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Colletti G, Trotolo A, Sanna G, Negrello S, Anesi A, Chiarini L, Rozell-Shannon L, Nocini R. Surgical treatment of small-sized S3 arterio-venous malformations with neo-adjuvant and adjuvant bleomycin. J Craniomaxillofac Surg 2024:S1010-5182(24)00231-2. [PMID: 39232863 DOI: 10.1016/j.jcms.2024.08.003] [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: 02/19/2024] [Revised: 06/03/2024] [Accepted: 08/14/2024] [Indexed: 09/06/2024] Open
Abstract
Arteriovenous Malformations are complex and challenging entities, and their treatment is often tailored on the patient. Interstitial sclerosing treatment with bleomycin is promising especially in cases where the aesthetical and/or functional burden of surgical intervention would be impactful as in the S3 AVM according to the SECg classification. We treated 15 patients presenting small (<10cm3) S3 arterio-venous malformations with 3 + 3 sessions of 15.000 IU of interstitial bleomycin. 9 patients presented moderate to good response to the first 3 sessions and thus surgical re-shaping was performed between the two cycles. US examination was done pre-treatment, before each session and every 3 months after the end of the protocol to assess the arterio-venous malformations. Fifteen of the seventeen patients concluded the protocol. 9 patients underwent surgical re-shaping while 6 skipped it because of their excellent response to the first 3 bleomycin injections. Major improvement in terms of appearance and symptoms (pulsations, ulcerations, bleeding or pain) were always achieved. There was a 20% of minor complications. The presented data are encouraging and seem to suggest that this may be a promising protocol to extend the use of bleomycin in arterio-venous malformations and reduce the impact of surgery.
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Affiliation(s)
- Giacomo Colletti
- Department of Medical and Surgical Sciences for Children & Adults, Cranio-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, 41124 Modena, Italy; The Vascular Birthmark Foundation, P.O. Box 106, Latham, NY, 12110, USA
| | - Alessandro Trotolo
- Department of Cranio-Maxillo-Facial Surgery, University Hospital of Modena, 41124, Modena, Italy.
| | - Giangiacomo Sanna
- Department of Cranio-Maxillo-Facial Surgery, University Hospital of Modena, 41124, Modena, Italy
| | - Sara Negrello
- Department of Cranio-Maxillo-Facial Surgery, University Hospital of Modena, 41124, Modena, Italy
| | - Alexandre Anesi
- Department of Medical and Surgical Sciences for Children & Adults, Cranio-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Luigi Chiarini
- Department of Medical and Surgical Sciences for Children & Adults, Cranio-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | | | - Riccardo Nocini
- Head and Neck Department, Section of Ear Nose Throat (ENT), University Hospital of Verona, 37134, Verona, Italy
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Ma F, Liu X, Wang C, Duan H, Zhou K, Hu F. Comparison of efficacy and safety between oral propranolol combined with and without intralesional injection of lauromacrogol for infantile hemangioma. Front Pediatr 2024; 12:1361105. [PMID: 38989270 PMCID: PMC11233721 DOI: 10.3389/fped.2024.1361105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 06/14/2024] [Indexed: 07/12/2024] Open
Abstract
Aims and objectives The purpose of this study was to compare efficacy and side effects between oral propranolol combined with and without intralesional injection of lauromacrogol for infantile hemangioma (IH). Material and methods This was a single center randomized controlled prospective study, all participants were firstly diagnosed with IH between August 2022 and January 2023 in our hospital and without any treatment before. Patients were randomized into two groups. PRO group: oral propranolol (2 mg/kg/day) continued for 6 months; PRO + LAU group: oral propranolol (2 mg/kg/day) for 6 months and intralesional injection of lauromacrogol for 2-4 times within 6 months. The dimensions, color, consistency, photographic documentation were well recorded based on Visual Analogue Scale (VAS) before and after starting treatment. According to the treatment response after 6 months, the results were classified into four levels: Grade 1, complete resolution achieved; Grade 2, with ≥50% reduction in size of IH; Grade 3, with <50% reduction in size of IH; Grade 4, no response or worsening of IH. Results A total of 67 patients were involved in the study (17 boys, 50 girls; mean age, 3.6 months, range, 1.1-7.2 months) and randomized to receive oral propranolol combined with or without intralesional injection of lauromacrogol (29 in PRO group, 38 in PRO + LAU group). All patients completed treatment. Eleven patients (37.9%) in PRO group were in Grade 1, 14 patients (48.3%) in Grade 2, 4 patients (13.8%) in Grade 3, compared with these in PRO + LAU group, 11 patients (28.9%) in Grade 1, 24 patients (63.2%) in Grade 2, and 3 patients (7.9%) in Grade 3. No patient was in Grade 4, and no severe side effects were observed in both group. In PRO group, it takes an average of 17.1 ± 5.4 weeks from the start of treatment to cure, and in PRO + LAU group, the average time is 13.7 ± 4.9 weeks. Conclusion Oral propranolol with intralesional injection of lauromacrogol was a safety treatment strategy for IH. But it was not superior to oral propranolol in final cure rates (P = 0.45), moreover, it cannot certainly offer the benefits of shortening the duration of oral drug treatment (P = 0.24).
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Affiliation(s)
- Fan Ma
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoliang Liu
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongyu Duan
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fan Hu
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Kacała A, Dorochowicz M, Korbecki A, Sobański M, Puła M, Patrzałek D, Janczak D, Guziński M. Transarterial Bleomycin-Lipiodol Chemoembolization for the Treatment of Giant Hepatic Hemangiomas: An Assessment of Effectiveness. Cancers (Basel) 2024; 16:380. [PMID: 38254869 PMCID: PMC10814004 DOI: 10.3390/cancers16020380] [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: 12/15/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
This study evaluates the effectiveness of superselective transcatheter arterial chemoembolization (TACE) using a bleomycin-lipiodol emulsion in treating giant hepatic hemangiomas. A retrospective review included 31 patients with a mean age of 53 ± 10.42 years who underwent TACE from December 2014 to October 2022, with follow-up imaging examinations to assess outcomes. Technical success was defined as successful embolization of all feeding arteries, and clinical success was defined as a reduction in hemangioma volume by 50% or more on follow-up imaging. This study observed a 100% technical success rate. Post-embolization syndrome was common, and two cases of asymptomatic hepatic artery dissection were noted. Clinical success was achieved in 80.6% of patients, with significant volume reduction observed in the majority. Conclusively, superselective transcatheter arterial chemoembolization with bleomycin-lipiodol emulsions is presented as a viable and effective treatment option for giant hepatic hemangiomas. With no procedure-related mortality and significant volume reduction in most cases, this method offers a promising alternative to surgical intervention. This study's findings suggest a need for further exploration and validation in larger-scale prospective studies.
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Affiliation(s)
- Arkadiusz Kacała
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | | | - Adrian Korbecki
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (A.K.); (M.P.)
| | - Michał Sobański
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (A.K.); (M.P.)
| | - Michał Puła
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (A.K.); (M.P.)
| | - Dariusz Patrzałek
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Maciej Guziński
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
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Fraissenon A, Fortin F, Durous V, Chauvel-Picard J, Gleizal A, Viremouneix L, Cabet S, Guibaud L. Percutaneous Sclerotherapy of Large Venous Malformations Using Consecutive Polidocanol and Bleomycin Foam: MR Imaging Volumetric and Quality-of-Life Assessment. J Vasc Interv Radiol 2024; 35:127-136.e1. [PMID: 37704038 DOI: 10.1016/j.jvir.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/23/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE To retrospectively evaluate sclerotherapy using consecutive polidocanol and bleomycin foam (CPBF) for large untreated venous malformations (VMs) and/or those resistant to prior treatment. MATERIALS AND METHODS This retrospective study included all patients treated with CPBF for untreated VMs larger than 10 mL and/or refractory to treatment between May 2016 and October 2019. Baseline and follow-up VM volumes were measured on fat-suppressed T2-weighted magnetic resonance (MR) imaging. Outcome was evaluated on postprocedural MR imaging volumetry and by a retrospective survey assessing clinical response and adverse events. Imaging response was considered good for volume reduction from 50% to 70% and excellent for volume reduction ≥70%. Symptoms and quality-of-life (QoL) scores were compared before and after CPBF sclerotherapy. RESULTS Forty-five patients (mean age, 16 years; range, 1-63 years; 25 males) with 57 VMs were analyzed and treated by 80 sclerotherapy. Sixty percent (27 of 45) of patients had undergone prior treatment for VM. Median VM volume was 36.7 mL (interquartile range, 84 mL) on pretherapy MR imaging. Good and excellent results after the last sclerotherapy were achieved in 36% (16 of 45) and 29% (13 of 45) of patients, respectively, corresponding to a decrease of >50% in 60% (34 of 57) of VMs. QoL score increased by at least 3 points, regardless of initial symptoms. Most patients did not desire additional sclerotherapy owing to near complete symptomatic relief, even for patients who did not achieve a good response. Swelling, pain, and motor impairment scores significantly improved after CPBF. Adverse events included fever (44%, 15 of 34) and nausea/vomiting (29%, 10 of 34). CONCLUSIONS CPBF sclerotherapy represents an effective therapy for large and/or refractory VMs with minimal adverse events.
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Affiliation(s)
- Antoine Fraissenon
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France; Service de Radiologie Mère-Enfant, Hôpital Nord, Saint Etienne, France
| | - Francis Fortin
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France; Département d'imagerie médicale, Hôpital Sainte-Justine, Montréal, Québec, Canada
| | - Vincent Durous
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France
| | - Julie Chauvel-Picard
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France; Service de chirurgie cranio-maxillo-faciale et plastique pédiatrique, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France
| | - Arnaud Gleizal
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France; Service de chirurgie cranio-maxillo-faciale et plastique pédiatrique, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France
| | - Loïc Viremouneix
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France
| | - Sara Cabet
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France
| | - Laurent Guibaud
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Lyon-Bron, France.
