prospective, multicenter, observational open-label trial with unequal study groups to generate prospective evidence for multimodal treatment of AVMs. A multicenter design with the potential to assess larger populations will provide an increased understanding of multimodal therapy outcome in this orphan disease. TRIAL REGISTRATION German Clinical Trials Register (identification number: DRKS00021019) https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021019 .
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Affiliation(s)
- Vanessa F. Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Masthoff
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Veronika Vielsmeier
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Caroline T. Seebauer
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Özlem Cangir
- Department of Pediatric Surgery, Center for Vascular Malformations, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany
| | - Lutz Meyer
- Department of Pediatric Surgery, Center for Vascular Malformations, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany
| | - Antje Mükke
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Axel Schmid
- Department for Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Peter B. Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Richard Brill
- Clinic and Policlinic of Diagnostic Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Walter A. Wohlgemuth
- Clinic and Policlinic of Diagnostic Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Regina Schinner
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Julia Küppers
- Department for Pediatric Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Beate Häberle
- Department for Pediatric Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Martin Zenker
- Institute for Human Genetics, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Melanie A. Kimm
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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31
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Cuong TC, Thang LM, Giang NL, Trung NA, Qui LV, Tha TTT, Huy NDN, Lam TV, Linh DH, Duc NM. Recurrent head and neck arteriovenous malformations: A case report. Radiol Case Rep 2022; 18:766-770. [PMID: 36589495 PMCID: PMC9794898 DOI: 10.1016/j.radcr.2022.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Head and neck arteriovenous malformations are rare, congenital, and high-flow vascular malformations characterized by abnormal communication between feeding arteries and draining veins without intervening capillaries. Arteriovenous malformations are considered the most dangerous type of vascular malformation because progressive symptoms and infiltration can result in potentially life-threatening consequences. Left untreated, arteriovenous malformations can cause significant cosmetic deformities, severe bleeding, and high-output cardiac failure associated with arteriovenous shunting. The effective treatment of arteriovenous malformations located in the head and neck region is quite challenging due to high rates of recurrence and potentially lethal complications. We describe a case presenting with large arteriovenous malformations in the face and neck. Despite attempting several treatments, including external carotid artery ligation and embolization with liquid embolic agents, the patient continued to experience recurrence and symptoms of bleeding and pain. After admission, reconstructive plastic surgery was performed, supplemented by percutaneous direct puncture embolization, using glue injected into the venous and transarterial embolization. The patient was discharged with clinical recovery. Digital subtraction angiography remains the gold standard for assessing symptomatic and aggressive arteriovenous malformations, both before and after treatment. The treatment of head and neck arteriovenous malformations often requires a multidisciplinary approach to achieve the best clinical results.
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Affiliation(s)
- Tran Chi Cuong
- Digital Subtraction Angiography Unit, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Le Minh Thang
- Digital Subtraction Angiography Unit, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Nguyen-Luu Giang
- Digital Subtraction Angiography Unit, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Nguyen Anh Trung
- Department of Surgery, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Luu Vinh Qui
- Department of Surgery, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Tran-Thi Thanh Tha
- Department of Cardiology, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Nguyen-Dao Nhat Huy
- Digital Subtraction Angiography Unit, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Tran-Van Lam
- Department of Surgery, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Duong-Hoang Linh
- Digital Subtraction Angiography Unit, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung Ward 12 District 10, Ho Chi Minh City, Vietnam,Corresponding author.
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Sawano M, Tanoue S, Tanaka N, Koganemaru M, Kuhara A, Kugiyama T, Shinjo Y, Abe T. Super-selective and staged glue embolization for labral AVMs using ultra-thin microcatheters: report of two cases. CVIR Endovasc 2022; 5:58. [PMID: 36394701 PMCID: PMC9672169 DOI: 10.1186/s42155-022-00335-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: 07/20/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Treating arteriovenous malformation (AVM) is challenging because of the high recurrence rate and because incomplete resection or embolization can induce aggressive growth. However, a standard strategy is not fully established. Although transcatheter arterial embolization (TAE) is currently almost always part of the treatment, in many cases, single treatment is not curative and only palliative. Additionally, the success and complication rates associated with TAE alone are unclear, and there has been limited study of staged TAE for facial AVMs. Furthermore, few reports have described the details of the procedure. CASE-PRESENTATION We report two cases of AVM of the upper lip in patients who were successfully treated by staged super-selective TAE at several-month intervals using ultra-thin microcatheters and n-butyl-2-cyanoacrylate. CONCLUSION Staged and super-selective TAE may prevent complications and provide high curability and might be a useful treatment in cases of AVM.
