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Zhang J, Nie Q, Ma B, Ye Z, Fan X. Embolization and sclerotherapy for head and neck arteriovenous malformations with uncontrollable torrential bleeding. J Vasc Surg Cases Innov Tech 2024; 10:101597. [PMID: 39296370 PMCID: PMC11407922 DOI: 10.1016/j.jvscit.2024.101597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/22/2024] [Indexed: 09/21/2024] Open
Abstract
Torrential bleeding is a rare and life-threatening complication of arteriovenous malformations (AVMs). We report a case of head and neck AVMs present with uncontrollable torrential bleeding, which was treated with embolization and sclerotherapy. Then we explored the potential multidisciplinary handling of the procedure for this kind of case. A 25-year-old female patient was born with right face and head AVMs. The AVMs had grown gradually and ruptured spontaneously with uncontrollable torrential bleeding before admission. Emergent direct hemostasis, nasotracheal intubation, and staged embolization and sclerotherapy were carried out on this patient. Finally, the bleeding stopped and the wound healed successfully. Embolization and sclerotherapy are effective for head and neck AVMs with uncontrollable torrential bleeding. Multidisciplinary collaboration is needed to achieve a good outcome.
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Affiliation(s)
- Jianbin Zhang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Qiangqiang Nie
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Bo Ma
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhidong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xueqiang Fan
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
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Wang Y, Liu D, Xiao L, Zuo S, Ren T, Dong C, Li T. Effect of interventional embolization based on absolute ethanol for peripheral arteriovenous malformations. Biotechnol Genet Eng Rev 2024; 40:4899-4910. [PMID: 37248733 DOI: 10.1080/02648725.2023.2217617] [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: 02/20/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Interventional embolization schedules based on absolute ethanol are usually used for peripheral arteriovenous malformations (PAVMs), and clinicians often choose the scheme according to the classification. AIM To evaluate different interventional embolization schedules based on absolute ethanol for PAVMs. METHODS A retrospective study was performed of 165 patients with PAVMs treated with interventional embolization based on absolute ethanol in Henan Provincial People's Hospital from January 2018 to May 2021. PAVMs were classified as type II (n = 67), type III (n = 81) and type IV (n = 17) according to the Yakes classification system, including 123 maxillofacial, 13 trunk and 29 limbs. Effectiveness of embolization was based on PAVM devascularization on angiography: 100% (total), 90%~99% (near-total), 70%~90% (substantial), 30%~70% (partial) and 0%~30% (failure). RESULTS PAVMs were classified as type II (n = 67), type III (n = 81) and type IV (n = 17) according to the Yakes classification system, including 123 maxillofacial (74.55%), 13 trunk (7.88%) and 29 limbs (17.58%). There are statistical differences in the angiographic outcomes among different Yakes classification and between different methods (P < 0.05), and there was a statistical difference in the failure rates among different Yakes classification (P < 0.05). CONCLUSIONS PAVMs occur maxillofacial usually, and Type II can achieve better effect by spring coil and absolute ethanol, while Type III and Type IV have no ideal effect by Pingyangmycin + iodized oil + PVA + absolute ethanol and spring coil + absolute ethanol, respectively. Both the two happen to be complications, and wound accounts the highest.
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Affiliation(s)
- Yanlin Wang
- Department of Hemangioma and Vascular Malformation, Zhengzhou University People's Hospital; Henan Provincial People's Hospital, Zhengzhou, China
| | - Dakan Liu
- Department of Hemangioma and Vascular Malformation, Zhengzhou University People's Hospital; Henan Provincial People's Hospital, Zhengzhou, China
| | - Li Xiao
- Department of Hemangioma and Vascular Malformation, Zhengzhou University People's Hospital; Henan Provincial People's Hospital, Zhengzhou, China
| | - Song Zuo
- Department of Hemangioma and Vascular Malformation, Zhengzhou University People's Hospital; Henan Provincial People's Hospital, Zhengzhou, China
| | - Tengfei Ren
- Department of Hemangioma and Vascular Malformation, Zhengzhou University People's Hospital; Henan Provincial People's Hospital, Zhengzhou, China
| | - Changxian Dong
- Department of Hemangioma and Vascular Malformation, Zhengzhou University People's Hospital; Henan Provincial People's Hospital, Zhengzhou, China
| | - Tianxiao Li
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
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Lee YD, Lee SY, Kim DI, Park KB, Yang SS, Park YJ, Lim SY, Hwang JH, Yoo KH, Ju HY, Do YS. Multidisciplinary approach to hand arteriovenous malformations: treatment strategies and clinical outcomes - insights from a 25-year experience at a single vascular anomalies center. J Vasc Surg Venous Lymphat Disord 2024:101964. [PMID: 39209025 DOI: 10.1016/j.jvsv.2024.101964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/15/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Hand arteriovenous malformations (AVMs) are extremely difficult to manage for their functional importance and cosmetic disfiguration. A single-center retrospective study was conducted to identify long-term outcomes of multidisciplinary team management of hand AVMs. METHODS Institutional review board approved this retrospective study. Multidisciplinary vascular anomalies center data was reviewed from 1995 to 2023. Patient demographics, Schobinger's AVM stage, sclerotherapy details, surgical history, and adverse events after sclerotherapy were reviewed. RESULTS A total of 150 patients with hand AVMs visited our hospital from 1995 to 2023, with a mean age of 33 years (range, 1-75 years), and 91 were females. Forty-four patients were Schobinger stage II, and 106 were stage III. Sclerotherapy was performed on 101 patients (67%) with 320 sessions. Angiographic devascularization rates after sclerotherapy were: 16 with 100%, 30 with over 90%, 34 with 50% to 90%, 15 with 0% to 50%, and six showed aggravation. Sclerotherapy-related adverse events occurred in 123 of 320 sessions (39%), with 112 minor and 11 major events. Fifteen patients (15%) eventually underwent amputation surgery a mean of 1618 days after sclerotherapy for necrosis (n = 3) and delayed complications (n = 12). Thirteen patients (9%) underwent primary surgical amputation for ulcers or bleeding (all Schobinger stage III). Thirty-six patients (24%) were followed without any procedure. CONCLUSIONS Multidisciplinary management of hand AVMs shows varied long-term outcomes. Although sclerotherapy is effective for many patients, it carries a significant risk of adverse events. The necessity for amputation in some cases highlights the severity of advanced AVMs and the need for individualized treatment approaches.