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Kacała A, Dorochowicz M, Patrzałek D, Janczak D, Guziński M. Safety and Feasibility of Transarterial Bleomycin-Lipiodol Embolization in Patients with Giant Hepatic Hemangiomas. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1358. [PMID: 37629648 PMCID: PMC10456525 DOI: 10.3390/medicina59081358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023]
Abstract
Giant hepatic hemangiomas present a significant clinical challenge, and effective treatment options are warranted. This study aimed to assess the safety and feasibility of transarterial bleomycin-lipiodol embolization in patients with giant hepatic hemangiomas. A retrospective analysis was conducted on patients with giant hepatic hemangiomas (>5 cm). Transarterial chemoembolization (TACE) was performed using 7-20 cc of lipiodol mixed with 1500 IU of bleomycin. Safety outcomes, including post-embolization syndrome (PES), hepatic artery dissection, systemic complications, and access site complications, were evaluated. Radiation doses were also measured. Feasibility was assessed based on the achieved hemangioma coverage. Seventy-three patients (49 female, 24 male) with a mean age of 55.52 years were treated between December 2014 and April 2023. The average hospitalization duration was 3.82 days, and 97.3% of lesions were limited to one liver lobe. The average bleomycin dose per procedure was 1301.5625 IU, while the average lipiodol dose was 11.04 cc. The average radiation dose was 0.56 Gy. PES occurred after 45.7% of TACE procedures, with varying severity. Complications such as hepatic artery dissection (three cases), access site complications (two cases), and other complications (one case) were observed. No treatment-related mortality occurred. Hemangioma coverage exceeding 75% was achieved in 77.5% of cases. The study results suggest that transarterial bleomycin-lipiodol embolization is a safe and feasible treatment option for a heterogeneous group of patients with giant hepatic hemangiomas. This approach may hold promise in improving outcomes for patients with this challenging condition.
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Affiliation(s)
- Arkadiusz Kacała
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Mateusz Dorochowicz
- Faculty of Medicine, Wroclaw Medical University, Wybrzeże L. Pasteura 1, 50-367 Wroclaw, Poland
| | - Dariusz Patrzałek
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Maciej Guziński
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
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Bertino FJ, Hawkins CM. Contemporary management of extracranial vascular malformations. Pediatr Radiol 2023; 53:1600-1617. [PMID: 37156889 DOI: 10.1007/s00247-023-05670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
Vascular malformations are congenital vascular anomalies that originate because of disorganized angiogenesis, most commonly from spontaneous somatic genetic mutations. The modern management of vascular malformations requires a multidisciplinary team that offers patients the gamut of medical, surgical, and percutaneous treatment options with supportive care. This manuscript discusses the standard and contemporary management strategies surrounding extracranial vascular malformations and overgrowth syndromes.
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Affiliation(s)
- Frederic J Bertino
- Department of Radiology, Interventional Radiology Section, NYU Langone Health/NYU Grossman School of Medicine, 2nd Floor Radiology-Tisch Hospital, 550 First Avenue, New York, NY, 10016, USA.
| | - C Matthew Hawkins
- Department of Radiology, Division of Interventional Radiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Lee SY, Kang DH, Kim YS, Lee J, Lee SJ, Huh S, Kim JY, Chung HY. Efficacy and safety of transarterial bleomycin sclerotherapy of early-stage facial arteriovenous malformation: Single-center multidisciplinary team experience. J Plast Reconstr Aesthet Surg 2023; 77:379-387. [PMID: 36623374 DOI: 10.1016/j.bjps.2022.12.002] [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: 04/05/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND To evaluate the efficacy and safety of transarterial bleomycin sclerotherapy of early-stage facial arteriovenous malformation (AVM). METHODS A retrospective review was performed of patients who underwent bleomycin sclerotherapy for early-stage AVM (Schobinger stage I or II) in a single-referral vascular anomalies center. Bleomycin was slowly infused transarterially with flow control techniques to prolong the effects of bleomycin. Procedure details, AVM characteristics, and previous treatments were reviewed. Initial therapeutic outcomes were determined by 5 categories using both radiological and clinical findings in a 6-month follow-up. Further follow-up outcomes were reviewed to evaluate the long-term efficacy and safety of the treatment. Procedure-related complications were also analyzed. RESULTS Nineteen patients (mean age 22.4 ± 14.0 years, 14 females) with 31 sessions of sclerotherapies were enrolled. All AVMs were Cho-Do classification type III (type IIIa [n = 13], type IIIb [n = 2], and type IIIa+b [n = 4]). Patients received a mean of 1.6 (range, 1-4) sessions of treatment. The mean cumulative bleomycin dose was 23,600 IU ± 14,500 (range, 8000 - 60,000 IU). The results showed that 14 patients (74%) were responsive to transarterial bleomycin sclerotherapy, including complete response (n = 3), marked improvement (n = 1), and partial improvement (n = 10). The remaining 5 (26%) showed no response. During a mean follow-up of 32.6 months, 5 (26%) showed slight progression compared with 6-month outcomes and 14 (74%) were stable. There were only 2 minor complications [hyperpigmentation (n = 1) and cellulitis (n = 1)]. CONCLUSIONS Transarterial bleomycin sclerotherapy using flow control techniques can be a safe and feasible alternative treatment option for facial early-stage AVM.
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Affiliation(s)
- Sang Yub Lee
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Dong Hun Kang
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea; Department of Neurosurgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Yong Sun Kim
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Jongmin Lee
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Seok Jong Lee
- Department of Dermatology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Seung Huh
- Department of Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Ho Yun Chung
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea.
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Fasching G, Dollinger C, Spendel S, Tepeneu N. Treatment of lymphangiomas by means of sclerotherapy with OK-432 (Picibanil®) is safe and effective - A retrospective case series. Ann Med Surg (Lond) 2022; 81:104531. [PMID: 36147081 PMCID: PMC9486752 DOI: 10.1016/j.amsu.2022.104531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/23/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Congenital cystic lymphangiomas (CCL) or lymphatic malformations (LMs) are benign malformations due to a developmental disorder of lymphatic vessels. Besides surgical excision, sclerosant therapy of these lesions by intracavitary injection of OK-432 (Picibanil®), a lyophilized mixture of group A Streptococcus pyogenes, is a common therapeutical option. Methods In a single center retrospective study we analyzed 37 consecutive patients (30 children, 3 adolescents and 4 adults) who were diagnosed with lymphangioma and subsequently treated with OK-432 (Picibanil®) in a general hospital between October 2000 and November 2021. Results The median follow-up period was 2.5 months (range 0.7-56.7 months). The lymphangiomas were localized in the head and neck region (n = 25), the thorax/abdomen (n = 6) and extremities (n = 6). The majority of patients had 1 injection with OK-432 (n = 28), five patients had 2 injections, three patients had 3 injections and one patient had more than 3 injections. The most common complications were swelling (89%), fever (81%), redness at the injection site (81%) and pain (73%). The response to therapy was excellent or good in 32 patients (86.4%), 2 patients had a medium response and 3 patients did not show any response. The clinical reaction after the instillation of OK-432 is not predictive for the quality of outcome. Conclusion The application of Picibanil is safe and without serious side effects. Parents and patients prefer local sclerotherapy versus surgery as it has less complications. We therefore suggest that Picibanil sclerotherapy should be the first-line treatment for macrocystic and mixed type lymphangiomas.
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Affiliation(s)
- G. Fasching
- Department of Pediatric and Adolescent Surgery, General Hospital Klagenfurt, Austria, Feschnigstraße 11, 9020, Klagenfurt, Austria
| | - C. Dollinger
- Department of Pediatric and Adolescent Surgery, General Hospital Klagenfurt, Austria, Feschnigstraße 11, 9020, Klagenfurt, Austria
| | - S. Spendel
- Division of Plastic Aestetic and Reconstructive Surgery, Medical University of Graz, Auenbruggerplatz 2/4, 8036, Graz, Austria
| | - N.F. Tepeneu
- Department of Pediatric and Adolescent Surgery, General Hospital Klagenfurt, Austria, Feschnigstraße 11, 9020, Klagenfurt, Austria
- University of Medicine and Pharmacy’‘Victor Babes'’ Timisoara, Romania, Eftimie Murgu Square No.2, 300041, Timisoara, Romania
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Safety and Efficacy of Bleomycin Slow Infusion Sclerotherapy Using a Syringe Pump for Microcystic and Mixed Lymphatic Malformations. Cardiovasc Intervent Radiol 2022; 45:1288-1294. [PMID: 35864208 DOI: 10.1007/s00270-022-03224-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/05/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of bleomycin infusion sclerotherapy using a syringe pump in microcystic and mixed (microcystic components with the presence of a cyst over 1 cm) lymphatic malformations (LMs). MATERIALS AND METHODS Patients who received bleomycin sclerotherapy with a syringe pump for microcystic or mixed LMs were reviewed. Cystic components of LMs were accessed under sonographic guidance, followed by injection of an opacified bleomycin solution using a syringe pump (infusion rate, 10-20 mL/h) under fluoroscopic guidance. Imaging outcomes were graded as complete (> 90% size reduction), partial (25-90%), or no response (< 25%). Clinical outcomes and procedure-related complications were also reviewed. RESULTS Forty-nine patients with 81 sclerotherapies were analyzed. The mean age was 17 years (range 0.1-65 y). Thirty-one (63%) patients had microcystic LMs, and 18 (37%) had mixed. A mean of 1.7 sessions (range 1-4) of sclerotherapy was performed using a mean cumulative dose of bleomycin of 10.8 U (range 1.5-39 U). The mean infusion time was 39 min (range 14-130 min). Regarding imaging outcomes, there was a complete response in 29% (n = 14), a partial response in 57% (n = 28), and no response in 14% (n = 7). Regarding clinical outcomes, there was a complete response in 39% (n = 19), a partial response in 51% (n = 25), and no response in 10% (n = 5). According to the CIRSE classification, no major complications were identified. CONCLUSIONS Bleomycin slow infusion sclerotherapy provides gradual filling of sclerosant to target microcystic components. This technique is safe and feasible for the management of microcystic or mixed LMs. LEVEL OF EVIDENCE Level 4, Case series.
