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Strübing F, Laurich A, Weiss C, Kneser U, Schoenberg S, Sadick M. Patient characteristics and disease spectrum in a German vascular anomalies center. Acta Radiol 2024; 65:145-151. [PMID: 37743550 DOI: 10.1177/02841851231196872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Vascular malformations are rare diseases that should be treated in dedicated vascular anomaly centers (VAC). There is only a small amount of data on the diagnostic and therapeutic handling of these patients, before they are referred to a VAC. PURPOSE To demonstrate the disease-specific patient characteristics in a German VAC, which are required to determine diagnostic and therapeutic steps. MATERIAL AND METHODS In a retrospective study, all patients who were treated in the VAC from April 2014 until August 2021 were identified. In total, 593 patients were included in this study. RESULTS Almost all patients had previously consulted a physician (591/593, 99.7%). A mean of two different physicians had been consulted (range 0-10). Patients with more complex, syndromal vascular malformations had significantly more previous appointments (P = 0.0018). In only 44% (261/593) of patients, the referral diagnosis was made correctly. Most patients had been previously treated for their vascular anomaly: pharmacotherapy (n = 130; 21.9%), compression garments (n = 141; 23.8%), surgical resection (n = 80; 17.3%) and sclerotherapy (n = 68; 11.5%). Fifty-two patients who had been falsely diagnosed had also received therapy prior to their referral to the VAC (8.8%). Most patients received an ultrasound examination in the VAC (n = 464; 78.2%). Most frequently, compression therapy was prescribed (n = 256; 43.2%), followed by sclerotherapy (n = 175, 29.5%) and pharmacotherapy (n = 55; 9.3%). CONCLUSION Patients suffering from vascular anomalies often go through a complicated scheduling with numerous outpatient appointments and have a high risk of misdiagnosis and mistreatment prolonging the medical condition. Therefore, patients with vascular anomalies should be treated in a dedicated vascular anomaly center.
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Affiliation(s)
- Felix Strübing
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Annette Laurich
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Christel Weiss
- Department for Statistical Analysis, University Medical Center Mannheim, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Stefan Schoenberg
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Ludwigshafen, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Ludwigshafen, Germany
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Allemang-Trivalle A, Leducq S, Maruani A, Giraudeau B. Designs used in published therapeutic studies of rare superficial vascular anomalies: a systematic literature search. BMC Med Res Methodol 2023; 23:196. [PMID: 37648985 PMCID: PMC10466846 DOI: 10.1186/s12874-023-02017-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/09/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Rare superficial vascular anomalies represent a wide range of diseases. Their management is difficult given the broad spectrum and the lack of clinical trials assessing treatment efficacy. A randomized clinical trial of vascular anomalies is difficult because of the rarity of the diseases and is enhanced by the population of interest often being children. Therefore, suitable designs are needed. We conducted a methodological systematic literature search to identify designs implemented for investigating the treatment of rare superficial vascular anomalies. METHODS We conducted a literature search on January 25, 2021, of the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, ClinicalTrials.gov and European Union Clinical Trials Register databases. This systematic methodological literature search was registered at the Prospective Register of Systematic Reviews (PROSPERO: CRD42021232449). Randomized and non-randomized studies were included if they met the following criteria: were prospective studies of rare superficial vascular anomaly therapies, dealt with humans (adults and children) and were published in English from 2000. We excluded case reports/case series reporting fewer than 10 patients, reviews, retrospective studies, animal studies, studies of systemic or common vascular anomalies and non-therapeutic studies. We did not assess risk of bias in the included studies because our review was a methodological one focused on the design used. The review provided a descriptive analysis of relevant features of eligible research studies. RESULTS From 2046 articles identified, we included 97 studies (62 reports and 35 ongoing studies): 25 randomized controlled studies, 7 non-randomized comparative studies, 64 prospective cohorts and 1 case series. Among the 32 comparative studies included, 21 used a parallel-group design. The 11 other studies used different designs such as cross-over, randomized placebo phase, delayed-start, within-person, or challenge-dechallenge-rechallenge or used a historical control group or an observational run-in period. CONCLUSIONS Our systematic literature search highlights the lack of randomized control trials in superficial vascular anomalies due to the rarity of patients and their heterogeneity. New designs are emerging and can overcome the limitations of testing treatments in parallel groups.