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Affiliation(s)
- Yong Deok Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Yub Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwang Bo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Shin Seok Yang
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So Young Lim
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hye Hwang
- Department of Physical Medicine & Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keon-Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Young Ju
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Soo Do
- Department of Radiology, Hallym University Sacred Heart Hospital, College of Medicine, Anyang, Republic of Korea
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Venkat N, Saraiya A, Ali MI, Jenkins M, Tjoumakaris S, Abai B. Staged endovascular and open surgical approach for treatment of a giant left upper back arteriovenous malformation. J Vasc Surg Cases Innov Tech 2024; 10:101528. [PMID: 39027724 PMCID: PMC11255887 DOI: 10.1016/j.jvscit.2024.101528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/09/2024] [Indexed: 07/20/2024] Open
Abstract
We present a case of a symptomatic, giant, left upper back arteriovenous malformation that was treated through a staged endovascular and open approach. Through a series of embolizations, followed by resection, we were able to preserve the limb and upper back neurovascular supply, demonstrating an approach to preserve sensation and function and improving quality of life.
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Affiliation(s)
- Nitya Venkat
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Avinash Saraiya
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - M. Irfan Ali
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Matthew Jenkins
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | | | - Babak Abai
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA
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Shen YC, Wang DM, Yang XT, Wang ZF, Wen MZ, Han YF, Zheng LZ, Di RY, Jiang CY, Wang JB, You JX, Zhang LM, Su LX, Fan XD. Novel radiopaque ethanol injection: physicochemical properties, animal experiments, and clinical application in vascular malformations. Mil Med Res 2024; 11:39. [PMID: 38902798 PMCID: PMC11188249 DOI: 10.1186/s40779-024-00542-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 06/02/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Despite the efficacy of absolute ethanol (EtOH), its radiolucency introduces several risks in interventional therapy for treating vascular malformations. This study aims to develop a novel radiopaque ethanol injection (REI) to address this issue. METHODS Iopromide is mixed with ethanol to achieve radiopacity and improve the physicochemical properties of the solution. Overall, 82 male New Zealand white rabbits are selected for in vivo radiopacity testing, peripheral vein sclerosis [animals were divided into the following 5 groups (n = 6): negative control (NC, saline, 0.250 ml/kg), positive control (EtOH, 0.250 ml/kg), low-dose REI (L-D REI, 0.125 ml/kg), moderate-dose REI (M-D REI, 0.250 ml/kg), and high-dose REI (H-D REI 0.375 ml/kg)], pharmacokinetic analyses (the blood sample was harvested before injection, 5 min, 10 min, 20 min, 40 min, 1 h, 2 h, 4 h, and 8 h after injection in peripheral vein sclerosis experiment), peripheral artery embolization [animals were divided into the following 5 groups (n = 3): NC (saline, 0.250 ml/kg), positive control (EtOH, 0.250 ml/kg), L-D REI (0.125 ml/kg), M-D REI (0.250 ml/kg), and H-D REI (0.375 ml/kg)], kidney transcatheter arterial embolization [animals were divided into the following 4 groups (n = 3): positive control (EtOH, 0.250 ml/kg), L-D REI (0.125 ml/kg), M-D REI (0.250 ml/kg), and H-D REI (0.375 ml/kg); each healthy kidney was injected with saline as negative control], and biosafety evaluations [animals were divided into the following 5 groups (n = 3): NC (0.250 ml/kg), high-dose EtOH (0.375 ml/kg), L-D REI (0.125 ml/kg), M-D REI (0.250 ml/kg), and H-D REI (0.375 ml/kg)]. Then, a prospective cohort study involving 6 patients with peripheral venous malformations (VMs) is performed to explore the clinical safety and effectiveness of REI. From Jun 1, 2023 to August 31, 2023, 6 patients [age: (33.3 ± 17.2) years] with lingual VMs received sclerotherapy of REI and 2-month follow-up. Adverse events and serious adverse events were evaluated, whereas the efficacy of REI was determined by both the traceability of the REI under DSA throughout the entire injection and the therapeutic effect 2 months after a single injection. RESULTS The REI contains 81.4% ethanol (v/v) and 111.3 mg/ml iodine, which can be traced throughout the injection in the animals and patients. The REI also exerts a similar effect as EtOH on peripheral venous sclerosis, peripheral arterial embolization, and renal embolization. Furthermore, the REI can be metabolized at a similar rate compared to EtOH and Ultravist® and did not cause injury to the animals' heart, liver, spleen, lungs, kidneys and brain. No REI-related adverse effects have occurred during sclerotherapy of VMs, and 4/6 patients (66.7%) have achieved complete response at follow-up. CONCLUSION In conclusion, REI is safe, exerts therapeutic effects, and compensates for the radiolucency of EtOH in treating VMs. TRIAL REGISTRATION The clinical trial was registered as No. ChiCTR2300071751 on May 24 2023.
