Intralesional laser therapy for vascular malformations

Successful Intralesional Laser Therapy for Sclerotherapy-resistant Huge Venous Malformation

Venous malformations (VMs) are compressible, blue-purple tumors that are present at birth, and are treated with either surgery or sclerotherapy, or a combination of both. Patients often experience recurrent hemorrhage, swelling, pain, or difficulty in daily life. Treatment of massive VMs can, therefore, be challenging. We applied intralesional laser photocoagulation (ILP) to a 19-year-old female patient with a huge VM who had shown resistance to sclerotherapy. It spanned from the dorsal area to the lateral chest. ILP is delivered directly into thick, deep lesions through a bare fiber delivery system. The effect on deep components is optimized without directly contacting the cutaneous or mucosal surfaces to minimize epithelial damage. We applied ILP to the lesion at 30 W in continuous mode (10 seconds) under ultrasound monitoring using an Nd:YAG laser of 1064-nm wavelength. In total, there have been 4 sessions of the same treatment; the lesion was treated with a combined 120 kJ of energy. Satisfactory regression of the huge VM was achieved by this ILP treatment. No significant complications (major bleeding, severe pain, post-perforation skin ulcer, and scar contraction) occurred during the treatment. ILP has been indicated for only sclerotherapy-resistant cases until now, but we suggest that it is a potentially safe and minimally-invasive resolution of VM without scarring or loss of normal shape, sensory feel, or function. ILP appears to be a safe and minimally-invasive resolution of VM. We propose that this technique could become a first-choice treatment modality for VM.

Management of disseminated intravascular coagulation associated with aortic aneurysm and vascular malformations

Aortic aneurysms and vascular malformations are sometimes associated with disseminated intravascular coagulation (DIC). A typical blood coagulation test shows decrease in platelet count and fibrinogen, and increases in fibrin/fibrinogen degradation products (FDP) and D-dimer. The coagulation activation marker thrombin-antithrombin complex (TAT) and the fibrinolysis activation marker plasmin-α₂ plasmin inhibitor (PIC) are significantly increased. α₂ plasmin inhibitor (α₂PI) is significantly reduced. Since no prolongation of prothrombin time (PT) is noticeable and activated partial thromboplastin time (APTT) is shortened in some cases, DIC cannot be diagnosed or ruled out by PT and APTT alone. The cornerstone of treatment for DIC is to treat the underlying disease. However, surgery is not possible in some cases. Follow-up may be appropriate in patients with abnormal results from coagulation tests and no bleeding. However, pharmacotherapy is often required in cases with bleeding. Unfractionated heparin, low molecular weight heparin, protease inhibitors, recombinant thrombomodulin, direct oral anticoagulants, and factor XIII preparations are effective. If PIC is significantly increased and α₂PI is significantly decreased, or if the bleeding is severe, tranexamic acid is used as an antifibrinolytic therapy with anticoagulant therapy. In such cases, attention should be paid not only to TAT but also changes in PIC.

Management of massive venous malformations by percutaneous injection of bleomycin combined with fibrin glue in the head and neck

PURPOSE

The aim of this study was to evaluate the effectiveness of percutaneous injection of bleomycin combined with fibrin glue in treating massive venous malformations (MVMs) in the head and neck region.

MATERIALS AND METHODS

A retrospective case series analysis of 22 patients who underwent percutaneous sclerotherapy between June 2015 and December 2018 was performed. All the patients were examined by comparing the size of the venous malformations (VMs) and their responses to treatment including complications in the follow-up.

RESULTS

The follow-up period ranged from 6 to 24 months. Ten patients (10/22) were completely cured and 10 patients (10/22) exhibited excellent size reduction of their VMs. Two patients (2/22) exhibited reasonable size reduction and were recommended to undergo a second sclerotherapy procedure. However, both patients were satisfied with the outcomes and refused subsequent treatment. Neither systemic nor local complications occurred in this study. All the patients were satisfied with their significant size reductions and symptom improvements without recurrences during follow-up.

CONCLUSION

Percutaneous injection of bleomycin combined with fibrin glue is a promising treatment option that yielded excellent size reduction with a low risk of complications on MVMs in the head and neck region.

The application of a carbon dioxide laser in the treatment of superficial oral mucosal lesions

To evaluate the safety and advantages of using carbon dioxide (CO2) laser in the treatment of oral mucosal lesion, including vascular malformations, precancerous lesions, and verrucous nevus, a retrospective analysis was conducted for 73 patients with oral mucosal lesions who received CO2 laser treatment during June 2012 to December 2013, including 25 patients with vascular malformations, 22 patients with oral leukoplakia, 18 patients with oral mucosal lichen planus, and 8 patients with oral mucosal and labial mucosal verrucous nevus. The lesions ranged from 0.8 × 0.8  cm to 4 × 3  cm. Twenty patients with lesions removed using the traditional scalpel, assisted with an electric knife, were the control group. The operative time was from 3 to 10 minutes, with an average of 5.5 minutes; the average amount of intraoperative bleeding was 5  mL. None of the 73 patients had postoperative infections, and all wounds healed well after the surgery. The patients were followed up for 1 year. Two patients with oral leukoplakia showed recurrence after the surgery, and a reoperation achieved satisfactory treatment effects. The operative time of the control group was in the range of 4 to 15 minutes, with an average of 9.5 minutes, and the average amount of intraoperative bleeding was 10  mL. None of the 20 patients had postoperative infections, and the wounds also showed healing well after the surgery. The application of CO2 laser in the treatment of oral mucosal lesions has the advantages of reduced bleeding, a clear view during surgery, and a shorter operative time.