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Affiliation(s)
- Aude Allemang-Trivalle
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France.
- INSERM CIC1415, CHRU de Tours, Tours, France.
| | - Sophie Leducq
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (Maladies Génétiques rares à Expression Cutanée-Tours), CHRU de Tours, Tours, France
| | - Annabel Maruani
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France
- INSERM CIC1415, CHRU de Tours, Tours, France
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (Maladies Génétiques rares à Expression Cutanée-Tours), CHRU de Tours, Tours, France
| | - Bruno Giraudeau
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France
- INSERM CIC1415, CHRU de Tours, Tours, France
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Pang C, Nisbet R, Gibson M, Evans N, Khalifa M, Papadopoulou A, Tsui J, Hamilton G, Brookes J, Lim CS. Early follow-up quality of life and mental health of patients with congenital vascular malformations cared for in a multi-disciplinary specialist centre. Phlebology 2023; 38:80-90. [PMID: 36541140 DOI: 10.1177/02683555221147469] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The study aimed to evaluate the early follow-up quality of life (QoL), pain and mental health of patients with congenital vascular malformation (CVM) from a variety of treatment options. METHODS All patients with CVM who received care and had follow-up between February 1st 2018 and January 31st 2020 were included. The health-related QoL, pain, and mental health were assessed with RAND Health Care 36-Item Short Form Survey (SF-36), visual analogue score for pain (VAS-P) and Hospital Anxiety and Depression Scale (HADS). Paired t-test was used for all analyses. p < .05 were considered significant. RESULTS In total, 110 patients with a mean age of 36.9 years were included in this study. In all patients following care, significant improvement was found in the bodily pain domain of SF-36 and VAS-P (both p = .01). This was largely driven by high-flow vascular malformation patients who responded better to embolo-sclerotherapy, which revealed significant improvement in the bodily pain domain of SF-36 (p = .002) and VAS-P (p = .02). Patients who received supportive treatment only reported significant improvement in mental health (p = .004) and social functioning (p = .03) domains of SF-36. Meanwhile, patients treated with embolo-sclerotherapy reported significant improvement only in VAS-P (p = .02). CONCLUSIONS This study concluded that the effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research should therefore, include larger sample size and longer term follow-up to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.
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Affiliation(s)
- Calver Pang
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, UK.,Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, UK
| | - Rebecca Nisbet
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Michael Gibson
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Nicholas Evans
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Mohamed Khalifa
- Department of Interventional Radiology, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Anthie Papadopoulou
- Department of Interventional Radiology, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Janice Tsui
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, UK.,Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, UK
| | - George Hamilton
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, UK.,Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, UK
| | - Jocelyn Brookes
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, UK.,Department of Interventional Radiology, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Chung Sim Lim
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, UK.,Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, UK
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Çay F, Altunbulak AY, Özbay Y, Eldem G, Çil BE, Vargel İ, Kutluk MT, Yalçın B, Peynircioğlu B. Clinical results of polidocanol sclerotherapy in venous malformation treatment: Patient-perceived improvement and satisfaction. Phlebology 2023; 38:36-43. [PMID: 36433742 DOI: 10.1177/02683555221142531] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE This study evaluated the results of polidocanol sclerotherapy in the treatment of venous malformations (VM) including patient satisfaction, perceived improvement, and predictors of satisfaction. MATERIAL AND METHOD Patients with VM that underwent polidocanol foam sclerotherapy between June 2013 and July 2021 in a single center were retrospectively evaluated. Patient demographics, VM, and treatment characteristics were analyzed. Patient-reported outcomes and satisfaction were analyzed with a questionnaire. RESULTS This study included 232 (136, 58.6%, female) patients. The mean age was 24.49 ± 12.45 years (range 3-72). The clinical response rate was 82.3%. The rate of satisfaction was 82.3%, and 116 (50%) patients were significantly satisfied. There were no major complications. Clinical response and VM margin were related to satisfaction (p < 0.01, p = 0.012, respectively). Clinical response to pretreatment swelling was related to significant satisfaction (p = 0.02). CONCLUSION Polidocanol sclerotherapy was safe and effective in VM treatment with high satisfaction and low complication rates.