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Affiliation(s)
- Yu-Chen Shen
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - De-Ming Wang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xi-Tao Yang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Zhen-Feng Wang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Ming-Zhe Wen
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yi-Feng Han
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Lian-Zhou Zheng
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Ruo-Yu Di
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Chun-Yu Jiang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jing-Bing Wang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jian-Xiong You
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Li-Ming Zhang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Li-Xin Su
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Xin-Dong Fan
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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Shiraishi M, Narushima M, Banda CH, Moriwaki Y, Fujisawa K, Nakajima M, Yamagata K, Kondo C, Okada Y, Mitsui K, Hashimoto K, Danno K, Hosomi K, Ishiura R, Kurita M, Okazaki M. Treatment Effectiveness and Recurrence of Extracranial Arteriovenous Malformations Following Surgical Operations: A 15-Year Retrospective Cohort Study. Ann Plast Surg 2024; 92:688-693. [PMID: 38747560 DOI: 10.1097/sap.0000000000003924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND At present, there is no golden standard for treatment of extracranial arteriovenous malformations (AVMs) and recurrence remains a major challenge with limited available evidence on the associated factors. This study aimed to evaluate the effectiveness of surgical treatment options, in terms of size reduction, symptoms, and early recurrence in patients treated surgically for AVMs. METHODS A retrospective cohort study was conducted to evaluate patients with AVMs following surgical treatment in 2 centers from 2005 to 2020. Posttreatment lesion size and symptoms, as well as recurrence, were assessed. Multiple regression analysis was performed to identify factors associated with recurrence. RESULTS Forty-four surgical treatment cases in 31 patients were assessed with a mean follow-up duration period of 67.9 ± 39.5 months. Treatment included total resection in 26 cases (59.1%) and partial resection 18 (40.9%), with free flap coverage used in 19 cases (43.2%). No acute exacerbation following treatment was observed in our cohort. Total resection significantly reduced posttreatment lesion size ( P < 0.001), symptoms ( P < 0.001), and recurrence (20.0%, P = 0.03). The recurrence rate was significantly higher after partial resection (73.7%, P = 0.03). Total resection was identified as an associated factor for significantly reduced AVM recurrence (odds ratio: 0.12; 95% confidence interval: 0.03, 0.52). However, the use of free flaps did not significantly reduce recurrence, post treatment size or improve AVM symptoms. CONCLUSIONS Total resection is the optimal treatment for AVMs. Free flaps are useful in covering large defects but the regulative effect of free flap remains controversial.
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Affiliation(s)
| | - Mitsunaga Narushima
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu
| | | | - Yuta Moriwaki
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kou Fujisawa
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Mayuri Nakajima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kosuke Yamagata
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu
| | - Chizuki Kondo
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu
| | | | - Kohei Mitsui
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu
| | - Kohei Hashimoto
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu
| | - Kanako Danno
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu
| | - Kento Hosomi
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu
| | | | | | - Mutsumi Okazaki
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Shen Y, Wang D, Fan X, Zheng L, Su L, Yang X. Ethanol embolization of arteriovenous malformations in the buttock: ten-year experiences in diagnoses and treatment options. Orphanet J Rare Dis 2024; 19:195. [PMID: 38741122 DOI: 10.1186/s13023-024-03205-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 05/05/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Clinically, arteriovenous malformations in the buttocks (bAVMs) are extremely rare. Our study aimed to evaluate the efficacy and safety of ethanol embolotherapy in managing bAVMs. RESULTS A total of 32 patients with bAVMs (14 females and 18 males) from 2012 to 2021 were included in this study. All patients underwent complete clinical and imaging examinations. Further, the AVMs lesions were analyzed according to Schöbinger staging and Yakes classification. Each patient had undergone a multistage ethanol embolization. The amelioration of clinical symptoms and devascularization on angiography were evaluated at regular follow-ups. In the present cohort, the 11-20 age group had the most patients (15/32; 46.88%). A total of 124 embolization procedures were performed (average 3.88 procedures per patient), and the average dose of absolute ethanol was 18.96 mL per procedure. Thirteen patients with dominant draining veins underwent additional coil deployment before ethanol embolization (13/32; 40.63%). During follow-ups, clinical improvement was found in 23 of 27 who presented with a pulsating mass (85.19%), 17 of 20 with abnormal local skin temperature (85%), 5 of 6 with bleeding (83.33%), and 5 of 5 patients treated for pain (100%). More than 75% angiographic devascularization was achieved in 18 patients (18/32; 56.25%). Finally, 12 out of 13 patients (92.31%) reduced from Schöbinger Stage III to a lower grade, and ten patients exhibited a complete response (10/32; 31.23%). There was a single serious complication of local necrosis, while neither paranesthesia nor infection was observed postoperatively. CONCLUSIONS Ethanol embolization assisted with coils can treat bAVMs effectively and safely. The Yakes classification contributed to the optimal ethanol embolotherapy of bAVMs.
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Affiliation(s)
- Yuchen Shen
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Deming Wang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Xindong Fan
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Lianzhou Zheng
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Lixin Su
- Fengcheng Hospital of Feng Xian District, Fengcheng Branch, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201413, China.
| | - Xitao Yang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai, 200011, China.
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Li R, Skeik N. A rare case of Bannayan-Riley-Ruvalcaba syndrome with concurrent arteriovenous malformation. J Vasc Surg Cases Innov Tech 2024; 10:101428. [PMID: 38379611 PMCID: PMC10877428 DOI: 10.1016/j.jvscit.2024.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/26/2023] [Indexed: 02/22/2024] Open
Abstract
Bannayan-Riley-Ruvalcaba syndrome (BRRS) is a congenital, autosomal-dominant disorder characterized by a triad of macrocephaly, lipomatosis, and pigmentation of the glans penis. The symptoms of this rare syndrome vary greatly and include multiple hamartomatous polyps, macrocephaly, increased birth weight, developmental delay, and intellectual disability. Vascular abnormalities, including arteriovenous malformations (AVMs), have rarely been reported as part of the vascular manifestations associated with BRRS. Congenital AVMs can rarely progress, resulting in limb- or life-threatening complications. We present the case of a young man with BRRS diagnosed in childhood and presenting with three AVMs involving the right upper extremity and chest. We also provide a brief literature summary of reported cases of BRRS with AVMs. Our paper highlights the importance of recognizing and understanding the vascular manifestations in patients with BRRS. Knowledge of the association between BRRS and AVMs is crucial for guiding patient diagnosis and management, optimizing treatment strategies, and improving overall patient outcomes.