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Bleomycin intralesional injections of maxillofacial venous malformations in pediatric patients. ORAL AND MAXILLOFACIAL SURGERY CASES 2022. [DOI: 10.1016/j.omsc.2022.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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11
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Pessanha I, Bravo M, Piedade C, Lopes MF. Complex lymphatic malformations in pediatrics: a review of treatment options. Minerva Pediatr (Torino) 2022; 74:70-80. [PMID: 35283478 DOI: 10.23736/s2724-5276.20.06037-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Lymphatic malformations (LMs) are low-flow lesions resulting from abnormalities in the development of lymphatics. The management of these lesions is complex and involve the collaboration of many specialties. The purpose of this review is to summarize current knowledge regarding the different therapeutic options used in complex lymphatic malformations, analyzing their indications, efficacy and complications. EVIDENCE ACQUISITION A search was made using the algorithm: "(lymphatic abnormality OR lymphatic malformation OR lymphangioma OR cystic hygroma) AND (extensive OR giant OR complex) AND (therapeutics OR treatment) AND (child OR children)". Of the 120 articles found, 53 were included. EVIDENCE SYNTHESIS Historically, surgery was the treatment of choice for this type of lesions. However, excision was often incomplete, associated with high rates of recurrence and severe complications. The use of sclerotherapy emerged as a minimal invasive option appropriate in selected cases as a single or adjuvant therapy. Inhibitors of the mammalian target of rapamycin, such as sirolimus, now play a central role in the treatment of complex malformations resistant to sclerotherapy, recurrent after surgery or more extensive malformations that affect vital structures. Other therapeutic options as sildenafil and laser ablation are also recognized as effective in selected cases. CONCLUSIONS Looking through the literature over the last decade authors realize that surgery had gradually been replaced by less invasive options such as sirolimus with or without adjuvant sclerotherapy. In conclusion, each treatment option seems to have its own indications and characteristics, which must be considered in therapeutic decision and individualized for each patient.
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Affiliation(s)
- Inês Pessanha
- Department of Pediatric Surgery, Pediatric Hospital, University Hospital of Coimbra, Coimbra, Portugal -
| | - Mariana Bravo
- Department of Pediatric Surgery, Pediatric Hospital, University Hospital of Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Cláudia Piedade
- Department of Pediatric Surgery, Pediatric Hospital, University Hospital of Coimbra, Coimbra, Portugal
| | - Maria F Lopes
- Department of Pediatric Surgery, Pediatric Hospital, University Hospital of Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Management of Macrocystic Lymphatic Malformation in the Cervicofacial Region: Ultrasound-Guided Iodine Tincture Cauterization Combined With Intralesional Negative Pressure. Ann Plast Surg 2022; 88:e9-e12. [PMID: 35102014 DOI: 10.1097/sap.0000000000003065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of our study was to evaluate the efficacy and safety of ultrasound-guided iodine tincture cauterization combined with postoperative intralesional negative pressure in the management of cervicofacial cystic lymphatic malformation (cLM). METHOD From January 2019 to July 2021, indocyanine green lymphography was performed preoperatively to confirm the lymph inflow, and this treatment was administered in 71 patients with cervicofacial cLM in our center. All cases were evaluated by curative effects, treatment frequency, and adverse events. The duration of posttreatment follow-up was from 12 to 14 months. RESULTS Indocyanine green lymphography indicated at least one lymphatic inflow in each cLM lesion. Excellent resolution was observed in 87.3% of cases, and good improvement of the treated cLM occurred in 9.9% of cases, and 2 cases with fair outcomes required subsequent treatment. It is noteworthy that no case was treated more than 3 times. Some minor adverse effects, including localized itch and scar, were managed by symptomatic treatment. CONCLUSIONS Because of satisfactory outcomes and low treatment frequency, ultrasound-guided iodine tincture cauterization combined with intralesional negative pressure represents an efficacious, safe, and feasible method for the management of macro-cLM in the cervicofacial region.
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Heninger J, Cheon E, Green J, Hajduk J, Benzon H. Intralesional Bleomycin Injection and Skin Hyperpigmentation: A Case Series of a Single-Center Experience With a Standardized Skin-Protective Protocol. A A Pract 2022; 16:e01551. [DOI: 10.1213/xaa.0000000000001551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Locker SH, Maxwell EA, Vilaplana Grosso F, Bertran J, Shiomitsu K. Novel treatment of recurrent abdominal lymphatic malformations in a dog. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Seth H Locker
- Department of Small Animal Clinical Sciences College of Veterinary Medicine University of Florida Gainesville Florida USA
| | - Elizabeth A Maxwell
- Department of Small Animal Clinical Sciences College of Veterinary Medicine University of Florida Gainesville Florida USA
| | - Federico Vilaplana Grosso
- Department of Small Animal Clinical Sciences College of Veterinary Medicine University of Florida Gainesville Florida USA
| | - Judith Bertran
- Department of Small Animal Clinical Sciences College of Veterinary Medicine University of Florida Gainesville Florida USA
| | - Keijiro Shiomitsu
- Department of Small Animal Clinical Sciences College of Veterinary Medicine University of Florida Gainesville Florida USA
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Sheng L, Yu Z, Li S, Cao W, Jiang Z. Bleomycin sclerotherapy for large diffuse microcystic lymphatic malformations. Gland Surg 2021; 10:1865-1873. [PMID: 34268071 DOI: 10.21037/gs-21-70] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/07/2021] [Indexed: 12/16/2022]
Abstract
Background Microcystic lymphatic malformations (LMs) are congenital lesions with the diameter of the majority of cysts <1 cm. Bleomycin sclerotherapy has been shown to yield beneficial results for macrocystic LMs. This study aims to evaluate the safety and efficacy of consecutive bleomycin sclerotherapy for large diffuse microcystic LMs. Methods The location and size of the lesions were detected by ultrasound for the 46 patients included in this study. Bleomycin lavage was performed in larger cysts and intradermal injection for the superficial lesion. The outcome and complications were assessed for its efficacy and safety. Results The large diffuse microcystic LMs mainly located in the neck, abdominal wall and axilla/lateral chest wall. The average lesion size was 10.6 cm × 7.2 cm. The mean number of treatment sessions was 4.5 with 7.3 mg bleomycin for per session averagely. Excellent (69.6%) and moderate (23.9%) responses were obtained. There was no recurrence for the 6 patients (13%) who received a long follow-up. Obvious local swelling, slight intralesional hemorrhage and low-grade fever were the most commonly occurred complications. No lung fibrosis was identified for the patients who received more than 6 sessions. Conclusions Local lavage combined with intradermal injection of bleomycin is effective and safe for large diffuse microcystic LMs with good therapeutic effect and low complication rates, and can be regarded as the mainstay of therapy for microcystic LMs.
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Affiliation(s)
- Lingling Sheng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ziyou Yu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shengli Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weigang Cao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaohua Jiang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Intralesional Bleomycin Injection in Management of Localized Venous Problems in Children with Klippel-Trenaunay Syndrome. Plast Reconstr Surg 2021; 147:918e-919e. [PMID: 33885399 DOI: 10.1097/prs.0000000000007815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Bleomycin for Percutaneous Sclerotherapy of Venous and Lymphatic Malformations: A Retrospective Study of Safety, Efficacy and Mid-Term Outcomes in 26 Patients. J Clin Med 2021; 10:jcm10061302. [PMID: 33809919 PMCID: PMC8004214 DOI: 10.3390/jcm10061302] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/21/2021] [Accepted: 03/18/2021] [Indexed: 12/27/2022] Open
Abstract
Percutaneous sclerotherapy is used to treat venous and lymphatic vascular malformations, which can cause significant discomfort and/or disfigurement. The purpose of this study is to describe the bleomycin sclerotherapy technique and to evaluate its clinical and radiological efficacy and safety. We retrospectively identified consecutive patients with venous malformations (VMs) and lymphatic malformations (LMs) who underwent bleomycin sclerotherapy in 2011–2020 at our institution. We collected the clinical and radiological success rates, complications and recurrences separately in the VM and LM groups. We identified 26 patients, 15 with VMs and 11 with LMs. The significant volume reductions obtained were 45% in the VM group and 76% in the LM group (p = 0.003 and p = 0.009, respectively). Significant reductions in discomfort/pain and in cosmetic disfigurement were obtained in both groups. An overall improvement was reported by 69% and 82% of patients in the VM and LM groups, respectively. No major complications occurred during the mean follow-up of 51 ± 34 months in the VM group and 29 ± 18 months in the LM group. A recurrence developed within 2 years in 23% of patients. Bleomycin is clinically and radiologically effective for the treatment of venous and lymphatic malformations, with a high level of patient safety.
