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Guzelbey T, Cingoz M, Erdim C, Mutlu IN, Kılıckesmez O. Effectiveness of polidocanol sclerotherapy in alleviating symptoms in patients with venous malformations. J Vasc Surg Venous Lymphat Disord 2024; 12:101698. [PMID: 37890587 DOI: 10.1016/j.jvsv.2023.101698] [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: 07/24/2023] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE The objective of this study was to retrospectively evaluate the effectiveness of polidocanol in managing pain, swelling, functional limiting and cosmetic disorders in patients with venous malformations (VMs). METHODS This retrospective study included patients who underwent sclerotherapy with polidocanol for VMs between 2020 and 2022. Patient records, imaging findings, and evaluation questionnaires used in the preprocedure and follow-up phases were reviewed. After sclerotherapy, patients were followed up at 1, 2, 3, and 6 months. During these visits, the previously used 11-point verbal numerical rating scale (from 0 [no pain] to 10 [worst pain thinkable]) was used to evaluate the severity of symptoms such as pain, swelling, cosmetic discomfort, and functional limitation, and patients were asked to report the number of days per week they experienced these symptoms owing to the VM. RESULTS A total of 194 sclerotherapy procedures (mean, 1.6 ± 0.3 procedures) in 84 patients (55 female and 29 male patients; mean age, 22.45 ± 11.83 years) were conducted. The majority of these malformations (81%, or 68 patients) were located in the extremities. We found a significant decrease in pain, swelling, functional limitation, cosmetic appearance, and number of painful days between all time points, except for the comparison between months 3 and 6 (P < .001) CONCLUSIONS: Polidocanol sclerotherapy is a safe and effective treatment for VMs that significantly decreases patient complaints and has a very low complication rate. Particularly, following patients at short intervals and administering additional sclerotherapy sessions when necessary will significantly increase patient satisfaction.
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Affiliation(s)
- Tevfik Guzelbey
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Mehmet Cingoz
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Cagri Erdim
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ilhan Nahit Mutlu
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ozgur Kılıckesmez
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Sporns PB, Psychogios M, Blackham K, Zech C, Wildgruber M, Takes M. Ultrasonography-guided radiofrequency ablation of vascular malformations-The moving shot technique. Front Med (Lausanne) 2024; 10:1345904. [PMID: 38283038 PMCID: PMC10811020 DOI: 10.3389/fmed.2023.1345904] [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: 11/28/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
Purpose To describe a novel ultrasound-guided technique for percutaneous radiofrequency ablation of vascular malformations-the "moving shot technique." Methods Preliminary observational cohort study, conducted from June 1, 2019, to January 31, 2021, including all consecutive patients diagnosed with vascular malformations who were treated with ultrasound-guided radiofrequency ablation using the moving shot technique. Only patients who had undergone at least one unsuccessful previous treatment were included (sclerotherapy with ethanol/aethoxysklerol or embolization/surgery). Results Eight patients with a median age of 22 years (interquartile range, 13-31) were included. Patients had different vascular malformations consisting of 1 arteriovenous malformation, 4 venous malformations, and 1 each a mixed venous-lymphatic malformation, a glomuvenous malformation and a FAVA (fibroadipose vascular anomaly). Malformations were located at the limbs in 5 patients (62.5%), the subcutaneous/intramuscular tissue of the body in 2 patients (25%) and at the chin in 1 patient (12.5%). Clinical symptoms were pain in 8 patients (100%), swelling in 6 patients (75%), and partial immobility in 4 patients (50%). All patients showed an improvement of clinical symptoms after treatment with 7 (87.5%) being completely asymptomatic and 1 (12.5%) showing improvement of immobility and pain. No procedural complications, such as nerve damage or skin burns occurred. Conclusion The moving shot technique using ultrasonography-guided radiofrequency ablation is a promising technique for the interventional treatment of vascular malformations and should be validated in multicenter-approaches.
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Affiliation(s)
- Peter B. Sporns
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Radiology and Neuroradiology, Stadtspital Zürich, Zürich, Switzerland
| | - Marios Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristine Blackham
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Zech
- Department of Interventional Radiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Moritz Wildgruber
- Department of Radiology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Martin Takes
- Department of Interventional Radiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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Shen WW, Xiao XD, Xia YC, Fu P, Ma JX, Tan S. Application of epinephrine mixed with local anaesthetics in injection sclerotherapy of early-stage arteriovenous malformation. Eur J Radiol 2023; 168:111073. [PMID: 37741058 DOI: 10.1016/j.ejrad.2023.111073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE To explore the effect of epinephrine mixed with local anaesthetic injection on blood flow control in early stage arteriovenous malformation (AVM) and explore suitable cases. METHODS Twenty-five patients with early stage (Schobinger clinical stage I/II) AVM were selected between September 2019 and March 2022. Local anaesthetics containing epinephrine were injected around the nourishing artery and into lesions under the guidance of ultrasound, and the blood flow distribution grade in the lesions as well as the changes in diameter, peak systolic velocity (PSV), and resistance index (RI) of the nourishing arteries and vessels in the lesions were observed to determine the type of AVM suitable for epinephrine injection. After blood flow was controlled, sclerosant agents were injected into the lesions for sclerotherapy. RESULTS After local injection of the epinephrine mixture, the blood flow distribution in the lesion decreased by one to three grades; the diameter and PSV also decreased, while RI increased. There were statistically significant differences before and after the injection (P < 0.05). The efficacy of the injection was 80% (20/25), especially in patients with lesion vessels, a nourishing artery lumen diameter <2 mm, and a PSV <40 cm/s in the lesion. Patients with Schobinger clinical stage I AWM showed good results. CONCLUSIONS Local anaesthetics containing epinephrine play a positive role in reducing the distribution and velocity of blood flow in patients with AVM lesions and may be used as an experimental method for the treatment of AVM, which is beneficial for sclerotherapy in patients with early AVM.