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Affiliation(s)
- Rina Li
- Minneapolis Heart Institute Foundation, Minneapolis, MN
| | - Nedaa Skeik
- Division of Vascular Medicine, Thrombophilia and Anticoagulation Clinic, Vein Center, Abbott Northwestern Hospital/Minneapolis Heart Institute, Minneapolis, MN
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Giurazza F, Corvino F, Pane F, Di Serafino M, Niola R. Combined DSA- and US-guided management of acute bleeding: effectiveness of percutaneous glue embolization in six cases. J Ultrasound 2024; 27:179-184. [PMID: 37162728 PMCID: PMC10908745 DOI: 10.1007/s40477-023-00785-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/14/2023] [Indexed: 05/11/2023] Open
Abstract
AIMS This study aims to report on safety and effectiveness of glue embolization of acute hemorrhages performed by US-guided percutaneous direct puncture, in patients where the standard endovascular approach is technically unfavourable. METHODS In this single center retrospective analysis, patients affected by traumatic or non traumatic acute hemorrhages were treated with glue embolization technically performed by US-guided direct puncture. Patients suffered from active bleeding detected at contrast-enhanced Computer Tomography and confirmed at Digital Subtracted Arteriography, with concomitant hemoglobin drop and blood pressure reduction. Six patients were reviewed; hemorrhages occurred in liver parenchima (1), gallbladder (1) and lower limbs (4). Bleedings etiologies were post-traumatic (5) and inflammatory (1); four had extraluminal blushes while 2 were pseudoaneurysms. In five cases (4 limbs and 1 hepatic bleedings) the direct-puncture approach was adopted because of technically unfavourable vascular anatomy for superselective embolization; in one case (cystic artery pseudoaneurysm), an endovascular embolization would entail a high risk of gallbladder ischemia because of its terminal arterial supply. Technical success was defined disappearance of bleeding signs at last arteriography; clinical success was considered stabilization and/or improvement of hemoglobin values and arterial pressure without additional interventions. RESULTS Both technical and clinical successes were obtained in 100% of the cases without major complications. No needle occlusion occurred during glue injection. CONCLUSIONS In this study percutaneous US-guided embolization by direct puncture was a safe and effective approach to manage acute bleedings; it could be considered as an alternative in patients with unfavourable vascular anatomy for the standard catheter-directed endovascular embolization.
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Affiliation(s)
- Francesco Giurazza
- Department of Vascular and Interventional Radiology, Cardarelli Hopistal, Via Cardarelli 9, 80131, Naples, Italy.
| | - Fabio Corvino
- Department of Vascular and Interventional Radiology, Cardarelli Hopistal, Via Cardarelli 9, 80131, Naples, Italy
| | - Francesco Pane
- Department of Vascular and Interventional Radiology, Cardarelli Hopistal, Via Cardarelli 9, 80131, Naples, Italy
| | - Marco Di Serafino
- Department of Radiology, Cardarelli Hopistal, Via Cardarelli 9, 80131, Naples, Italy
| | - Raffaella Niola
- Department of Vascular and Interventional Radiology, Cardarelli Hopistal, Via Cardarelli 9, 80131, Naples, Italy
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Jiang C, You J, Wang J. Treatment of a Pathologic Radial Fracture Associated with an Arteriovenous Malformation Using Sclerotherapy and Cementoplasty. J Vasc Interv Radiol 2024; 35:318-320.e2. [PMID: 37806349 DOI: 10.1016/j.jvir.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/20/2023] [Accepted: 09/28/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Chunyu Jiang
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai 200233, People's Republic of China
| | - Jianxiong You
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai 200233, People's Republic of China
| | - Jingbing Wang
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai 200233, People's Republic of China.
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Salimi J, Atieh A, Ftouni Y. Calf arteriovenous malformation presenting as an iliac artery aneurysm: A case report. Int J Surg Case Rep 2023; 113:109082. [PMID: 37988993 PMCID: PMC10667722 DOI: 10.1016/j.ijscr.2023.109082] [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: 10/20/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Arteriovenous malformations (AVMs) are abnormal connections between arteries and veins. Common signs of AVMs include a pulsating mass, pain, ulceration, bleeding, and tissue necrosis. This case report discusses a rare presentation of an iliac artery aneurysm in a patient with an extensive calf AVM. CASE PRESENTATION A 35-year-old male presented with a pulsatile mass in the abdomen, along with symptoms of chronic venous insufficiency in the lower limb. He had undergone multiple surgeries for varicose veins in the past. Initially, external iliac artery aneurysm was diagnosed. Further assessment revealed the presence of an AVM in the calf. After multiple unsuccessful endovascular interventions, amputation was recommended. However, the patient opted for conservative management. CLINICAL DISCUSSION AVMs are vascular malformations that are present from birth. Angiography is considered the gold standard for confirming the diagnosis of AVMs. As there is no consensus on the best treatment for AVMs, a multidisciplinary approach is recommended on a case-by-case basis. Delaying treatment can lead to serious complications and increase morbidity and mortality. Treating extensive AVMs that involve the entire extremity can be particularly challenging and often result in poor outcomes. CONCLUSION The presence of varicose veins at a young age may indicate an underlying AVM. AVM can manifest in various ways, including arterial aneurysms. In severe cases, extensive AVMs may require limb amputation when other treatments fail.