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Narsinh KH, Gautam A, Baker A, Cooke DL, Dowd CF. Vascular anomalies: Classification and management. HANDBOOK OF CLINICAL NEUROLOGY 2021; 176:345-360. [PMID: 33272404 DOI: 10.1016/b978-0-444-64034-5.00003-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Vascular anomalies are broadly classified into two major categories: vascular tumors and vascular malformations. Most vascular anomalies are caused by sporadic mosaic gene mutations, and recent genetic studies have advanced our understanding of the molecular pathways involved in their pathogenesis. These findings have suggested new therapeutic approaches to vascular anomalies, focusing on their pathogenetic mechanism. This chapter seeks to integrate an improved molecular understanding within the updated classification system of the International Society for Study of Vascular Anomalies. We emphasize the genetic, radiologic, and interventional aspects of diagnosis and management in hopes of allowing improved multidisciplinary collaboration surrounding these complex and interesting anomalies.
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Affiliation(s)
- Kazim H Narsinh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Ayushi Gautam
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Amanda Baker
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Christopher F Dowd
- Departments of Radiology and Biomedical Imaging, Neurological Surgery, Neurology, and Anesthesia and Perioperative Care, University of California San Francisco, School of Medicine, San Francisco, CA, United States.
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Han T, Ji Y, Cui J, Shen W. Inflow Occlusion Combined With Bleomycin Sclerotherapy for Management of Macro/Mixed Cystic Lymphatic Malformation in Children. Front Pediatr 2021; 9:749983. [PMID: 34631633 PMCID: PMC8493213 DOI: 10.3389/fped.2021.749983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The link between cystic lymphatic malformation (cLM) and normal lymphatic system has become the focus of research. This study aimed to assess the outcomes of indocyanine green (ICG) lymphography-guided inflow occlusion combined with bleomycin sclerotherapy for the management of macro or mixed cLM in children. Methods: Between June 2018 and October 2020, inflow occlusion combined with bleomycin sclerotherapy was performed in 81 cLM patients (age range from 6 months to 8 years). All cases were evaluated by the following parameters: cLM location, histological typing, number of afferent lymph vessels, dermal backflow, curative effects, treatment frequency, and postoperative complications. The duration of postoperative follow-up was from 10 to 16 months. Results: All cLM cases could be found with at least one lymphatic inflow. Excellent outcomes were observed in 68 cases (84.0%), 11 cases (13.6%) experienced good outcomes, and two (2.5%) cases had fair outcome. No case experienced repeated treatment for more than three times. Wound infection, fever, and scar hyperplasia were the independent adverse events, which were managed by symptomatic treatment. Conclusion: Inflow occlusion combined with bleomycin sclerotherapy renders a safe and efficient approach for the management of macro or mixed cLM.
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Affiliation(s)
- Tao Han
- Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Ji
- Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Cui
- Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Weimin Shen
- Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
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Lymphatic malformations in children: treatment outcomes of sclerotherapy in a large cohort. Eur J Pediatr 2021; 180:959-966. [PMID: 33051716 PMCID: PMC7886713 DOI: 10.1007/s00431-020-03811-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/03/2020] [Accepted: 09/14/2020] [Indexed: 11/12/2022]
Abstract
This retrospective study examines the outcomes of sclerotherapy in children with (veno)lymphatic malformations who received sclerotherapy between 2011 and 2016 (116 children, 234 procedures). Complication severity was classified using the Society of Interventional Radiology classification. Clinical response was rated on a scale of 0 (no change) to 3 (good improvement). The sclerosants used were bleomycin (n = 132; 56%), lauromacrogol (n = 42; 18%), doxycycline (n = 15; 6%), ethanol (n = 12; 5%), or a combination (n = 33; 14%). Four major and 25 minor complications occurred without significant differences between the agents. The median response rate per procedure was 2-some improvement-for all sclerosants. However, in pure LMs (67%), bleomycin and a combination of agents resulted in the best clinical response. On patient level, all had some or good clinical response. Mixed macrocystic and microcystic lesions showed a significantly lower clinical response (median 2 versus 3; p = 0.023 and p = 0.036, respectively) and required significantly more procedures (median 2 versus 1; p = 0.043 and p = 0.044, respectively) compared with lesions with one component.Conclusion: Sclerotherapy for (V)LMs in children is safe and effective. Bleomycin is the most frequently used agent in this clinic and seemed most effective for pure LMs. Mixed macrocystic and microcystic lesions are most difficult to treat effectively. What is Known: • A variety of agents can be used for sclerotherapy of lymphatic malformations in children. • Macrocystic lesions have favorable outcomes compared with microcystic and mixed lesions. What is New: • Bleomycin and a combination of agents seem to be most effective to treat lymphatic malformations in children. • Mixed macrocystic and microcystic lesions are more difficult to treat effectively compared with lesions with either one of these components.
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21
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Abstract
Lymphangioma is a common type of congenital vascular disease in children with a broad spectrum of clinical manifestations. The current classification of lymphangioma by International Society for the Study of Vascular Anomalies is largely based on the clinical manifestations and complications and is not sufficient for selection of therapeutic strategies and prognosis prediction. The clinical management and outcome of lymphangioma largely depend on the clinical classification and the location of the disease, ranging from spontaneous regression with no treatment to severe sequelae even with comprehensive treatment. Recently, rapid progression has been made toward elucidating the molecular pathology of lymphangioma and the development of treatments. Several signaling pathways have been revealed to be involved in the progression and development of lymphangioma, and specific inhibitors targeting these pathways have been investigated for clinical applications and clinical trials. Some drugs already currently in clinical use for other diseases were found to be effective for lymphangioma, although the mechanisms underlying the anti-tumor effects remain unclear. Molecular classification based on molecular pathology and investigation of the molecular mechanisms of current clinical drugs is the next step toward developing more effective individualized treatment of children with lymphangioma with reduced side effects.
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Affiliation(s)
- Xiaowei Liu
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, China
| | - Cheng Cheng
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, China
| | - Kai Chen
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, China
| | - Yeming Wu
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, China.,Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, China
| | - Zhixiang Wu
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, China.,Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, China
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Cherkas E, Champion AF, Gates JC. Sclerotherapy for atypical oral manifestation of Cowden syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:e290-e293. [PMID: 32636168 DOI: 10.1016/j.oooo.2020.05.018] [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: 03/17/2020] [Revised: 05/13/2020] [Accepted: 05/31/2020] [Indexed: 11/18/2022]
Abstract
Cowden syndrome is an autosomal dominant disorder characterized by hamartomas, as well as benign and malignant neoplasms that may present in organ systems throughout the body. It also poses an increased lifetime cancer risk in those with the disorder. Its clinical presentation is often variable, and diagnosis can be challenging. In the head and neck region, it can present as thyroid enlargement or mass formation, cutaneous and mucocutaneous lesions of the skin and the oral cavity. The most typical oral manifestations of Cowden syndrome are oral papillomatosis and a cobblestone appearance of the mucosa. We present a case of vascular malformation of the tongue in a patient with Cowden syndrome. This lesion was similar in appearance to a cutaneous hamartoma on the patient's upper extremity. He had received prior surgical intervention for this tongue mass, and complete resection was recommended subsequently. However, in search of a less invasive treatment to minimize impact on speech and oral function, sclerotherapy was performed, resulting in resolution of the lesion. Sclerotherapy is a well-documented treatment for head and neck vascular malformations, but it is not universally employed. In our patient with atypical oral manifestation of Cowden syndrome, bleomycin sclerotherapy was employed, resulting in resolution of the lesion, as well as preservation of speech articulation and oral function.
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Affiliation(s)
- Elliot Cherkas
- Medical Student, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Allen F Champion
- Assistant Professor, Thomas Jefferson University, Department of Oral and Maxillofacial Surgery, Philadelphia, PA, USA
| | - James C Gates
- Clinical Instructor, Thomas Jefferson University, Department of Oral and Maxillofacial Surgery, Philadelphia, PA, USA.
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Lin P, Chen F, Chen J, Jiang C. Aesthetic outcome of intralesional injection of lauromacrogol as a single‐agent treatment for uncomplicated infantile hemangiomas: A long‐term follow‐up study. J Dermatol 2020; 47:1119-1125. [PMID: 32643255 DOI: 10.1111/1346-8138.15473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/27/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Peng‐Fei Lin
- Department of Plastic Surgery Fujian Medical University Union Hospital Fuzhou China
| | - Fa‐Chun Chen
- Department of Plastic Surgery Fujian Medical University Union Hospital Fuzhou China
| | - Jia‐Yao Chen
- Department of Plastic Surgery The First Affiliated Hospital of Guangzhou Medical University Guangzhou China
| | - Cheng‐Hong Jiang
- Department of Plastic Surgery Fujian Medical University Union Hospital Fuzhou China
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Cho AL, Kiang SC, Lodenkamp J, Tritch WTH, Tomihama RT. Fatal Lung Toxicity After Intralesional Bleomycin Sclerotherapy of a Vascular Malformation. Cardiovasc Intervent Radiol 2020; 43:648-651. [DOI: 10.1007/s00270-020-02420-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/18/2020] [Indexed: 11/29/2022]
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Abstract
PURPOSE Despite many advances in the knowledge of vascular malformations, extracranial arteriovenous malformations (AVMs) remain an enigma and are usually misdiagnosed and mismanaged due to their associated rare morbidity. This study aimed to describe the clinical course and emphasize the progressive nature of AVMs through a retrospective study of 446 patients. METHODS Patients with cutaneous and soft-tissue AVMs presenting to our Vascular Anomalies Center between March 2011 and March 2017 were reviewed. Medical records were examined for disease course, age at first presentation at our institution, distributions and locations of lesions, clinical staging, progression, and previous treatments. Progression was defined as advancement to a higher Schobinger stage from a lower stage. RESULTS A total of 446 patients (mean age, 25.6 ± 14.0 years) were enrolled in this study, including 232 (52.0%) males (gender ratio, 1.08:1). Arteriovenous malformations lesions in 76.7% (342/446) of the patients were located in the head and neck. Children with Stage I AVMs had a 41.9% risk of progression before adolescence and an 80.0% risk of progression before adulthood. Nearly all patients (96.2%) showed progression in adulthood. Diffuse lesions were more likely to progress than localized lesions (P < 0.05) in childhood and adolescence. Lesions in the head and neck regions were less likely to progress than those in other regions in childhood (P = 0.005). A total of 216 (48.4%) patients had undergone previous treatments. Among these patients, bleomycin showed an unintentional positive effect in the treatment of AVMs. CONCLUSIONS Extracranial AVMs have a continuously progressive nature. A full understanding regarding the progressive course of AVMs can lead patients and physicians to attach importance to early diagnosis and management. Meanwhile exploring innovative treatments should be focused in the future to prevent potential destructive progression.