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Affiliation(s)
- Ferdi Çay
- Department of Radiology, 64005Hacettepe University School of Medicine, Ankara-Turkey
| | - Ahmet Y Altunbulak
- Department of Radiology, 64005Hacettepe University School of Medicine, Ankara-Turkey
| | - Yakup Özbay
- Department of Radiology, 64005Hacettepe University School of Medicine, Ankara-Turkey
| | - Gonca Eldem
- Department of Radiology, 64005Hacettepe University School of Medicine, Ankara-Turkey
| | - Barbaros E Çil
- Department of Radiology, 587267Koç University School of Medicine, Istanbul-Turkey
| | - İbrahim Vargel
- Department of Plastic and Reconstructive Surgery, 64005Hacettepe University School of Medicine, Ankara-Turkey
| | - Mustafa T Kutluk
- Department of Pediatrics, Pediatric Oncology Unit, 64005Hacettepe University School of Medicine, Ankara-Turkey
| | - Bilgehan Yalçın
- Department of Pediatrics, Pediatric Oncology Unit, 64005Hacettepe University School of Medicine, Ankara-Turkey
| | - Bora Peynircioğlu
- Department of Radiology, 64005Hacettepe University School of Medicine, Ankara-Turkey
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5
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He B, Yang B, Nie QQ, Zhang JB, Chen J, Liu P, Fan XQ, Ye ZD. Comparison of polidocanol foam versus bleomycin polidocanol foam for treatment of venous malformations. J Vasc Surg Venous Lymphat Disord 2023; 11:143-148. [PMID: 35940448 DOI: 10.1016/j.jvsv.2022.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/17/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this research was to retrospectively investigate the difference of safety and efficacy between polidocanol foam and bleomycin polidocanol foam (BPF) in the treatment of venous malformations (VMs), and provide clinical evidence for the application of BPF for VMs. METHODS Patients with VMs treated with polidocanol foam and BPF were included between July 2018 and July 2020. The VM tissue involvements and symptoms were collected. The treatment outcomes were evaluated by the clinical improvement of symptoms and the degree of devascularization on ultrasound examination or magnetic resonance imaging. Patients were followed up for 1, 3, and 6 months after the sclerotherapy. Immediate and delayed complications were closely followed and recorded. RESULTS A total of 51 patients were included, including 34 females and 17 males with a mean age of 26.8 years (range, 5-65 years). The most commonly involved sites were lower extremities (31/60 [51.7%]) and the most common symptom was pain (33/51 [64.7%]). Fifty-four sclerotherapies were performed with a mean of 1.06 ± 0.24 sessions (range, 1-2 sessions) per patient. The reduction percentage of lesion volume in the BPF group was significantly higher than the polidocanol foam group (79.4 ± 1.6% vs 55.7 ± 6.1%; P < .001). Patient satisfaction scores in the BPF group were significantly higher than the polidocanol foam group (7.2 ± 1.1 vs 5.7 ± 0.8; P < .001). No major complication was observed in either group. Cardiovascular and Interventional Radiological Society of Europe (CIRSE) grade 1 complications occurred in 5 of 21 patients in the BPF group and 7 of 30 patients in the polidocanol foam group, CIRSE grade 2 complications occurred in 5 of 21 patients in the BPF group and 4 of 30 patients in the polidocanol foam group; there were no significant differences between the two groups. CONCLUSIONS BPF is a safe and effective sclerosant for VMs, showing better efficacy and similar safety as commonly used mild sclerosants. It could be a promising agent to treat VMs or other slow-flow vascular malformations.