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Affiliation(s)
- Miyuki Sawano
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Shuichi Tanoue
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Norimitsu Tanaka
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Masamichi Koganemaru
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Asako Kuhara
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tomoko Kugiyama
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yasumoto Shinjo
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
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Multimodal Treatment for a Giant Unresectable Peripheral Arteriovenous Malformation. J Vasc Interv Radiol 2022; 33:1443-1445. [PMID: 35839987 DOI: 10.1016/j.jvir.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/30/2022] [Accepted: 07/03/2022] [Indexed: 12/15/2022] Open
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Wei T, Richter GT, Zhang H, Sun RW, Smith CH, Strub GM. Extracranial arteriovenous malformations demonstrate dysregulated TGF-β/BMP signaling and increased circulating TGF-β1. Sci Rep 2022; 12:16612. [PMID: 36198763 PMCID: PMC9534897 DOI: 10.1038/s41598-022-21217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022] Open
Abstract
Extracranial arteriovenous malformations (AVMs) are characterized by anomalous arterial-to-venous connections, aberrant angiogenesis, local inflammation and hypoxia, and disorganized histological architecture; however, the precise molecular perturbations leading to this phenotype remain elusive. We hypothesized that extracranial AVM tissue would demonstrate deregulation of the TGF-β/BMP signaling pathway, which may serve as a potential target in the development of molecular-based therapies for AVMs. AVM tissue was harvested during resection from 10 patients with AVMs and compared to control tissue. Blood was collected from 14 AVM patients and 10 patients without AVMs as controls. Expression of TGF-β/BMP pathway components was analyzed using RT-PCR, western blotting, and immunohistochemistry. Circulating levels of TGF-β1 were analyzed by ELISA. Paired t tests were utilized to perform statistical analysis. The mRNA levels of TGF-β1, ALK1, Endoglin (ENG), Smad6, Smad7, and Smad8 were significantly elevated in AVM tissue when compared to controls. Protein levels of TGF-β1 and Smad3 were elevated in AVM tissue while protein levels of BMP-9, ALK1, Smad1, Smad6, and Smad8 were significantly decreased in AVMs. Immunohistochemistry demonstrated increased TGF-β1 in the perivascular cells of AVMs compared to normal controls, and circulating levels of TGF-β1 were significantly higher in AVM patients. Patients with AVMs demonstrate aberrant TGF-β/BMP expression in AVM tissue and blood compared to controls. Targeting aberrantly expressed components of the TGF-β/BMP pathway in extracranial AVMs may be a viable approach in the development of novel molecular therapies, and monitoring circulating TGF-β1 levels may be a useful indicator of treatment success.
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Affiliation(s)
- Ting Wei
- Arkansas Children's Research Institute, 13 Children's Way, Little Rock, AR, 72202, USA
| | - Gresham T Richter
- Arkansas Children's Research Institute, 13 Children's Way, Little Rock, AR, 72202, USA.,Department of Otolaryngology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Haihong Zhang
- Arkansas Children's Research Institute, 13 Children's Way, Little Rock, AR, 72202, USA.,Department of Otolaryngology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Ravi W Sun
- Arkansas Children's Research Institute, 13 Children's Way, Little Rock, AR, 72202, USA.,Department of Otolaryngology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Conor H Smith
- Department of Otolaryngology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Graham M Strub
- Arkansas Children's Research Institute, 13 Children's Way, Little Rock, AR, 72202, USA. .,Department of Otolaryngology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA.