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Outcome measurement instruments for peripheral vascular malformations and an assessment of the measurement properties: a systematic review. Qual Life Res 2019; 29:1-17. [PMID: 31549367 PMCID: PMC6962285 DOI: 10.1007/s11136-019-02301-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2019] [Indexed: 11/06/2022]
Abstract
Purpose The Outcome measures for vascular malformation (OVAMA) group reached consensus on the core outcome domains for the core outcome set (COS) for peripheral vascular malformations (venous, lymphatic and arteriovenous malformations). However, it is unclear which instruments should be used to measure these domains. Therefore, our aims were to identify all outcome measurement instruments available for vascular malformations, and to evaluate their measurement properties. Methods With the first literature search, we identified outcomes and instruments previously used in prospective studies on vascular malformations. A second search yielded studies on measurement properties of patient- and physician-reported instruments that were either developed for vascular malformations, or used in prospective studies. If the latter instruments were not specifically validated for vascular malformations, we performed a third search for studies on measurement properties in clinically similar diseases (vascular or lymphatic diseases and benign tumors). We assessed the methodological quality of these studies following the Consensus-based Standards for the selection of health Measurement Instruments methodology, and evaluated the quality of the measurement properties. Results The first search yielded 27 studies, none using disease-specific instruments. The second and third search included 22 development and/or validation studies, concerning six instruments. Only the Lymphatic Malformation Function Instrument was developed specifically for vascular malformations. Other instruments were generic QoL instruments developed and/or partly validated for clinically similar diseases. Conclusions Additional research on measurement properties is needed to assess which instruments may be included in the COS. This review informs the instrument selection and/or the development of new instruments. Systematic review registration PROSPERO, 42017056242. Electronic supplementary material The online version of this article (10.1007/s11136-019-02301-x) contains supplementary material, which is available to authorized users.
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Legiehn GM. Sclerotherapy with Adjunctive Stasis of Efflux (STASE) in Venous Malformations: Techniques and Strategies. Tech Vasc Interv Radiol 2019; 22:100630. [PMID: 31864535 DOI: 10.1016/j.tvir.2019.100630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Venous malformations are very commonly encountered in interventional radiologic practice. Indications for therapy are clearly defined based on the lesion's impact on patient's quality of life. Screening laboratory coagulation studies in patients with historical or lesion morphologic risk factors often reveal abnormal coagulation parameters consistent with localized intravascular coagulation or more severe coagulopathic states. These may require chronic or periprocedural medical management to avoid potentially life-threatening disseminated intravascular coagulation or other thromboembolic phenomena. Once a multidisciplinary decision to treat a venous malformation is made, one must decide between percutaneous and/or surgical techniques. Sclerotherapy with adjunctive stasis of efflux (STASE) techniques have become the mainstay of therapy for most venous malformations as they are well-tolerated and effective. STASE techniques work primarily by (i) the administration of sclerosant(s) exerting an inhibitory and/or endotheliocidal effect on venous malformation endothelium leading to thrombosis, involution, and fibrosis, and secondarily via adjunctive outflow occlusion using any combination of local compression, balloons, gelatin, coils, laser, radiofrequency, or adhesives to improve sclerosant penetration and dwell-time in the lesion. Adhesives alone can fill the lesion to facilitate surgical resection in some cases. Common sclerosants in modern practice include sodium tetradecyl sulfate, bleomycin, polidocanol, ethanol, and hypertonic saline. Most agents can be given directly in unmodified or "neat" form or can be mixed with a gas to form a sclerofoam or embolic such as gelatin to form a sclerogel. Choice and method of sclerosant delivery in each patient is based on the intraluminal lesion volume, architecture, vital structure proximity, agent toxicity, viscosity, and level of experience of the interventional radiologist with that particular agent. Multi-session STASE therapy usually reduces symptoms of chronic pain or mass with low risk of known complications of skin or nerve impairment, compartment syndrome, hemoglobinuria, deep venous thrombosis, or pulmonary phenomena.
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Affiliation(s)
- Gerald M Legiehn
- Division of Interventional Radiology, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
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Düzenli Kar Y, Özdemir ZC, Acu B, Bör Ö. Infantile hemangioma: Efficacy of low-dose propranolol and of intralesional bleomycin injection for propranolol non-response. Pediatr Int 2019; 61:459-464. [PMID: 30861274 DOI: 10.1111/ped.13830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/26/2019] [Accepted: 03/07/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infantile hemangioma (IH) is the most common form of benign childhood vascular tumor. Most resolve spontaneously, but treatment is recommended in patients who develop complication. Propranolol is recommended as the first-line therapy, while the treatment in the case of non-response to first-line therapy depends on the clinical experiences of each center. The aim of this study was to investigate the efficacy of low-dose propranolol in the treatment of IH, and the outcomes of percutaneous intralesional bleomycin injection (IBI) in patients unresponsive to propranolol. METHODS Medical records of 104 children diagnosed with IH between June 2014 and June 2017 were reviewed retrospectively. RESULTS Median patient age was 6 months (range, 3-12 months). Forty-five patients (43.3%) received therapy: 18 (40%) for cosmetic problems and 27 (60%) for lesion-related complications. The most common complications were hemorrhage (15.6%) and impairment in visual function (15.6%). All of the patients received propranolol 1 mg/kg/day as the first-line therapy. Response to treatment was excellent in 35 patients, good in four and poor in one, while five patients did not respond to therapy. The five unresponsive patients received percutaneous IBI at 0.3-0.5 mg/kg/dose as second-line therapy. The response to treatment was excellent in four patients, good in one. CONCLUSIONS The majority of IH resolved spontaneously. In the patients who required treatment, low-dose propranolol was successful in most, and IBI was effective and safe in the remaining five patients who did not respond to propranolol.
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Affiliation(s)
- Yeter Düzenli Kar
- Division of Pediatric Hematology and Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Zeynep Canan Özdemir
- Division of Pediatric Hematology and Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Berat Acu
- Division of Radiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Özcan Bör
- Division of Pediatric Hematology and Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
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Milbar HC, Jeon H, Ward MA, Mitchell SE, Weiss CR, Cohen BA. Hyperpigmentation after Foamed Bleomycin Sclerotherapy for Vascular Malformations. J Vasc Interv Radiol 2019; 30:1438-1442. [PMID: 30956080 DOI: 10.1016/j.jvir.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 10/27/2022] Open
Abstract
The present report documents 6 patients who developed distinctive hyperpigmented skin lesions after bleomycin sclerotherapy for vascular malformations of the face, neck, and extremities. The patients ranged in age from 2 to 65 years and included both black and white and male and female patients. The bleomycin treatment dose varied from 15 to 45 U, with 5 of the 6 patients receiving foamed bleomycin. The hyperpigmented lesions were near the patient's vascular anomaly and attributable to postprocedural cutaneous pressure (eg, electrocardiographic [ECG] leads or tape). Hyperpigmentation faded slowly over time but was visible up to 3 years after the procedure.
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Affiliation(s)
- Heather C Milbar
- Department of Dermatology, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287.
| | - Hana Jeon
- Department of Dermatology, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287
| | - Margaret A Ward
- Department of Dermatology, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287
| | - Sally E Mitchell
- Interventional Radiology Center, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287
| | - Clifford R Weiss
- Interventional Radiology Center, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287
| | - Bernard A Cohen
- Department of Dermatology, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287
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Transarterial Bleomycin-Lipiodol Embolization (B/LE) for Symptomatic Giant Hepatic Hemangioma. Cardiovasc Intervent Radiol 2018; 41:1674-1682. [PMID: 29922860 DOI: 10.1007/s00270-018-2010-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/13/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Large hepatic hemangiomas can cause symptoms such as pain and bleeding. No consensus currently exists on the optimal management of large and symptomatic hemangiomas. The purpose of this study was to evaluate the role of transarterial bleomycin-lipiodol embolization (B/LE) in the treatment of symptomatic large hepatic hemangioma. MATERIALS AND METHODS We retrospectively reviewed 23 patients (29 hemangiomas) treated between July 2011 and August 2017. Transarterial B/LE was performed using 7-15 cc of Lipiodol mixed with 30-45 IU of bleomycin by standard three-way stopcocks. All patients were followed clinically and by imaging for an average of 7.5 months. Patterns of bleomycin-lipiodol distribution in the periphery of hemangiomas were categorized into four different grades. Technical success was defined as proper delivery of bleomycin-lipiodol into the hemangioma confirmed by post-embolization computed tomography. Clinical success was defined as more than 50% reduction of hemangioma volume and symptom improvement during follow-ups. RESULTS Technical success and clinical success were 100 and 73.9% (17 patients), respectively. Six patients (26.08%) experienced transient post-embolization syndrome. Significant size reduction was seen in patients with grade 4 hemangioma border coverage (P = 0.042). CONCLUSION Transarterial B/LE is a safe and efficient alternative for controlling symptoms related to large hemangiomas.