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Affiliation(s)
- Bin He
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Bo Yang
- Department of Vascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiang-Qiang Nie
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jian-Bin Zhang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jie Chen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Peng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xue-Qiang Fan
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhi-Dong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
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6
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Cao J, Liu J, Zhang X, Wang Z. A systematic review and network meta-analysis of the effectiveness of sclerotherapy for venous malformation. J Vasc Surg Venous Lymphat Disord 2023; 11:210-218.e3. [PMID: 36179784 DOI: 10.1016/j.jvsv.2022.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 07/24/2022] [Accepted: 08/02/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Sclerotherapy for venous malformation has been widely used; however, no guidelines are available to assess the effectiveness of different sclerotherapy agents. We conducted a systematic review and network meta-analysis to investigate the effectiveness of sclerotherapy agents for venous malformations. METHODS Three electronic databases were searched from their inception (1950) to April 29, 2021. Studies comparing the effectiveness of different sclerotherapy agents were included. The risk of bias within and across studies was assessed. Pairwise meta-analyses were conducted, followed by a network meta-analysis. We also assessed inconsistency and publishing bias using various approaches. RESULTS Seven studies with 547 patients in six arms were included in the present study. We defined the response and complete response as two separate outcomes. Significant differences were observed in four comparisons with respect to the response (ethanol vs bleomycin, ethanol vs polidocanol, ethanol vs sodium tetradecyl sulfate, polidocanol vs sodium tetradecyl sulfate). No statistically significant differences were found in the other comparisons. The evidence network revealed that for the response outcome, ethanol ranked first, followed by pingyangmycin, polidocanol, sodium morrhuate, bleomycin, and, finally, sodium tetradecyl sulfate. For the complete response outcome, pingyangmycin had the best results, followed by sodium morrhuate, polidocanol, ethanol, bleomycin, and, finally, sodium tetradecyl sulfate. Major complications, such as facial nerve palsy, serious local swelling, and necrosis, had occurred mostly in the ethanol group and rarely in the other groups. Because of the limited data, no further analysis of major complications was conducted. Our confidence in the comparisons and rankings was low. We found no verified inconsistency or publishing bias in the present study using the existing approaches. CONCLUSIONS Ethanol showed a significantly better response statistically compared with the other agents. However, ethanol had also resulted in the highest incidence of complications. Pingyangmycin showed the second-best response, best complete response, and a low rate of complications, respectively. Overall, pingyangmycin achieved excellent performance and balance in terms of the different outcomes. However, they could not be adequately recommended from the available data. More superior trials, especially randomized controlled trials, are needed in the future.
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Affiliation(s)
- Jiajie Cao
- Department of Stomatology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiajing Liu
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Xinyue Zhang
- Department of Stomatology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhiming Wang
- Department of Stomatology, Shengjing Hospital of China Medical University, Shenyang, China.
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Müller-Wille R, Wildgruber M, Wohlgemuth WA. Interventionelle Behandlungsoptionen bei vaskulären Malformationen. PHLEBOLOGIE 2022. [DOI: 10.1055/a-1808-2566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Klassifikation von vaskulären Malformationen Während Hämangiome zu den vaskulären Tumoren zählen, sind vaskuläre Malformationen angeboren und bilden sich von selbst nicht zurück. Sie werden nach der ISSVA-Klassifikation unterschieden.
Indikation zur Therapie Ziele der Therapie von Gefäßmalformationen sind die Linderung der Symptome, der Organerhalt und die Verhinderung von Krankheitsprogress und Komplikationen.
Nichtinvasive Therapieoptionen Die Kompressionstherapie sowie physiotherapeutische Maßnahmen zählen zu den wichtigsten konservativen Therapieoptionen.
Invasive Therapieoptionen Die chirurgische Resektion, die oberflächliche Lasertherapie und die interventionelle Therapie stellen die invasiven Therapieoptionen dar. Für die Behandlung symptomatischer Gefäßmalformationen stehen mittlerweile zahlreiche minimalinvasive interventionelle Verfahren zur Verfügung. Slow-Flow-Malformationen können relativ komplikationsarm mittels perkutaner Sklerotherapie behandelt werden, die zu einem zeitversetzten entzündlichen Verschluss der Läsion führt. Dysplastische Venen wie die Marginalvene können mittels endoluminaler Verfahren erfolgreich verödet werden. Die zumeist Katheter-gesteuerten Embolisationsverfahren mittels Flüssigembolisaten, Plugs und Coils erlauben den Verschluss von Fast-Flow-Gefäßmalformationen.