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Affiliation(s)
- Javad Salimi
- Vascular and Endovascular Surgery Department, Sina Hospital, Tehran University of Medical Science, Iran.
| | - Ammar Atieh
- Vascular and Endovascular Surgery Department, Sina Hospital, Tehran University of Medical Science, Iran.
| | - Yaser Ftouni
- Vascular and Endovascular Surgery Department, Sina Hospital, Tehran University of Medical Science, Iran
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12
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Zhou J, Hua C, Yang X, Jia H, Yu W, Jin Y, Lin X. Ethanol Embolotherapy for Cutaneous Erythema of High-Flow Vascular Malformations in the Head and Neck. Dermatol Surg 2023; 49:1017-1022. [PMID: 37669082 DOI: 10.1097/dss.0000000000003923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
BACKGROUND Cutaneous erythema is one of the most common signs of arteriovenous malformations (AVMs) in the head and neck region, influencing aesthetic appearance. Surgical resection of AVMs may lead to cicatrization of the skin or aggravation of the lesion. Laser treatment, although effective in improving superficial vascular lesions, cannot prevent deep AVMs from further development. OBJECTIVE The authors propose an absolute ethanol embolization therapy that can effectively and safely eradicate the nidus with a favorable aesthetic outcome. METHODS The authors conducted a retrospective observational study of 14 AVM patients with distinct cutaneous erythema in the head and neck region undergoing embolotherapy in a single primary care center. Symptoms before and after treatment, complications, and degree of devascularization were recorded and assessed. Changes in cutaneous redness were evaluated using a previously reported quantitative measurement. RESULTS Complete symptomatic relief was observed in 5 patients, and major improvement was observed in 9 patients. The mean Δ a * value of the color change had a significant reduction of 6.50 ± 4.04, p < .001, indicating a remarkable remission of cutaneous erythema. CONCLUSION Ethanol embolization is an effective and safe treatment for head and neck AVMs with excellent aesthetic outcomes and might become a potential treatment method for other superficial vascular anomalies.
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Affiliation(s)
- Jingwei Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Chen Hua
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xi Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Hechen Jia
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Wenxin Yu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yunbo Jin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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13
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Shen Y, Wang D, Wen M, Di R, Fan X, Su L, Yang X. Coil-assisted ethanol embolotherapy for refractory head and neck arteriovenous malformations with Onyx recrudescence: 10-Year experiences. J Vasc Surg Venous Lymphat Disord 2023; 11:1219-1230. [PMID: 37473869 DOI: 10.1016/j.jvsv.2023.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/29/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE This study aimed to evaluate the outcomes of coil-assisted ethanol embolotherapy in recanalized head and neck arteriovenous malformations (HNAVMs) with dilated outflowing veins after Onyx treatment. METHODS Thirty-six patients with HNAVMs (18 females and 18 males with a mean age of 26.83 years) who experienced recurrence after Onyx embolization from October 2007 to October 2017 were included in this study. All patients underwent complete clinical and angiographic examinations. Further, each patient was classified based on the Schobinger stage before undergoing staged ethanol embolization. All patients were followed up for 5 years in-person at an interval of 3 months after discharge. The Kaplan-Meier method was used to perform the recurrence-free survival analysis. RESULTS Sixteen patients (44.4%) had Schobinger stage II HNAVMs, and the remaining patients had Schobinger stage III or IV (20/36 patients [55.6%]) HNAVMs. A total of 116 embolization procedures were performed, coils were applied in 107 procedures (92.2%) among patients with dilated outflowing veins. The dose of absolute ethanol was 16.39 mL per procedure in patients with Schobinger II HNAVMs, and 22.45 mL per procedure in patients with Schobinger III and IV HNAVMs (P = .024, 95% confidence interval, 1.128-5.009). During the 3-month evaluation, complete response was observed in 13 of 36 patients (36.1%), and partial response was observed in 23 of 36 patients (63.9%). The 5-year recurrence-free survival rate for patients who underwent Onyx treatment had improved 58.3% after ethanol embolization (95% confidence interval, 2.853-9.595; P < .0001). CONCLUSIONS Coil-assisted ethanol embolotherapy could treat refractory HNAVMs with Onyx recrudescence effectively.
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Affiliation(s)
- Yuchen Shen
- Vascular Anomaly Center. Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Deming Wang
- Vascular Anomaly Center. Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingzhe Wen
- Vascular Anomaly Center. Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruoyu Di
- Vascular Anomaly Center. Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xindong Fan
- Vascular Anomaly Center. Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lixin Su
- Fengcheng Hospital of Feng Xian District, Fengcheng Branch, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xitao Yang
- Vascular Anomaly Center. Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Shen Y, Su L, Wang D, Fan X. Overview of peripheral arteriovenous malformations: From diagnosis to treatment methods. J Interv Med 2023; 6:170-175. [PMID: 38312130 PMCID: PMC10831390 DOI: 10.1016/j.jimed.2023.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 02/06/2024] Open
Abstract
Based on the latest classification by the International Society for the Study of Vascular Anomalies in 2018, vascular malformations (VMs) can be categorized into simple, combined VMs of major named vessels, and VMs associated with other anomalies. Simple VMs include lymphatic, venous, capillary, and arteriovenous malformations (AVMs). AVMs represent disorders of direct arteriovenous shunts caused by the absence of a capillary bed between the involved arteries and veins. This abnormal vascular communication causes arterial blood to accumulate in the venous vessels, thus resulting in venous hypertension and characteristic clinical manifestations, such as pulsation, tremors, and elevated temperature. AVMs can occur sporadically or as manifestations of syndromic lesions and are considered among the most complex and challenging VMs. The diagnosis and treatment of AVMs can vary depending on the lesion location and associated clinical symptoms, thus complicating their management. Herein, we discuss peripheral AVMs in terms of their clinical manifestations, imaging examinations, and staging systems to provide a comprehensive reference for the treatment, evaluation methods, and follow-up procedures for this vascular anomaly.