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Shigematsu T, Sorscher M, Dier EC, Berenstein A. Bleomycin sclerotherapy for eyelid venous malformations as an alternative to surgery or laser therapy. J Neurointerv Surg 2018; 11:57-61. [PMID: 29674482 DOI: 10.1136/neurintsurg-2018-013813] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the clinical outcome of patients with venous malformation (VM) involving the eyelid treated with bleomycin sclerotherapy. METHODS A retrospective review was performed of 18 consecutive patients with VM involving the eyelid who underwent bleomycin sclerotherapy. Patients' clinical presentation, details of sclerotherapy, and post-sclerotherapy resolution of the lesion as well as any procedure-related complications were evaluated. RESULTS Twelve women and six men of mean age 34.3±20.4 years underwent sclerotherapy with bleomycin. Chief complaints were cosmetic disfigurations with or without hemifacial deformity (n=2), pain in engorgement area (n=2), pain and swelling from venous thrombosis (n=2), swelling or engorgement obstructing their eyesight (n=2), or eyelid dysfunction (n=1). The lesions were only in the eyelid in three patients; otherwise they were extended out of the eyelid either superiorly (n=3), laterally (n=8), inferiorly (n=8), and/or posteriorly to the orbit (n=8) to various extents. Conjunctival involvement was present in 13 patients. 14 patients had received prior treatments including surgery, laser therapy, or non-bleomycin sclerotherapy. With an average three sessions of bleomycin sclerotherapy (average total dose 34.5 mg), more than 80% shrinkage was observed in seven patients (38.9%), 50-80% shrinkage in eight patients (44.4%), and 30-50% shrinkage in two patients (11.1%). One patient had recurrence, which was successfully treated again with bleomycin. No procedure-related complications were noted. CONCLUSIONS The use of bleomycin appears to be a simple, safe, and effective treatment for venous malformations involving the eyelid, avoiding more elaborate and challenging surgical or laser interventions, and is even effective in full thickness lesions.
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Affiliation(s)
- Tomoyoshi Shigematsu
- Department of Neurosurgery, Cerebrovascular Center, Mount Sinai Health System, New York City, New York, USA
| | - Michelle Sorscher
- Department of Neurosurgery, Cerebrovascular Center, Mount Sinai Health System, New York City, New York, USA
| | - Evelyn C Dier
- Department of Neurosurgery, Cerebrovascular Center, Mount Sinai Health System, New York City, New York, USA
| | - Alejandro Berenstein
- Department of Neurosurgery, Cerebrovascular Center, Mount Sinai Health System, New York City, New York, USA
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Abstract
Propranolol has been the first-line treatment for alarming hemangiomas. However, some hemangiomas are propranolol-resistant. The authors reported 1 propranolol-resistant hemangioma which was treated with intralesional bleomycin injections. Sixteen months after 3 injections, the lesion still remained stable. Its potential mechanism was clarified by ultrasonic monitoring. Intralesional bleomycin injection can be considered an ideal option in treating propranolol-resistant hemangiomas.
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Méndez-Echevarría A, Fernandez-Prieto A, de la Serna O, Lopez-Gutierrez JC, Parron M, Marin-Aguilera B, Calvo C. Acute Lung Toxicity After Intralesional Bleomycin Sclerotherapy. Pediatrics 2018; 141:peds.2016-1787. [PMID: 29269387 DOI: 10.1542/peds.2016-1787] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 11/24/2022] Open
Abstract
Bleomycin has progressively been used to treat low-flow vascular malformations in children. No significant systemic side effects have been reported in large series after low doses, but some authors are still concerned about its use. We report a case of a severe acute lung toxicity after a low dose of a second bleomycin intralesional injection in a 5-year-old girl. She had no risk factors and presented a cervical low-flow venous malformation. Twenty-four hours after this second administration, she presented with fever and respiratory distress. A chest radiograph showed bilateral opacities and computerized tomography revealed extensive and diffuse lung ground-glass opacities. The patient started to receive intravenous methylprednisolone, but she experienced progressively increased dyspnea, and montelukast was added. She improved and was discharged from the hospital without oxygen support, with montelukast and prednisolone for tapering doses during months. Five months after onset, the patient is developing well, is active, and walks and talks without dyspnea. A new low-dose computed tomography shows improvement in radiologic findings. This is the second case of pulmonary toxicity observed in a child after bleomycin intralesional administration, and the first reported after the lowest dose of this drug to date (7 mg: 0.28 mg/kg; 10 U: 0.4 U/kg). A delay in the diagnosis and treatment of this complication can be fatal. Any physician who treats these patients must be alert and consider this complication in children with respiratory symptoms after bleomycin sclerotherapy. Early detection of pulmonary toxicity would allow prompt therapy and could avoid pulmonary damage.
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Affiliation(s)
| | | | | | | | - Manuel Parron
- Pediatric Radiology Section, Hospital La Paz, Madrid, Spain
| | | | - Cristina Calvo
- Departments of General Pediatrics and Infectious and Tropical Diseases
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Jin Y, Zou Y, Hua C, Chen H, Yang X, Ma G, Chang L, Qiu Y, Lyu D, Wang T, Chang SJ, Qiao C, Luo C, Tremp M, Lin X. Treatment of Early-stage Extracranial Arteriovenous Malformations with Intralesional Interstitial Bleomycin Injection: A Pilot Study. Radiology 2017; 287:194-204. [PMID: 29237147 DOI: 10.1148/radiol.2017162076] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To assess the efficacy and safety of intralesional interstitial bleomycin injection in the treatment of early-stage (Schobinger stage I or II) extracranial arteriovenous malformations (AVMs). Materials and Methods This prospective study involved 34 patients with early-stage AVMs, as defined by the Schobinger staging system. The patients received intralesional interstitial bleomycin injected at a maximum dose of 15 000 IU or 1000 IU per kilogram of body weight for children who weighed less than 15 kg per procedure for a total of 6 months (once every month). Therapeutic outcome was evaluated by the degree of devascularization at angiography and the clinical outcome 3 months after the last treatment. Further follow-up was evaluated based on further clinical outcome. Adverse events were recorded according to the Society of Interventional Radiology classification. Results Of the 34 patients with early-stage AVM, 32 (mean age, 20.5 years; 24 female [75%]) completed the study. The results showed that 27 (84.4%, 95% confidence interval [CI]: 71.1, 97.7) patients were responsive to bleomycin injection, including nine (28.1%) with a complete response. Four (12.5%) patients showed no response, and one (3.1%) patient experienced worsening 3 months after the last treatment. During further follow-up (mean follow-up time, 20.7 months; range, 5-28 months), the outcome remained stable in 31 (96.9%) of the 32 patients. A major complication, anaphylactic shock, was observed in one (3.1%, 95% CI: 0, 9.5) patient. Common minor complications included hyperpigmentation, nausea, pruritus, and bullae. Conclusion Intralesional interstitial bleomycin injection is a feasible approach for early-stage AVMs and yields safe and effective outcomes. © RSNA, 2017.
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Affiliation(s)
- Yunbo Jin
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Yun Zou
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Chen Hua
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Hui Chen
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Xi Yang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Gang Ma
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Lei Chang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Yajing Qiu
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Dongze Lyu
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Tianyou Wang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Shih-Jen Chang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Congzhen Qiao
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Chunfen Luo
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Mathias Tremp
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Xiaoxi Lin
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
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Da Ros V, Iacobucci M, Puccinelli F, Spelle L, Saliou G. Lymphographic-Like Technique for the Treatment of Microcystic Lymphatic Malformation Components of <3 mm. AJNR Am J Neuroradiol 2017; 39:350-354. [PMID: 29191875 DOI: 10.3174/ajnr.a5449] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/12/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The treatment of microcystic lymphatic malformations remains challenging. Our aim was to describe the lymphographic-like technique, a new technique of slow bleomycin infusion for the treatment of microcyst components of <3 mm, performed at our institution. MATERIALS AND METHODS A retrospective analysis of a prospectively collected lymphatic malformation data base was performed. Patients with at least 1 microcystic lymphatic malformation component demonstrated on MR imaging treated by lymphographic-like technique bleomycin infusion were included in the study. Patient interviews and MR imaging were performed to assess subjective and objective (microcystic lymphatic malformation size decrease of >30%) clinical improvement, respectively. Patients were reviewed 3 months after each sclerotherapy session. Lymphographic-like technique safety and efficacy were assessed. RESULTS Between January 2012 and July 2016, sixteen patients (5 males, 11 females; mean age, 15 years; range, 1-47 years) underwent the bleomycin lymphographic-like technique for microcystic lymphatic malformations. Sixty sclerotherapy sessions were performed, with a mean of 4 sessions per patient (range, 1-8 sessions) and a mean follow-up of 26 months (range, 5-58 months). We observed no major and 3 minor complications: 1 eyelid infection, 1 case of severe postprocedural nausea and vomiting, and 1 case of skin discoloration. One patient was lost to follow-up. Overall MR imaging objective improvement was observed in 5/16 (31%) patients; overall improvement of clinical symptoms was obtained in 93% of treated patients. CONCLUSIONS The bleomycin lymphographic-like technique for microcystic lymphatic malformations is safe and feasible with objective improvement in about one-third of patients. MR signal intensity changes after the lymphographic-like technique are associated with subjective improvement of the patient's symptoms.