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Cortivo FD, Diallo R, Preudhomme R, Coulibaly A, Salami A, Benateau H. Exclusive surgical approach for facial arteriovenous malformations in precarious conditions. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e549-e555. [PMID: 35066172 DOI: 10.1016/j.jormas.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
Arteriovenous malformations (AVMs) are high-flow vascular lesions that does not regress spontaneously. They are located in the cranio-facial region in 50% of cases. Most of the time, the management of these lesions is a combination of surgery and vascular embolization. However, when the conditions are precarious, even without access to embolization, it's possible to treat some of those lesions with safety. We report four cases of patients suffering from cranio-facial AVM, treated exclusively by surgery during humanitarian missions.
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Affiliation(s)
- F Dal Cortivo
- Department of Maxillofacial Surgery, Caen University Hospital, France
| | - R Diallo
- Department of Maxillofacial Surgery, Donka Hospital, Conakry, Guinea
| | - R Preudhomme
- Department of Maxillofacial Surgery, Caen University Hospital, France.
| | - A Coulibaly
- Department of Maxillofacial Surgery, University Hospital of Bamako, Mali
| | - A Salami
- Department of Maxillofacial Surgery, University Hospital of Treichville, Abidjan, Ivory Coast
| | - H Benateau
- Department of Maxillofacial Surgery, Caen University Hospital, France
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36
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Arteriovenous Malformations. Dermatol Clin 2022; 40:445-448. [DOI: 10.1016/j.det.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lilje D, Wiesmann M, Hasan D, Ridwan H, Hölzle F, Nikoubashman O. Interventional embolization combined with surgical resection for treatment of extracranial AVM of the head and neck: A monocentric retrospective analysis. PLoS One 2022; 17:e0273018. [PMID: 36048777 PMCID: PMC9436082 DOI: 10.1371/journal.pone.0273018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/29/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The aim of this study was to demonstrate the efficacy and feasibility of treating patients with extracranial arteriovenous malformations (AVM) of the head and neck with interventional embolization followed by surgical resection. Methods We reviewed the charts of all patients between 2012 and 2021 with extracranial AVM of the head and neck scheduled for interdisciplinary treatment according to University Hospital RWTH Aachen’s protocol and conducted standardized interviews using a newly developed questionnaire. Interview results, as well as clinical examination and radiographic outcome results were analyzed to help determine the efficacy of our treatment approach. Results We included 10 patients (8 female, 2 male), with a mean age of 33.5 (11–61) years who were scheduled for treatment of the AVM with interventional embolization followed by surgical resection. In 6 of the 10 patients (60%) the lesion was located in extracranial soft tissue only. In one patient (10%), the lesion was located in bone tissue only. A combined intraosseous and oral soft tissue lesion was seen in the remaining 3 patients (30%). Radiographic resolution was achieved in 62.5% of cases and a significant decrease of symptoms was identified (p = 0.002). None of the patients reported dissatisfaction and no major complications occurred. Conclusion An interdisciplinary treatment approach combining neuroradiological interventions with surgical resection appears to be an effective treatment with an acceptable complication rate. Patients treated according to our protocol showed a high satisfaction rate, regardless of the radiographic outcome. Standardized follow-up allows for early detection of recurrences and helps with subjective patient satisfaction.