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Affiliation(s)
| | | | - Deming Wang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd, 200011, Shanghai, China
| | - Xindong Fan
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd, 200011, Shanghai, China
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15
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Shen Y, Wang D, Wen M, Su L, Fan X, Yang X. Angiographic Types of Palpebral Arteriovenous Malformations and Relevant Therapeutic Options Based on Ethanol Embolization: A Multicenter Study. J Endovasc Ther 2023:15266028231201534. [PMID: 37750474 DOI: 10.1177/15266028231201534] [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: 09/27/2023]
Abstract
PURPOSE The present work aimed to determine the different angio-architectural types of palpebral arteriovenous malformations (pAVMs) and appropriate ethanol embolotherapy for each type. MATERIALS AND METHODS This was a multi-center comparative effectiveness research retrospectively conducted from November 2012 to October 2021. A total of 70 patients with pAVMs were included, which was classified into cystic pAVMs (n=29) and diffuse pAVMs (n=41) based on the angio-architecture. Of the included patients, 17 with cystic pAVMs and 13 with diffuse pAVMs underwent ethanol embolization combined with coils (CE). The remaining participants underwent no-coil ethanol embolization (NCE). Participants had undergone 60 months of follow-up. Normality of data was tested by the D'Agostino and Pearson test. Correlation was tested by the Pearson χ2 test. Deterioration-free survival (DFS) rate was estimated using the Kaplan-Meier survival analysis. Multivariate Cox regression models included variables that were significant at a p value<0.05 in the univariate analysis to screen the prognostic factor. RESULTS The local symptoms of pAVMs, including pulsation, warmth, red plaque, blepharoptosis, bleeding, and visual blurring, along with the devascularizational grade of angiography were recorded before and after the respective procedures. Post-treatment complications were either evaluated at the 3-month routine follow-up or were self-reported by patients. Cystic pAVMs presented with significantly different clinical and angiographic features compared with diffuse pAVMs. With CE, patients with cystic pAVMs obtained a higher devascularizational grade (p<0.0001) and better clinical outcomes (p=0.0009) than those with diffuse pAVMs. Contrarily, with NCE, patients with diffuse pAVM had better outcomes than those with cystic pAVMs (p=0.0248). Moreover, the overall DFS rate was higher in patients with cystic pAVMs (p=0.0006). Finally, the angio-architecture of pAVMs was found to independently influence its prognosis (p=0.02). CONCLUSIONS In pAVMs, the angio-architectural type was associated with the relative prognostic status. Ethanol embolization combined with coils was an effective method to treat cystic pAVMs, whereas NCE was more suitable for the diffuse type, further emphasizing the importance of a type-based therapeutic strategy for pAVMs. CLINICAL IMPACT Palpebral arteriovenous malformations (pAVMs) are rare and tricky in clinical practices. The present study has divided the pAVMs into cystic and diffuse types according to their angiographic characteristics. Ethanol embolization with (CE) or without coils (NCE) was performed on both types. CE was suitable for cystic pAVMs; whereas NCE was a better choice for diffuse pAVMs. The five-year survival analyses provided evidence of the safety and efficacy of ethanol application in pAVMs. Finally, our work demonstrated that both the short- and long-term clinical outcomes of diffuse pAVMs were poor compared to those of cystic pAVM.
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Affiliation(s)
- Yuchen Shen
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Deming Wang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mingzhe Wen
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lixin Su
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xindong Fan
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xitao Yang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Su L, Yang X, Wang Z, Wen M, Fan X, Wang D. Eradication of the nidus in arteriovenous malformations with a dominant outflow vein in the lower extremities using coils and absolute ethanol. J Vasc Surg Venous Lymphat Disord 2023; 11:809-815. [PMID: 37076100 DOI: 10.1016/j.jvsv.2022.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 04/21/2023]
Abstract
OBJECTIVE In the present study, we summarize our experience in locating the nidus of arteriovenous malformations (AVMs) with a dominant outflow vein (DOV) in the lower extremities and eradicating the nidus with ethanol and coils. METHODS Twelve patients with lower extremity AVMs who underwent ethanol embolization combined with DOV occlusion from January 2017 to May 2018 were enrolled in the present study. Selective angiography was used to locate the nidus of the AVMs, which was eradicated using ethanol and coils via the direct puncture pathway. All treated patients underwent postoperative follow-up (mean, 25.5 months; range, 14-37 months). RESULTS The 12 patients underwent a total of 29 procedures (mean, 2.4; range, 1-4) with 27 detachable coils and 169 Nester coils (Cook Medical Inc, Bloomington, IN). Of the 12 patients, 7 (58.3%) had a complete response and 5 (41.7%) a partial response. Three patients (25%) had minor complications such as blister and superficial skin ulcers during follow-up. However, they recovered spontaneously and completely. No major complications were recorded. CONCLUSIONS Ethanol embolization combined with coil-assisted DOV occlusion has the potential to eradicate the nidus of lower extremity AVMs with acceptable complication rates.
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Affiliation(s)
- Lixin Su
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xitao Yang
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenfeng Wang
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingzhe Wen
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xindong Fan
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Deming Wang
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Fan X, Zhang J, Liu P, Ye Z. Embolo/sclerotherapy for the treatment of hand arteriovenous malformations: a single-center retrospective cohort experience. Front Surg 2023; 10:1191876. [PMID: 37396293 PMCID: PMC10312000 DOI: 10.3389/fsurg.2023.1191876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose To retrospectively report our preliminary experience of treating hand arteriovenous malformations (AVMs) with embolo/sclerotherapy. Materials and methods Retrospectively review the demographics, treatment detail, outcome data, and complications of 13 consecutive patients with hand AVMs from January 2018 to December 2021. We embolize the dominant outflow vein with elastic coils and then use absolute ethanol or polidocanol for intravascular sclerotherapy and bleomycin for interstitial sclerotherapy. Results Yakes type II presents in four lesions, type IIIa in six, and type IIIb in three. A total of 29 treatment episodes were conducted for the 13 patients (1 episode for 3 patients, 2 for 4 patients, and 3 for 6 patients; the repeated treatment rate was 76.9%). The mean stretched length of coils for 1 treatment episode was 95 cm. The mean absolute ethanol dosage was 6.8 ml (range 4-30 ml). In addition, 10 ml of 3% polidocanol foam was injected and interstitial sclerotherapy with 150,000 IU bleomycin was performed on every patient. The post-operative arterial-dominant outflow vein pressure index (AVI) increased in the 29 procedures (6.55 ± 1.68 vs. 9.38 ± 2.80, P < 0.05). The Mann-Whitney U test showed that the post-operative AVI was higher in patients without re-intervention (P < 0.05). Local swelling occurred after all the procedures. Blistering occurred in 6 of the patients in 13 (44.8%) of the 29 procedures. Superficial skin necrosis occurred in 3 of the patients in 5 (17.2%) of the 29 procedures. The swelling, blistering, and superficial skin necrosis recovered within 4 weeks. No finger amputation occurred. The follow-up time was 6 months. The 6-month assessment of clinical improvement after the last treatment episode showed that 2 patients were cured, 10 were improved, and 1 remained unchanged. With regard to angiographic evaluation, 9 showed partial response and 4 complete response. Conclusion Embolo/sclerotherapy can be effective and safe for hand AVM. The AVI increased significantly after embolo/sclerotherapy, and the index may be valuable in predicting recurrence in further study.