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Affiliation(s)
- V Da Ros
- From the Department of Neuroradiology (V.D.R., M.I., L.S., G.S.), Bicêtre Hospital, Le Kremlin Bicêtre Cedex, France.,Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy (V.D.R.), Policlinico Tor Vergata, Rome, Italy
| | - M Iacobucci
- From the Department of Neuroradiology (V.D.R., M.I., L.S., G.S.), Bicêtre Hospital, Le Kremlin Bicêtre Cedex, France.,Department of Bioimaging and Radiological Sciences (M.I.), Policlinico "A. Gemelli," Rome, Italy
| | - F Puccinelli
- Department of Neuroradiology (F.P., G.S.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - L Spelle
- From the Department of Neuroradiology (V.D.R., M.I., L.S., G.S.), Bicêtre Hospital, Le Kremlin Bicêtre Cedex, France
| | - G Saliou
- Department of Neuroradiology (F.P., G.S.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Hwang J, Lee YK, Burm JS. Treatment of Tongue Lymphangioma with Intralesional Combination Injection of Steroid, Bleomycin and Bevacizumab. Arch Craniofac Surg 2017; 18:54-58. [PMID: 28913305 PMCID: PMC5556746 DOI: 10.7181/acfs.2017.18.1.54] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/02/2017] [Accepted: 01/02/2017] [Indexed: 11/22/2022] Open
Abstract
Lymphangioma is a congenital malformed lymphatic tumor that rarely involves the tongue. In our clinic, a 10-year-old female presented with lymphangioma circumscriptum involving the right two-thirds of the tongue. We administered an intralesional combination injection of triamcinolone, bleomycin, and bevacizumab as a treatment. Almost complete remission after combination therapy was achieved without complications such as edema, swallowing difficulties or recurrence. Bevacizumab, an inhibitor of vascular endothelial growth factor, was effective for the treatment of lymphangioma of the tongue in this case. No recurrence was noted at the 1-year follow up.
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Affiliation(s)
- Jungil Hwang
- Department of Plastic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Yung Ki Lee
- Department of Plastic Surgery, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jin Sik Burm
- Department of Plastic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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Vlahovic A, Gazikalovic A, Adjic O. Bleomycin sclerotherapy for lymphatic malformation after unsuccessful surgical excision: case report. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 35:365-7. [PMID: 26824921 PMCID: PMC4720922 DOI: 10.14639/0392-100x-105513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Lymphatic malformations (LMs) are benign cystic masses resulting from the abnormal development of lymphatic channels. Lymphatic malformations occur primarily in the head and neck region. Surgical excision of lymphatic malformation is followed by high rate of recurrence and a high risk of complications. Bleomycin is an established antineoplastic drug. It can be used as a sclerosing agent in vascular anomalies. We present a child who was unsuccessfully treated with four surgical resections, with peripheral palsy of facial nerve as complication. The lymphatic malformation was successfully treated in our institution with intralesional administration of bleomycin.
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Affiliation(s)
- A Vlahovic
- Department of Plastic and Reconstructive Surgery and Burns
| | - A Gazikalovic
- Department of Radiology, Institute for Mother and Child Health Care of Republic Serbia, New Belgrade, Serbia
| | - O Adjic
- Center for Diagnostic Imaging, Oncology Institute of Sremska Kamenica
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Lee HJ, Kim TW, Kim JM, Kim GW, Ko HC, Kim BS, Kim MB, Kim HS. Percutaneous sclerotherapy using bleomycin for the treatment of vascular malformations. Int J Dermatol 2017; 56:1186-1191. [PMID: 28869282 DOI: 10.1111/ijd.13733] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 05/10/2017] [Accepted: 07/21/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Some vascular malformations are difficult to manage with surgical treatment. Thus, percutaneous sclerotherapy has been utilized with several advantages over surgical treatment. Bleomycin is one of several sclerosing agents used for the treatment of vascular malformations. OBJECTIVES To evaluate therapeutic efficacy and safety of percutaneous sclerotherapy using bleomycin for the treatment of vascular malformations. METHODS Thirty patients diagnosed with vascular malformations, including four with capillary malformations with nodular change, nine with lymphatic malformations, and 17 with venous malformations, were involved in the study. Patients received magnetic resonance imaging and pulmonary surveillance prior to the treatment. Clinical assessments for the degree of vascularity disappearance and adverse effects were performed by the investigator. RESULTS Percutaneous sclerotherapy using bleomycin was performed in 3.2 sessions (mean) over 3 months (mean). Significant improvement was observed in 90.0% of all lesions. All lesions of capillary malformation with nodular change and lymphatic malformation demonstrated significant improvement, and 82.4% of lesions of venous malformation improved significantly. Seven patients (23.3%) complained of side effects including pain and headache. All occurred within 24 hours and were tolerable. CONCLUSIONS Percutaneous sclerotherapy using bleomycin is effective and tolerable in the treatment of vascular malformation through a percutaneous approach. Therefore, it could be applied usefully for vascular malformations by dermatologists.
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Affiliation(s)
- Hyun-Joo Lee
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Tae-Wook Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Jeong-Min Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Gun-Wook Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Yılmaz H, Yılmaz Ö, Çamlıdağ İ, Belet Ü, Akan H. Single center experience with intralesional bleomycin sclerotherapy for lymphatic malformations. Jpn J Radiol 2017; 35:590-596. [PMID: 28779454 DOI: 10.1007/s11604-017-0672-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/26/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of our study was to evaluate the efficacy of percutaneous sclerotherapy using bleomycin in treatment of lymphatic malformations. METHODS Between January 2009 and January 2013, ten patients with lymphatic malformations who were admitted to the interventional radiology department were included in this retrospective study. Intralesional bleomycin was administered by percutaneous injection through 21-23 Gauge needles with a dose of 1 mg/kg body weight. Patients were clinically and radiologically assessed at baseline and followed at first and third months after treatment. Response to treatment was measured visually by using photographs and by radiological images. Symptomatic improvement was also evaluated either by patients or parents. RESULTS Excellent resolution was obtained visually in 80% of patients with lymphatic malformation. Significant resolution was achieved in 20% of patients. The percentage of radiographic resolution in size and the improvement in symptoms evaluated by patients or parents were similar with visual outcomes. No side effects were recorded except for fever in one patient and transient erythema in another patient. CONCLUSION Intralesional bleomycin is a safe and effective treatment for patients with lymphatic malformations.
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Affiliation(s)
- Hakan Yılmaz
- Department of Radiology, Hitit University, Çorum Training and Research Hospital, Çorum, Turkey
| | - Özlem Yılmaz
- Department of Dermatology, Hitit University, Çorum Training and Research Hospital, 19200, Çorum, Turkey
| | - İlkay Çamlıdağ
- Department of Radiology, Ondokuz Mayıs University, 55139, Kurupelit/Samsun, Turkey. .,, Cumhuriyet M., Adnan Menderes Bulv., Zeren Sitesi, C Blok Kat:4 No:8, 55200, Atakum/Samsun, Turkey.
| | - Ümit Belet
- Department of Radiology, Ondokuz Mayıs University, 55139, Kurupelit/Samsun, Turkey
| | - Hüseyin Akan
- Department of Radiology, Ondokuz Mayıs University, 55139, Kurupelit/Samsun, Turkey
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Dokania V, Rajguru A, Kaur H, Agarwal K, Kanetkar S, Thakur P, Patel F, Shukla D. Sudden Onset, Rapidly Expansile, Cervical Cystic Hygroma in an Adult: A Rare Case with Unusual Presentation and Extensive Review of the Literature. Case Rep Otolaryngol 2017; 2017:1061958. [PMID: 28630776 PMCID: PMC5463163 DOI: 10.1155/2017/1061958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/26/2017] [Indexed: 12/30/2022] Open
Abstract
Cystic hygroma (CH) is a benign infiltrative malformation of the lymphatic channels. We report a case of a 28-year-old Indian female who presented with rapidly enlarging right sided neck swelling over the posterior triangle since 5 days. Complete resection of CH is sometimes not amenable because of its infiltrative nature and involvement of surrounding vital structures. However, in our patient successful complete surgical resection was undertaken. The MRI findings of our patient were consistent with brachial cleft cyst; this posed a challenge in the diagnosis of CH. The histopathological analysis of the resected mass confirmed CH. CH is rare in adults and such an acute presentation is exceptionally atypical. History of prior trauma and infection are known etiological factors for adult CH; these were conspicuously absent in our patient. CH should be considered in the differentials of rapidly enlarging cystic swelling of posterior region of neck in adults. Optimal and timely management is necessary to achieve a favorable prognosis. Therefore, we report a case of rapidly enlarging cervical CH in an adult along with extensive literature review to have a better understanding regarding epidemiology, etiopathogenesis, clinical presentation, optimal management, and prognosis of such a rare entity in adults.
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Affiliation(s)
- Vivek Dokania
- Department of ENT, Krishna Institute of Medical Sciences Deemed University, Karad 415110, India
| | - Anagha Rajguru
- Department of ENT, Krishna Institute of Medical Sciences Deemed University, Karad 415110, India
| | | | - Ketan Agarwal
- Department of ENT, Krishna Institute of Medical Sciences Deemed University, Karad 415110, India
| | - Sujata Kanetkar
- Department of Pathology, Krishna Institute of Medical Sciences Deemed University, Karad 415110, India
| | - Prajakta Thakur
- Dr. Vasantrao Pawar Medical College, Hospital & Research Center, Nashik 422003, India
| | - Femina Patel
- Krishna Institute of Medical Sciences Deemed University, Karad 415110, India
| | - Dhirajkumar Shukla
- Department of Pathology, Krishna Institute of Medical Sciences Deemed University, Karad 415110, India
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Behravesh S, Yakes W, Gupta N, Naidu S, Chong BW, Khademhosseini A, Oklu R. Venous malformations: clinical diagnosis and treatment. Cardiovasc Diagn Ther 2016; 6:557-569. [PMID: 28123976 DOI: 10.21037/cdt.2016.11.10] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Venous malformation (VM) is the most common type of congenital vascular malformation (CVM). They are present at birth and are often symptomatic, causing morbidity and pain. VMs can be challenging to diagnose and are often confused with hemangioma in terminology as well as with imaging. An accurate clinical history and cross-sectional imaging are critical for diagnosis and for devising management. This manuscript will review imaging approaches to diagnosing VMs and current treatment strategies.