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Affiliation(s)
- Wei-Wei Shen
- Department of Ultrasound, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing 100191, China
| | - Xiao-Di Xiao
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing 100191, China
| | - You-Chen Xia
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing 100191, China
| | - Peng Fu
- Department of Ultrasound, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing 100191, China
| | - Jian-Xun Ma
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing 100191, China
| | - Shi Tan
- Department of Ultrasound, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing 100191, China.
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Waters MJ, Hinshelwood J, Chaudry MI. Interventional Treatment of Vascular Anomalies. Dermatol Clin 2022; 40:489-497. [DOI: 10.1016/j.det.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kronfli AP, McLaughlin CJ, Moroco AE, Grant CN. Lymphatic malformations: a 20-year single institution experience. Pediatr Surg Int 2021; 37:783-790. [PMID: 33586010 DOI: 10.1007/s00383-021-04859-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Lymphatic malformations (LMs) are congenital abnormalities which result from disturbances in the embryologic development of the lymphatic system. We sought to determine the characteristics and treatment patterns for LMs in a rural setting, and the effect of a specialized vascular malformations clinic on triage and follow-up. METHODS This is a retrospective cohort study at a single tertiary care institution. Sixty-two patients were identified; chart review was completed to obtain demographic, surgery/sclerotherapy session and follow-up information. RESULTS The head/neck region was the most predominant LM location (N = 26, 41.9%), followed by trunk (N = 16, 25.8%), extremity (N = 11, 17.7%), and intraabdominal/retroperitoneal (N = 7, 11.3%). Twenty-eight patients were managed non-surgically, while 21, 7 and 6 patients required surgery, sclerotherapy, or both. Head/neck LMs were the most likely to recur (73%, p = 0.028). Patients seen in specialty clinic had similar duration of follow-up and time to intervention, but were more often below 1 year of age (p = 0.030). Average LM volume among patients with available imaging was much larger in those referred to specialty clinic (73.2 cm3 versus 14.8 cm3, p = 0.022). CONCLUSION Our experience reiterates not only the wide variety of clinical presentations of lymphatic malformations, but also demonstrates the necessity of multiple subspecialties and their collaboration to achieve prompt and efficacious treatment.
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Affiliation(s)
- Anthony P Kronfli
- Department of Surgery, Milton S. Hershey Medical Center, The Pennsylvania State University, 500 University Drive, P. O. Box 850, Hershey, PA, 17033-0850, USA.
| | - Christopher J McLaughlin
- Department of Surgery, Milton S. Hershey Medical Center, The Pennsylvania State University, 500 University Drive, P. O. Box 850, Hershey, PA, 17033-0850, USA
| | | | - Christa N Grant
- Department of Surgery, Milton S. Hershey Medical Center, The Pennsylvania State University, 500 University Drive, P. O. Box 850, Hershey, PA, 17033-0850, USA
- Penn State College of Medicine, Hershey, PA, USA
- Division of Pediatric Surgery, Penn State Children's Hospital, Hershey, PA, USA
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Keystone Flap Reconstruction after Resection of a Large Paraspinal Venous Malformation in an Infant. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3141. [PMID: 33173671 PMCID: PMC7647660 DOI: 10.1097/gox.0000000000003141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022]
Abstract
The keystone flap is well known to plastic surgeons and is frequently utilized for its ease of implementation, limited donor site morbidity, and favorable aesthetic outcomes. Although keystone flaps have been described in reconstruction of myelomeningocele defects, there have been no reports of their application to infants with large vascular malformations. This case illustrates the utilization of a keystone flap in reconstruction of a large posterior trunk defect that resulted from excision of a massive venous malformation in an 8-week-old infant with blue rubber bleb nevus syndrome. The patient’s consumptive coagulopathy resolved in the early postoperative period, and long-term follow-up demonstrated a favorable aesthetic outcome. This case reiterates the power and versatility of the keystone flap technique through its novel application to an infant with a life-threatening venous malformation on the posterior trunk.
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Garcia-Vilariño E, Thione A, Salmeron-Gonzalez E, Sanchez-Garcia A, Perez-Garcia A. Simultaneous Opponensplasty and Free Gracilis Muscle Flap for Thenar Reconstruction after Arteriovenous Malformation Resection. Indian J Plast Surg 2020; 53:147-149. [PMID: 32367932 PMCID: PMC7192698 DOI: 10.1055/s-0040-1709958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
We report the case of a thenar eminence arteriovenous malformation presenting with continuous growth and pain that was treated with surgical excision after embolization. Extracapsular resection compromised thenar muscles which function was reconstructed with extensor indicis proprius transfer for opposition and abduction, and neurotized free gracilis muscle flap for opposition and adduction, as well as thenar eminence reconstruction.
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Affiliation(s)
- Elena Garcia-Vilariño
- Department of Plastic Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alessandro Thione
- Department of Plastic Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Alberto Sanchez-Garcia
- Department of Plastic Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alberto Perez-Garcia
- Department of Plastic Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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