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Tannai H, Oguro S, Nagao M, Ota H, Takase K. High-flow arteriovenous malformation in the finger with transvenous ethanolamine oleate sclerotherapy using an arterial tourniquet and microballoon occlusion: A case report. Radiol Case Rep 2023; 18:1973-1977. [PMID: 36970241 PMCID: PMC10036881 DOI: 10.1016/j.radcr.2023.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/22/2023] Open
Abstract
Endovascular therapy is an important method of treating high-flow arteriovenous malformations (AVMs). The nidus of AVMs can be treated by transarterial or percutaneous approaches with the use of ethanol as a strong embolic agent; however, treatment outcomes are not always satisfactory and complications including skin necrosis often occur, particularly following the treatment of superficial lesions. Herein, we describe successful transvenous sclerotherapy of high-flow AVMs in the finger of a 47-year-old female patient that were causing erythema and spontaneous pain using ethanolamine oleate (EO) as a safe sclerosant. Dynamic contrast-enhanced computed tomography and angiography revealed a high-flow type Ⅲb AVM according to Yakes classification. Using the transvenous approach, 5% EO with idoxanol was injected into the nidus of the AVM 3 times over 2 sessions. An arterial tourniquet was used to achieve stasis of blood flow at the nidus and microballoon occlusion of the outflow vein was used to ensure the sclerosant effectively reached the nidus. Near-total occlusion of the nidus was achieved leading to improved symptoms. Mild edema lasting 2 weeks occurred as a minor reaction after each session. Finger amputation may have been avoided by using this treatment. Transvenous EO sclerotherapy using an arterial tourniquet and balloon occlusion may have utility in treating AVMs in the extremities.
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Affiliation(s)
- Hiromitsu Tannai
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 2...1 Seiryo...machi, Aoba...ku, Sendai, Miyagi, 980-8575, Japan
| | - Sota Oguro
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 2...1 Seiryo...machi, Aoba...ku, Sendai, Miyagi, 980-8575, Japan
- Corresponding author.
| | - Munetomo Nagao
- Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 2...1 Seiryo...machi, Aoba...ku, Sendai, Miyagi, 980-8575, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 2...1 Seiryo...machi, Aoba...ku, Sendai, Miyagi, 980-8575, Japan
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Chang CT, Lim WX, Liu TT, Lin YM, Chang CD. Inferior mesenteric artery arteriovenous malformation, a rare cause of ischemic colitis: A case report. Medicine (Baltimore) 2023; 102:e33413. [PMID: 36961132 PMCID: PMC10036045 DOI: 10.1097/md.0000000000033413] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023] Open
Abstract
RATIONALE An arteriovenous malformation (AVM) is an abnormal tangle of blood vessels that connects the arteries and the veins. Because normal capillary bed is partially or completely absented in the AVM, the blood passes quickly from the arteries to the veins, which disrupts normal blood flow and oxygen supply to the surrounding tissues. This is called "steal phenomenon," and in the inferior mesenteric artery (IMA) territory, this may lead to abdominal pain, gastrointestinal bleeding, portal hypertension, and even ischemic colitis. PATIENT CONCERNS A 67-year-old man presented to our emergency department because of left side abdominal pain. DIAGNOSES The abdominal computed tomography with contrast enhancement revealed a cluster of abnormal vascular lesions abutting the IMA with early opacification of the left colonic marginal vein. In addition, poor enhancement of segmental colonic wall was found from proximal descending colon to middle rectum. The diagnosis of AVM of the IMA and ischemic colitis was made. INTERVENTIONS The patient underwent left hemicolectomy as well as the AVM resection. OUTCOMES He was discharged uneventfully after the surgery without complications. LESSONS IMA AVM carries the risk of ischemic colitis. computed tomography scan is helpful not only to the diagnosis of AVMs but also to exclude other lesions as well. Treatment options include endovascular embolization, surgical intervention, and a combination of both. Due to the complexity of this disease, treatment requires a case-specific multidisciplinary approach and a coordination of medical, radiological, and surgical staffs.
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Affiliation(s)
- Ching-Tang Chang
- Department of Emergency, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Wei-Xiong Lim
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ting-Ting Liu
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Ming Lin
- Department of Surgery, Division of Colorectal Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Di Chang
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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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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Lee SY, Kim KR. Cone-Beam CT-Guided Percutaneous Transgluteal Venous Sac Embolization in Type II Perirectal High-Flow Arteriovenous Malformations. J Vasc Interv Radiol 2023; 34:143-145. [PMID: 36167299 DOI: 10.1016/j.jvir.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/15/2022] [Accepted: 09/18/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Sang Yub Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Rae Kim
- Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, 2022 Old Clinic Building, Campus Box 7510, Chapel Hill, NC 27599.