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Affiliation(s)
- Sasan Behravesh
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Wayne Yakes
- Vascular Malformation Center, Englewood, CO 80113, USA
| | - Nikhil Gupta
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Sailendra Naidu
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Brian W Chong
- Department of Radiology and Neurological Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Ali Khademhosseini
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA;; Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
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42
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Fowell C, Verea Linares C, Jones R, Nishikawa H, Monaghan A. Venous malformations of the head and neck: current concepts in management. Br J Oral Maxillofac Surg 2016; 55:3-9. [PMID: 27894790 DOI: 10.1016/j.bjoms.2016.10.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/31/2016] [Indexed: 01/20/2023]
Abstract
Low-flow venous malformations are congenital lesions and they are the third most common vascular anomaly in the head and neck. In this paper, the third in a series of three educational reviews, we discuss current trends in their management, and include a summary of common sclerosant agents used in their control.
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Affiliation(s)
- C Fowell
- Consultant, Oral & Maxillofacial Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ.
| | - C Verea Linares
- Oral and Maxillofacial Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB
| | - R Jones
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB
| | - H Nishikawa
- Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH
| | - A Monaghan
- Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB
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Swarnakar RN, Hazarey JD, Dhoble C, Vaghani B, Ainsley AS, Khargie JF, Likaj L. A 36-Year-Old Female with Recurrent Left Sided Pleural Effusion: A Rare Case of Mediastinal Lymphangioma. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:799-804. [PMID: 27789902 PMCID: PMC5087561 DOI: 10.12659/ajcr.895258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Lymphangioma is an atypical non-malignant, lymphatic lesion that is congenital in origin. Lymphangioma is most frequently observed in the head and neck, but can occur at any location in the body. About 65% of lymphangiomas are apparent at birth, while 80-90% are diagnosed by two years of age. Occurrence in adults is rare, as evidenced by less than 100 cases of adult lymphangiomas reported in the literature. CASE REPORT A 36-year-old Indian woman with a medical history of recurrent pleural effusions presented with chief complaints of dyspnea on exertion for one year and a low-grade fever for one month. A thorax CT revealed left-sided pleural effusion with thin internal septations. Thoracoscopy revealed a large cystic lesion arising from the mediastinum from the hilum surrounding the mediastinal great vessels. The diagnosis of lymphangioma was confirmed via histopathologic examination of the cyst. It was managed with partial cystectomy along with the use of a sclerosing agent (talc). CONCLUSIONS The size and location of lymphangiomas can vary, with some patients presenting with serious problems like respiratory distress, while others may be asymptomatic. Complete cyst resection is the gold standard treatment for mediastinal cystic lymphangioma. Partial cyst resection along with the use of sclerosing agents can be an effective option when complete cystectomy is not possible. Although lymphangioma is a rare patient condition, it should be included in the differentials for patients presenting with pleural effusions. Also, a biopsy should be done at the earliest opportunity to differentiate lymphangioma from other mediastinal malignant tumors.
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Affiliation(s)
- Rajesh N Swarnakar
- Department of Pulmonology, Getwell Hospital and Research Institute, Nagpur, India
| | - Jetendra D Hazarey
- Department of Thoracic Surgery, Getwell Hospital and Research Institute, Nagpur, India
| | - Chetan Dhoble
- Department of Pulmonology, Getwell Hospital and Research Institute, Nagpur, India
| | - Bhavesh Vaghani
- Department of Pulmonology, Getwell Hospital and Research Institute, Nagpur, India
| | - Alaine S Ainsley
- Graduated Student, Atlantic University School of Medicine, New York, NY, USA
| | - James F Khargie
- Department of Internal Medicine, Windsor School of Medicine,Cayon, Saint Kitts and Nevis
| | - Lorena Likaj
- Department of Internal Medicine, Saint James School of Medicine, New York, NY, USA
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Azene E, Mitchell S, Radvany M, Agrawal N, Eisele D, Weiss C. Foamed bleomycin sclerosis of airway venous malformations: The role of interspecialty collaboration. Laryngoscope 2016; 126:2726-2732. [DOI: 10.1002/lary.26077] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Ezana Azene
- Department of Radiology; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
- Department of Radiology; Gundersen Health System; La Crosse Wisconsin U.S.A
| | - Sally Mitchell
- Department of Radiology; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Martin Radvany
- Department of Radiology; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
- Department of Endovascular Neurosurgery; WellSpan Health; York Pennsylvania U.S.A
| | - Nishant Agrawal
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - David Eisele
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Clifford Weiss
- Department of Radiology; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
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Igoumenakis D, Logothetis I, Barmpagadaki A, Ieromonachou P, Mastorakis G. Temporal Space Lymphatic Malformation in a 15-Year-Old Adolescent: An Extraordinary Case. J Maxillofac Oral Surg 2016; 15:274-8. [PMID: 27408452 DOI: 10.1007/s12663-015-0789-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 03/23/2015] [Indexed: 11/29/2022] Open
Abstract
Lymphatic malformations-previously called lymphangiomas or cystic hygromas-are regarded as non-malignant primary disorders of the lymphatic system. They appear predominantly in infants and children, with 90 % of cases being diagnosed by the age of 2 years. Also, they constitute an infrequent entity, accounting for 5 % of all benign tumors in infants and children. In adults they are extremely rare. In the present article we present an extraordinary case of a lymphatic malformation that ensued in the temporal area of a 15-year old adolescent.
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Affiliation(s)
- Dimosthenis Igoumenakis
- Department of Oral and Maxillofacial Surgery, General Hospital of Attica "KAT", 2 Nikis Street, 14561 Kifisia, Athens, Greece
| | - Ioannis Logothetis
- Department of Oral and Maxillofacial Surgery, Venizeleio-Pananeio General Hospital of Heraklion, Knossos Avenue, P.O. Box 44, Heraklion, Crete, Greece
| | | | - Panayotis Ieromonachou
- Department of Pathology, Venizeleio-Pananeio General Hospital of Heraklion, Knossos Avenue, P.O. Box 44, Heraklion, Crete, Greece
| | - George Mastorakis
- Department of Oral and Maxillofacial Surgery, Venizeleio-Pananeio General Hospital of Heraklion, Knossos Avenue, P.O. Box 44, Heraklion, Crete, Greece
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Multimodality Image-Guided Sclerotherapy of Low-Flow Orbital Vascular Malformations: Report of Single-Center Experience. J Vasc Interv Radiol 2016; 27:987-995.e4. [DOI: 10.1016/j.jvir.2016.02.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/29/2016] [Accepted: 02/29/2016] [Indexed: 11/18/2022] Open
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Yakes WF. Use of Multiple Sclerosant Agents in Vascular Malformation Management: A World in Endovascular Confusion and Chaos. J Vasc Interv Radiol 2016; 26:1494-6. [PMID: 26408215 DOI: 10.1016/j.jvir.2015.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Wayne F Yakes
- Vascular Malformation Center, 501 E. Hampden Ave., Englewood, CO 80113..
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Horbach SER, Rigter IM, Smitt JHS, Reekers JA, Spuls PI, van der Horst CMAM. Intralesional Bleomycin Injections for Vascular Malformations: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2016; 137:244-256. [PMID: 26710030 DOI: 10.1097/prs.0000000000001924] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Vascular malformations are congenital anomalies of the vascular system. Intralesional bleomycin injections are commonly used to treat vascular malformations. However, pulmonary fibrosis could potentially be a severe complication, known from systemic bleomycin therapy for malignancies. In this study, the authors investigate the effectiveness and safety of bleomycin (A2, B2, and A5) injections for vascular malformations, when possible relative to other sclerosants. METHODS The authors performed a PubMed, Embase, Cochrane Central Register of Controlled Trials, and gray literature search for studies (1995 to the present) reporting outcome of intralesional bleomycin injections in patients with vascular malformations (n ≥ 10). Predefined outcome measures of interest were size reduction, symptom relief, quality of life, adverse events (including pulmonary fibrosis), and patient satisfaction. RESULTS Twenty-seven studies enrolling 1325 patients were included. Quality of evidence was generally low. Good to excellent size reduction was reported in 84 percent of lymphatic and 87 percent of venous malformations. Pulmonary fibrosis was never encountered. Meta-analysis of four studies on venous malformations treated with bleomycin versus other sclerosants showed similar size reduction (OR, 0.67; 95 percent CI, 0.24 to 1.88) but a significantly lower adverse event rate (OR, 0.1; 95 percent CI, 0.03 to 0.39) and fewer severe complications after bleomycin. Symptom relief, quality of life, and patient satisfaction were reported inadequately. CONCLUSIONS The authors' data suggest that bleomycin is effective in reducing the size of lymphatic and venous malformations, and leads to a lower adverse event rate and fewer severe complications than other sclerosants. The included literature does not provide evidence that pulmonary fibrosis is a complication of intralesional bleomycin injections. This study represents the "best available" evidence; however, only low- to moderate-quality studies were available. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Sophie E R Horbach
- Amsterdam, The Netherlands From the Departments of Plastic, Reconstructive and Hand Surgery, Hospital Pharmacy, Dermatology, and Interventional Radiology, Academic Medical Center, University of Amsterdam
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Sclerotherapy for low-flow vascular malformations of the head and neck: A systematic review of sclerosing agents. J Plast Reconstr Aesthet Surg 2016; 69:295-304. [DOI: 10.1016/j.bjps.2015.10.045] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 10/26/2015] [Accepted: 10/30/2015] [Indexed: 11/21/2022]
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50
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Vascular Malformations and Their Treatment in the Growing Patient. Oral Maxillofac Surg Clin North Am 2016; 28:91-104. [DOI: 10.1016/j.coms.2015.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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