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Affiliation(s)
- Daniel Lilje
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Dimah Hasan
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Hani Ridwan
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
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38
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Formation of bilateral arteriovenous malformations. J Vasc Surg Cases Innov Tech 2022; 8:441-442. [PMID: 36016701 PMCID: PMC9395753 DOI: 10.1016/j.jvscit.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/15/2022] [Indexed: 11/22/2022] Open
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39
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Lilje D, Wiesmann M, Hasan D, Riabikin A, Ridwan H, Hölzle F, Nikoubashman O. Interventional therapy of extracranial arteriovenous malformations of the head and neck—A systematic review. PLoS One 2022; 17:e0268809. [PMID: 35839171 PMCID: PMC9286278 DOI: 10.1371/journal.pone.0268809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/06/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The primary aim of this study was to conduct a meta-analysis of the literature on interventional treatment for patients with extracranial AVM of the head and neck to identify a superior treatment. The secondary aim was to evaluate the methodological quality of associated articles published between 2000–2020. Methods The literature search was conducted on PubMed, Embase, the Cochrane Library, and scholar.google.com. Studies, meeting the acceptable reference standard underwent meta-analysis. All identified literature underwent methodological quality analysis. Results Of 1560 screened articles, 56 were included in the literature review. Appropriate diagnostic tests were reported in 98% of included articles. 13% of included articles did not specify the embolization agent. Outcome analysis varied throughout. 45% of the authors used radiographic imaging for follow-up. 77% specified the span of follow-up of their entire patient collective. Two articles met the inclusion criteria for meta-analysis. Curing rate of transarterial ethanol embolization for intraosseous AVM was 83% with a complication rate of 58%. Curing rate of ethanol combined with NBCA or Onyx in soft tissue AVM was 18% with a complication rate of 87%. Conclusion Our literature review revealed an absence of treatment or reporting standards for extracranial AVM of the head and neck. The meta-analysis is comprised of two articles and methodological quality is heterogeneous. We recommend implementing consistent reporting standards to facilitate comparability of studies and to provide robust data for the development of an evidence-based treatment strategy. Advances in knowledge Meta-analysis showed a favorable radiological outcome for intraosseous AVM when treated with intraarterial ethanol embolization. Our analysis demonstrated that the published data on extracranial AVMs of the head and neck is lacking in consistency and quality, prompting agreement for the need of standardized reporting on AVM treatments.
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Affiliation(s)
- Daniel Lilje
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Dimah Hasan
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Alexander Riabikin
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Hani Ridwan
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Hölzle
- Department of Oral, Maxillofacial and Facial Plastic Surgery University Hospital RWTH Aachen, Aachen, Germany
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
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40
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Dawkins D, Motiwala M, Peterson J, Gleysteen J, Fowler B, Arthur A, Elijovich L. Head and neck arteriovenous malformations: University of Tennessee experience, 2012–2022. Neurosurg Focus 2022; 53:E17. [DOI: 10.3171/2022.4.focus22123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Head and neck arteriovenous malformations (AVMs) are complex lesions that represent a subset of vascular anomalies (VAs). The authors present an analysis of their institutional experience managing these lesions as a multidisciplinary team.
METHODS
A retrospective chart review was performed of head and neck AVM patients treated at the authors’ institution from 2012 to 2022. Recorded data included patient demographic characteristics, details of clinical presentation, Schöbinger clinical scale and Yakes AVM classification results, and details of all endovascular and surgical treatments. The primary outcome of the study was clinical response to treatment. Angiographic occlusion and complication rates were reported. Chi-square tests were used for comparative statistics.
RESULTS
Sixteen patients (9 female, 56%) with AVMs of the head and neck presented from age 3 to 77 years. The Schöbinger stage was stage II in 56% of patients (n = 9) and stage III in 44% of patients (n = 7). The Yakes AVM classification was nidus type (2a, 2b, or 4) in 7 patients (43%) and fistula type (1, 3a, or 3b) in 9 patients (57%). The majority of patients (n = 11, 69.0%) were managed with embolization as the only treatment modality, with an average of 1.5 embolizations/patient (range 1–3). Surgical resection was employed in 5 patients (4 in combination with embolization). Symptom resolution and symptom control were achieved in 69% and 31% of patients, respectively, in the entire cohort. A radiographic cure was demonstrated in 50% of patients. There were no statistical differences in clinical outcomes or radiographic cure rates between patients treated with different modalities.
CONCLUSIONS
Head and neck AVMs can be treated successfully with a primarily endovascular management strategy by a multidisciplinary team with the goal of symptomatic control.