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Affiliation(s)
| | - Moritz Wildgruber
- Klinik und Poliklinik für Radiologie, Klinikum der Ludwig-Maximilians-Universität München
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Yu MW, Han YY, Wang Q, Wang M, Chen Y, Yuan SM. Treatment outcomes and effects of ethanol sclerotherapy on systemic coagulation profile of patients with venous malformation. Ann Vasc Surg 2022; 85:268-275. [PMID: 35395373 DOI: 10.1016/j.avsg.2022.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Venous malformations (VMs) and sclerotherapy may disrupt the normal systemic coagulation profile in individuals. This study investigated a correlation between the clinical efficacy of sclerotherapy in the treatment of VMs and the changes in coagulation indexes to provide data that will inform future application of this therapy. METHODS From September 2019 to September 2020, 61 patients were enrolled in this study to receive sclerotherapy with absolute alcohol. The clinical outcomes and the coagulation profile were assessed. RESULTS Sclerotherapy induced increasing in fibrin (original) degradation products (FDP), D-dimer (D-D). The changes in FDP and D-D level pre- and post-treatment were positively correlated with treatment outcomes. Moreover, repeated treatment with absolute alcohol may restore normal levels of FDP and D-D. CONCLUSIONS Upregulation of FDP and D-D levels after sclerotherapy results in good therapeutic outcomes. Therefore, monitoring changes in FDP and D-D levels in patients with VMs undergoing sclerotherapy may reflect the effects of sclerotherapy.
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Affiliation(s)
- Ming-Wei Yu
- Department of Plastic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yu-Yu Han
- Department of Plastic Surgery, Jinling Hospital, Jiangsu, China
| | - Qian Wang
- Department of Plastic Surgery, Jinling Hospital, Jiangsu, China
| | - Min Wang
- Department of Plastic Surgery, Jinling Hospital, Jiangsu, China
| | - Yong Chen
- Department of Plastic Surgery, Jinling Hospital, Jiangsu, China
| | - Si-Ming Yuan
- Department of Plastic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Plastic Surgery, Jinling Hospital, Jiangsu, China; Department of Plastic Surgery, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China.
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9
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Song D, Wu C, Guo L, Wang L, Li J, Zhang X. Efficacy and safety of DSA-guided percutaneous sclerotherapy for venous malformations of penile region in children. J Pediatr Surg 2021; 56:601-604. [PMID: 32854923 DOI: 10.1016/j.jpedsurg.2020.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the effectiveness and security of DSA-guided percutaneous sclerotherapy for venous malformations of penile region in children. METHODS A total of 9 cases children with penile venous malformations treated by DSA-guided percutaneous sclerotherapy from January 2017 to June 2018 were enrolled in this study. Local angiography was performed under DSA fluoroscopy, and the shape, extent and venous drainage of the tumor nest were judged. Then sclerosing agents (Pingyangmycin and Polidocanol) were selected according to the flow rate of angiography and treated by percutaneous injection under DSA monitoring. Imaging examination (MRI) was performed to evaluate clinical improvement. RESULTS A total of 26 interventional sclerotherapy sessions were performed in 9 children, with an average of (2.3±0.5) sessions per case. After a mean follow-up of 7.3 months, 6 cases were cured, and 3 cases were in basic remission. There were 9 cases of temporary edema secondary to the treatment site and 3 cases of mild pain. No serious complications such as ulceration, hemorrhage, infection and dysfunction occurred in any patients. CONCLUSION DSA-guided percutaneous sclerotherapy for venous malformations of penile region in children is safe and effective, does not affect the appearance and function of penis, and is worthy of clinical promotion. TYPE OF STUDY Treatment Study. LEVEL OF EVIDENCE Level IV, Case series with no comparison group.
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Affiliation(s)
- Dan Song
- Department of Vascular anomalies and Interventional Radiology, Qilu Children's Hospital of Shandong University, Room 23976, Jingshi Road, Jinan City, Shandong prov. China 250022
| | - Changhua Wu
- Department of Vascular anomalies and Interventional Radiology, Qilu Children's Hospital of Shandong University, Room 23976, Jingshi Road, Jinan City, Shandong prov. China 250022
| | - Lei Guo
- Department of Vascular anomalies and Interventional Radiology, Qilu Children's Hospital of Shandong University, Room 23976, Jingshi Road, Jinan City, Shandong prov. China 250022.