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22
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Muacevic A, Adler JR, Watkins A, Tonis A, Greuner DA. Shoulder Pain Associated With Multiple Arteriovenous Malformations Successfully Treated With Embolization. Cureus 2023; 15:e33669. [PMID: 36788884 PMCID: PMC9918440 DOI: 10.7759/cureus.33669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
A 44-year-old male presented with left upper extremity and shoulder pain with worsening functional impairment after years of repetitive use, overtraining, and multiple injuries from weightlifting and mixed martial arts. Imaging showed no obvious injury or ligamentous deformity other than mild osteoarthritis (OA) of the left glenohumeral joint. Duplex ultrasonography (US) revealed four arteriovenous malformations (AVMs) surrounding the shoulder joint and left upper extremity. The vasculature was mapped via angiography through a transradial approach. Initial treatment included transarterial embolization of two AVMs off the axillary artery and branching anterior circumflex humeral artery. Secondary treatment included embolization of two lesions months later via direct puncture, one through a transvenous approach and the second through direct transmalformation cannulation, via the nidus, near the clavicle and posterior scapular lateral border. Treatment resulted in significant improvement in pain and range of motion. Follow-up assessments revealed improvement in overall symptoms, recovered function, and return to exercise and competitive mixed martial arts. This case highlights the value of duplex ultrasonography, embolization, and transarterial and transvenous approaches for the treatment of AVM-associated extremity or joint pain.
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Li X, Li J, Wang M, Wang J, Wang L, He H, Li M, Li Q, Shu C. Case Report: A Rare Abdominopelvic Arteriovenous Malformation: Originating From Splenic Artery and Draining Into Portal Vein. Front Cardiovasc Med 2022; 9:916096. [PMID: 35811714 PMCID: PMC9260105 DOI: 10.3389/fcvm.2022.916096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAbdominopelvic arteriovenous malformation is an uncommon congenital vascular lesion, for which the diagnosis and treatment are usually difficult. Though embolization and sclerotherapy are the primary treatment strategies, traditional surgical resection remains a valuable option.Case PresentationHerein, we present a 32-year-old female diagnosed with a massive abdominopelvic arteriovenous malformation that originates from the splenic artery and drains into the portal vein. The vascular lesion was evaluated with multiple imaging modalities and then surgically resected successfully. The patient was discharged post-operatively on day 6 and free of symptoms during the 12-month follow-up.ConclusionTo our knowledge, the presented abdominopelvic arteriovenous malformation is the first to be reported in the literature, with such a rare condition originating from the splenic artery and draining into the portal vein.
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Affiliation(s)
- Xin Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jiehua Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mo Wang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Junwei Wang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lunchang Wang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hao He
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ming Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
- Center of Vascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
- *Correspondence: Chang Shu
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Liu R, Chen J, Jia L, Pan B, Jiang H. Surgical management of auricular arteriovenous malformations: A literature review. Laryngoscope Investig Otolaryngol 2022; 7:604-613. [PMID: 35434337 PMCID: PMC9008162 DOI: 10.1002/lio2.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/01/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022] Open
Abstract
Auricular arteriovenous malformations (AVMs) can cause a variety of symptoms that seriously impact the patient's appearance, life, and mental well‐being. Surgery is the primary management method for auricular AVMs, but there is no consensus on how to surgically manage auricular AVMs. In this article, we document a comprehensive review of the characteristics, classification, and surgical interventions to treat auricular AVMs.
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Affiliation(s)
- Ruiquan Liu
- Department of Auricular Reconstruction Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- Graduate School of Peking Union Medical College Chinese Academy of Medical Sciences Beijing China
| | - Jianguo Chen
- Department of Auricular Reconstruction Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- Graduate School of Peking Union Medical College Chinese Academy of Medical Sciences Beijing China
| | - Litao Jia
- Department of Auricular Reconstruction Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- Graduate School of Peking Union Medical College Chinese Academy of Medical Sciences Beijing China
| | - Bo Pan
- Department of Auricular Reconstruction Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Haiyue Jiang
- Department of Auricular Reconstruction Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Noda Y, Iritani Y, Kawai N, Miyoshi T, Ishihara T, Hyodo F, Matsuo M. Deep learning image reconstruction for pancreatic low-dose computed tomography: comparison with hybrid iterative reconstruction. Abdom Radiol (NY) 2021; 46:4238-4244. [PMID: 33973060 DOI: 10.1007/s00261-021-03111-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/12/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate image quality, image noise, and conspicuity of pancreatic ductal adenocarcinoma (PDAC) in pancreatic low-dose computed tomography (LDCT) reconstructed using deep learning image reconstruction (DLIR) and compare with those of images reconstructed using hybrid iterative reconstruction (IR). METHODS Our institutional review board approved this prospective study. Written informed consent was obtained from all patients. Twenty-eight consecutive patients with PDAC undergoing chemotherapy (14 men and 14 women; mean age, 68.4 years) underwent pancreatic LDCT for therapy evaluation. The LDCT images were reconstructed using 40% adaptive statistical iterative reconstruction-Veo (hybrid-IR) and DLIR at medium and high levels (DLIR-M and DLIR-H). The image noise, diagnostic acceptability, and conspicuity of PDAC were qualitatively assessed using a 5-point scale. CT numbers of the abdominal aorta, portal vein, pancreas, PDAC, background noise, signal-to-noise ratio (SNR) of the anatomical structures, and tumor-to-pancreas contrast-to-noise ratio (CNR) were calculated. Qualitative and quantitative parameters were compared between the hybrid-IR, DLIR-M, and DLIR-H images. RESULTS CT dose-index volumes and dose-length product in pancreatic LDCT were 2.3 ± 1.0 mGy and 74.9 ± 37.0 mGy•cm, respectively. The image noise, diagnostic acceptability, and conspicuity of PDAC were significantly better in DLIR-H than those in hybrid-IR and DLIR-M (all P < 0.001). The background noise was significantly lower in the DLIR-H images (P < 0.001) and resulted in improved SNRs (P < 0.001) and CNR (P < 0.001) compared with those in the hybrid-IR and DLIR-M images. CONCLUSION DLIR significantly reduced image noise and improved image quality in pancreatic LDCT images compared with hybrid-IR.
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