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Affiliation(s)
- Demi Dawkins
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Mustafa Motiwala
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Jeremy Peterson
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
| | | | | | - Adam Arthur
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Lucas Elijovich
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Department of Neurology, University of Tennessee Health Sciences Center, Memphis, Tennessee
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41
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SURGICAL TREATMENT of ARTERIOVENOUS MALFORMATIONS OF THE BUTTOCK. J Vasc Surg Cases Innov Tech 2022; 8:703-707. [DOI: 10.1016/j.jvscit.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 04/27/2022] [Accepted: 05/15/2022] [Indexed: 11/18/2022] Open
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42
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Coulie J, Boon L, Vikkula M. Molecular Pathways and Possible Therapies for Head and Neck Vascular Anomalies. J Oral Pathol Med 2022; 51:878-887. [PMID: 35610188 DOI: 10.1111/jop.13318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
Vascular Anomalies are a heterogenous group of vascular lesions that can be divided, according to the International Society for the Study of Vascular Anomalies Classification, into two main groups : Vascular Tumors and Vascular Malformations. Vascular Malformations can be further subdivided into slow-flow and fast-flow malformations. This clinical and radiological classification allows for a better understanding of vascular anomalies and aims to offer a more precise final diagnosis. Correct diagnosis is essential to propose the best treatment, which traditionally consists of surgery, embolization or sclerotherapy. Since a few years, medical treatment has become an important part of multidisciplinary treatment. Genetic and molecular knowledge of vascular anomalies are increasing rapidly and opens the door for a molecular classification of vascular anomalies according to the underlying pathways involved. The main pathways seem to be: PI3K/AKT/mTOR (PIKopathies) and RAS/RAF/MEK/ERK (RASopathies). Knowing the underlying molecular cascades allows us to use targeted medical therapies. The first part of this article aims to review the vascular anomalies seen in the head and neck region and their underlying molecular causes and involved pathways. The second part will propose an overview of the available targeted therapies based on the affected molecular cascade. This article summarizes theragnostic treatments available in vascular anomalies.
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Affiliation(s)
- Julien Coulie
- Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Saint Luc University Hospital, Brussels, Belgium.,Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
| | - Laurence Boon
- Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Saint Luc University Hospital, Brussels, Belgium.,Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
| | - Miikka Vikkula
- Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Saint Luc University Hospital, Brussels, Belgium.,Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
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43
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Suzuki T, Murata S. Hemorrhagic shock due to colonic arteriovenous malformation in late pregnancy: a case report. Int J Emerg Med 2022; 15:20. [PMID: 35581559 PMCID: PMC9112530 DOI: 10.1186/s12245-022-00424-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background Intestinal arteriovenous malformations are difficult to detect because they often present asymptomatically. However, pregnancy increases the hemorrhagic risk of intestinal arteriovenous malformations. This can lead to massive bleeding and hemodynamic instability, threatening the lives of both the mother and fetus. We describe a life-threatening case of hemorrhagic shock due to a colonic intestinal arteriovenous malformation during late pregnancy that was successfully treated through endovascular management. Case presentation A 36-year-old gravida 1, para 1 woman at 35 weeks’ gestation presented with hemodynamic instability and painless hematochezia. The patient had hemorrhagic shock and required massive transfusion. A colonoscopy failed to secure a visual field due to bloody fluid, and endoscopic hemostasis was difficult. Before the bleeding could be controlled, the condition of the fetus continued to deteriorate, showing bradycardia dysrhythmia. Therefore, an emergency cesarean section was performed, which was successful. However, the bleeding did not subside, with the patient’s hemodynamic instability and hematochezia persisting. An angiogram revealed an ascending colonic intestinal arteriovenous malformation, with extravasation of the contrast medium from a branch of the ileocolic artery. Localized blood flow control and hemodynamic stability were achieved via angioembolization. The patient had an uneventful postoperative recovery and was discharged on postoperative day 12. The newborn was admitted to the neonatal intensive care unit. She successfully recovered and was discharged when she was 22 days old. Conclusions We reported a case of colonic intestinal arteriovenous malformation resulting in hemodynamic instability due to hematochezia during late pregnancy, which was successfully treated via angioembolization. Intestinal arteriovenous malformation should be considered as a differential diagnosis in pregnant patients with hemodynamic instability and hematochezia.