| | - Liang Wang
- Department of Vascular anomalies and Interventional Radiology, Qilu Children's Hospital of Shandong University, Room 23976, Jingshi Road, Jinan City, Shandong prov. China 250022
| | - Jing Li
- Department of Vascular anomalies and Interventional Radiology, Qilu Children's Hospital of Shandong University, Room 23976, Jingshi Road, Jinan City, Shandong prov. China 250022
| | - Xin Zhang
- Department of Vascular anomalies and Interventional Radiology, Qilu Children's Hospital of Shandong University, Room 23976, Jingshi Road, Jinan City, Shandong prov. China 250022
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10
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Effectiveness and Safety of Ethanol for the Treatment of Venous Malformations: A Meta-Analysis. Dermatol Surg 2020; 46:1514-1518. [DOI: 10.1097/dss.0000000000002389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Song D, Guo L, Sheng H, Li J, Wang L, Wu C, Wang C, Niu Y, Zeng Q. DSA-guided percutaneous sclerotherapy for children with oropharyngeal low-flow venous malformation. Exp Ther Med 2020; 19:3405-3410. [PMID: 32266040 DOI: 10.3892/etm.2020.8581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 11/05/2019] [Indexed: 11/06/2022] Open
Abstract
The present study investigated the efficacy and safety of digital subtraction angiography-guided 3% polidocanol foam sclerosing agent, as well as the combination of pingyangmycin and dexamethasone, for the treatment of children with oropharyngeal low-flow venous malformation. A total of 27 children with 35 lesions with oropharyngeal low-flow venous malformation were included. The subjects were randomly divided into Groups A (13 patients with 16 lesions, treated with 3% polidocanol foam sclerosing agent) and B (14 patients with 19 lesions, treated with pingyangmycin + dexamethasone), respectively. The clinical efficacies and adverse reactions were analyzed and compared between these two groups. The average number of treatment times for Group A was 2.45±0.6, with an efficacy rate of 87.50%, while the average number of treatment times for Group B was 2.07±0.4, with an efficacy rate of 84.21%. No significant difference was found in the average treatment times or efficacy rates between Groups A and B. In addition, the adverse reaction incidence for Groups A and B were 38.46 and 14.29%, respectively, with statistically significant differences between these two groups. The combination of pingyangmycin and dexamethasone was safe and effective in treating children with oropharyngeal low-flow venous malformation, with fewer adverse reactions and is worthy of clinical promotion.
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Affiliation(s)
- Dan Song
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.,Department of Vascular Anomalies and Interventional Radiology, Jinan, Shandong 250022, P.R. China
| | - Lei Guo
- Department of Vascular Anomalies and Interventional Radiology, Jinan, Shandong 250022, P.R. China
| | - Hui Sheng
- Department of Radiology, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, P.R. China
| | - Jing Li
- Department of Vascular Anomalies and Interventional Radiology, Jinan, Shandong 250022, P.R. China
| | - Liang Wang
- Department of Vascular Anomalies and Interventional Radiology, Jinan, Shandong 250022, P.R. China
| | - Changhua Wu
- Department of Vascular Anomalies and Interventional Radiology, Jinan, Shandong 250022, P.R. China
| | - Changfeng Wang
- Department of Vascular Anomalies and Interventional Radiology, Jinan, Shandong 250022, P.R. China
| | - Yanli Niu
- Department of Vascular Anomalies and Interventional Radiology, Jinan, Shandong 250022, P.R. China
| | - Qingshi Zeng
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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The Efficacy of Absolute Ethanol and Polidocanol in the Treatment of Venous Malformations. J Craniofac Surg 2020; 31:e272-e275. [PMID: 32068725 DOI: 10.1097/scs.0000000000006268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Using meta-analysis to evaluate the efficacy of absolute ethanol and polidocanol in the treatment of venous malformations. MATERIALS AND METHODS A systematic search of the English literature was conducted in April 2019 including PubMed, Embase and Web of Science. Article selection was based on preset criteria. The included literature was scored on the MINORS scale, and the meta-analysis and the forest plot were made using the R 3.5.1 software for efficiency. RESULTS Ten articles were included in the meta-analysis. Absolute ethanol response rate ranged between 79% and 92% with a pooled rate of 85%, and polidocanol response rate ranged between 63% and 94% with a pooled rate of 77%. DISCUSSION Although sclerotherapy is effective in most studies, a large number of randomized controlled trials are still needed to confirm the best treatment options at different sites.
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