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Affiliation(s)
- Toshinao Suzuki
- Interventional Radiology Center, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan.
| | - Satoru Murata
- Interventional Radiology Center, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
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Merfeld EC, Labby ZE, Miller JR, Burr AR, Wong F, Diamond C, Wieland AR, Aagaard-Kienitz B, Howard SP. Stereotactic Radiation Therapy for an Arteriovenous Malformation of the Oral Tongue: A Teaching Case. Adv Radiat Oncol 2022; 7:100870. [PMID: 35079666 PMCID: PMC8777148 DOI: 10.1016/j.adro.2021.100870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
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45
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Cai R, Wang Z, Sun Y, Yang X, Wen M, Zheng L, Wang D, Yu L, Fan X, Su L. Genotype-guided Targeted Treatment of KRAS-mutated Arteriovenous Malformations. J Eur Acad Dermatol Venereol 2022; 36:e708-e710. [PMID: 35445448 DOI: 10.1111/jdv.18165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/24/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Ren Cai
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Zhenfeng Wang
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Yi Sun
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Xitao Yang
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Mingzhe Wen
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Lianzhou Zheng
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Deming Wang
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Lan Yu
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, 310052, China
| | - Xindong Fan
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Lixin Su
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, 200011, China
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46
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Dash S, Singh A, Dawar R, Singhal M. Atypical case of arteriovenous malformation invading into a pedicled medial arm flap. BMJ Case Rep 2022; 15:e245545. [PMID: 35444019 PMCID: PMC9021813 DOI: 10.1136/bcr-2021-245545] [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] [Accepted: 01/10/2022] [Indexed: 11/03/2022] Open
Abstract
A 54-year-old woman who had previously undergone total excision of an arteriovenous malformation (AVM) of lower lip and chin along with pedicled medial arm flap reconstruction, presented with recurrence of swelling in the same region. The patient reported progressive difficulty in feeding, talking and constant aching pain besides aesthetic concerns. On evaluation, recurrence of AVM with invasion into the flap substance was identified. We performed debulking surgery, which resulted in a considerable reduction in pain and improved lower lip functioning and aesthetic appeal of the face. This case is unique due to the rare presentation of an AVM invading the normal flap tissue. Such a finding has never been reported before for a pedicled flap, along with details of the histopathology and imaging description. There are lacunae in the understanding of the progression of vascular malformations and this additional information will add to the existing literature on AVM.
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Affiliation(s)
- Suvashis Dash
- Plastic, Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amiteshwar Singh
- Plastic, Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Dawar
- Plastic, Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Maneesh Singhal
- Plastic, Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
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47
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Liu R, Chen J, Jia L, Pan B, Jiang H. Surgical management of auricular arteriovenous malformations: A literature review. Laryngoscope Investig Otolaryngol 2022; 7:604-613. [PMID: 35434337 PMCID: PMC9008162 DOI: 10.1002/lio2.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/01/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022] Open
Abstract
Auricular arteriovenous malformations (AVMs) can cause a variety of symptoms that seriously impact the patient's appearance, life, and mental well‐being. Surgery is the primary management method for auricular AVMs, but there is no consensus on how to surgically manage auricular AVMs. In this article, we document a comprehensive review of the characteristics, classification, and surgical interventions to treat auricular AVMs.
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Affiliation(s)
- Ruiquan Liu
- Department of Auricular Reconstruction Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- Graduate School of Peking Union Medical College Chinese Academy of Medical Sciences Beijing China
| | - Jianguo Chen
- Department of Auricular Reconstruction Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- Graduate School of Peking Union Medical College Chinese Academy of Medical Sciences Beijing China
| | - Litao Jia
- Department of Auricular Reconstruction Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- Graduate School of Peking Union Medical College Chinese Academy of Medical Sciences Beijing China
| | - Bo Pan
- Department of Auricular Reconstruction Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Haiyue Jiang
- Department of Auricular Reconstruction Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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48
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Chetan C, Patnaik S, Suryawanshi P, Garegrat R. Sirolimus used for treatment of retroperitoneal arteriovenous malformation in a premature neonate. BMJ Case Rep 2022; 15:e246265. [PMID: 35260399 PMCID: PMC8905918 DOI: 10.1136/bcr-2021-246265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a premature infant with antenatally detected retroperitoneal arteriovenous malformation (AVM) with extensive intraspinal extension. Treatment of the malformation with embolectomy and sclerotherapy was not feasible in view of intraspinal extensions and small size of vessels of the lesion. During a trial of propranolol over 20 days, the lesion progressed in size, roughly doubling in volume and was accompanied with deranged coagulation parameters. Treatment was therefore switched to oral prednisolone and sirolimus. The steroid was stopped after 6 weeks and sirolimus was continued with serum drug level monitoring and serial imaging of the malformation. After 4 months of sirolimus, the AVM remained at the same size as at the start of treatment, thus we propose that the drug may have arrested the growth of the lesion. This case highlights the use of sirolimus in management of AVMs in infants.
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Affiliation(s)
- Chinmay Chetan
- Neonatology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Suprabha Patnaik
- Neonatology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Pradeep Suryawanshi
- Neonatology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Reema Garegrat
- Neonatology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
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49
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El Sissy FN, Wassef M, Faucon B, Salvan D, Nadaud S, Coulet F, Adle-Biassette H, Soubrier F, Bisdorff A, Eyries M. Somatic Mutational Landscape of Extracranial Arteriovenous Malformations and Phenotypic Correlations. J Eur Acad Dermatol Venereol 2022; 36:905-912. [PMID: 35238086 DOI: 10.1111/jdv.18046] [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: 11/29/2021] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Somatic genetic variants may be the cause of extracranial arteriovenous malformations, but few studies have explored these genetic anomalies, and no genotype-phenotype correlations have been identified. OBJECTIVES To characterize the somatic genetic landscape of extracranial arteriovenous malformations and correlate these findings with the phenotypic characteristics of these lesions. METHODS This study included twenty-three patients with extracranial arteriovenous malformations that were confirmed clinically and treated by surgical resection, and for whom frozen tissue samples were available. Targeted next-generation sequencing analysis of tissues was performed using a gene panel that included vascular disease-related genes and tumor-related genes. RESULTS We identified a pathogenic variant in 18 out of 23 samples (78.3%). Pathogenic variants were mainly located in MAP2K1 (n=7) and KRAS (n=6), and more rarely in BRAF (n=2) and RASA1 (n=3). KRAS variants were significantly (p<0.005) associated with severe extended facial arteriovenous malformations, for which relapse after surgical resection is frequently observed, while MAP2K1 variants were significantly (p<0.005) associated with less severe, limited arteriovenous malformations located on the lips. CONCLUSIONS Our study highlights a high prevalence of pathogenic somatic variants, predominantly in MAP2K1 and KRAS, in extracranial arteriovenous malformations. In addition, our study identifies for the first time a correlation between the genotype, clinical severity and angiographic characteristics of extracranial arteriovenous malformations. The RAS/MAPK variants identified in this study are known to be associated with malignant tumors for which targeted therapies have already been developed. Thus, identification of these somatic variants could lead to new therapeutic options to improve the management of patients with extracranial arteriovenous malformations.
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Affiliation(s)
- F N El Sissy
- Sorbonne Université, Département de génétique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Pathology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Faculty of Medicine, Paris, France
| | - M Wassef
- Department of Pathology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Faculty of Medicine, Paris, France
| | - B Faucon
- Department of Otorhinolaryngology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - D Salvan
- Department of Otorhinolaryngology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - S Nadaud
- Sorbonne Université, INSERM, UMR_S1166, Unité de recherche sur les maladies cardiovasculaires, ICAN, le métabolisme et la nutrition, Paris, France
| | - F Coulet
- Sorbonne Université, Département de génétique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - H Adle-Biassette
- Department of Pathology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Faculty of Medicine, Paris, France
| | - F Soubrier
- Sorbonne Université, Département de génétique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMR_S1166, Unité de recherche sur les maladies cardiovasculaires, ICAN, le métabolisme et la nutrition, Paris, France
| | - A Bisdorff
- Department of Neuroradiology, Lariboisère Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - M Eyries
- Sorbonne Université, Département de génétique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMR_S1166, Unité de recherche sur les maladies cardiovasculaires, ICAN, le métabolisme et la nutrition, Paris, France
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50
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Aryafar H. Commentary on Ethanol Embolization of Nasal Arteriovenous Malformations: A Ten-Year, Single Institution Experience. Cardiovasc Intervent Radiol 2022; 45:486-487. [PMID: 35166886 DOI: 10.1007/s00270-022-03082-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Hamed Aryafar
- San Diego Imaging, 8745 Aero Drive #200, San Diego, CA, 92123-1774, USA.
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