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Xu Z, Yang Y, Ge C, Tai M, Chen T, Zhang Q, Li K, Yang X, Qin Z. Venous malformations of the lower limb with severe localized intravascular coagulopathy treated with radiofrequency ablation and resection. J Thromb Thrombolysis 2023:10.1007/s11239-023-02822-w. [PMID: 37184627 DOI: 10.1007/s11239-023-02822-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/16/2023]
Abstract
Diffuse venous malformations (VMs) are relatively rare, especially the lesions locting special anatomical sites, and they are prone to casuse localized intravascular coagulopathy (LIC). Diffuse VMs can also cause bleeding and life-threatening disseminated intravascular coagulopathy (DIC) from trauma, surgery, and improper treatments. Thus, the treatment of diffuse VMs with LIC is quite tough. We report of a diffuse VMs with severe LIC that was treated with the combined use of minimally invasive treatment and open surgery.
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Affiliation(s)
- Zhenguo Xu
- Special Department of Vascular Anomalies, LinYi Tumor Hospital, Linyi, Shandong, 276000, P.R. China
| | - Yaowu Yang
- Department of Head and Neck Tumor Surgery, School of Stomatology, Air Force Military Medical University, Xi'an, Shanxi710000, P.R. China
| | - Chunxiao Ge
- Special Department of Vascular Anomalies, LinYi Tumor Hospital, Linyi, Shandong, 276000, P.R. China
| | - Maozhong Tai
- Special Department of Vascular Anomalies, LinYi Tumor Hospital, Linyi, Shandong, 276000, P.R. China
| | - Tao Chen
- Special Department of Vascular Anomalies, LinYi Tumor Hospital, Linyi, Shandong, 276000, P.R. China
| | - Qiuqi Zhang
- Department of Breast Diseases, LinYi Tumor Hospital, Ward 1, Linyi, Shandong, 276000, P.R. China
| | - Kelei Li
- Special Department of Vascular Anomalies, LinYi Tumor Hospital, Linyi, Shandong, 276000, P.R. China
| | - Xia Yang
- Department of Head and Neck Tumor Surgery, School of Stomatology, Air Force Military Medical University, Xi'an, Shanxi710000, P.R. China
| | - Zhongping Qin
- Special Department of Vascular Anomalies, LinYi Tumor Hospital, Linyi, Shandong, 276000, P.R. China.
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Nelson KJ, Bennett R, Lam A, Javan H, Findeiss L, Kelly KM, Nelson JS, Abi-Jaoudeh N. Clinical presentation and outcomes after endovascular management in a mixed pediatric and adult Klippel-Trenaunay syndrome population. J Vasc Surg Venous Lymphat Disord 2021:S2213-333X(21)00168-2. [PMID: 33753300 DOI: 10.1016/j.jvsv.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/07/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We retrospectively studied the clinical presentations and outcomes of endovascular management in a mixed pediatric and adult Klippel-Trenaunay syndrome (KTS) population at a single academic medical center. METHODS We performed a retrospective study of patients with KTS who had been referred for endovascular intervention after evaluation and diagnosis by a multidisciplinary team at a single academic medical center during a 10-year period. The patient demographics, areas affected, presenting symptoms, previous treatments, imaging modalities, endovascular treatment types, number of treatments, and complications were assessed. The technical and clinical success rates were calculated. RESULTS Twenty-six patients with suspected KTS were evaluated. Of these 26 patients, 20, aged 2 to 75 years, had been diagnosed with KTS using the International Society for the Study of Vascular Anomalies criteria and referred for endovascular management. The left lower extremity was affected most often. The presenting symptoms were pain (80%), edema (70%), bleeding (10%), numbness (25%), and claudication (25%). Of the 20 patients, 16 (80%) had undergone treatment of KTS before presenting to our institution. Magnetic resonance imaging and ultrasound (US) were the most common imaging modalities. Fifteen patients underwent 46 endovascular treatments during the study period. The treatments included 5 endovenous ablations only, 4 US-guided sclerotherapies with endovenous ablation, 5 US-guided sclerotherapies only, and 32 catheter-directed venograms with additional interventions. Localized intravascular coagulopathy was the only procedure-related complication and occurred in one patient after three treatments. The technical success rate was 97.8%, and the clinical success rate was 100%. CONCLUSION Endovascular intervention is safe and effective for KTS patients for whom conservative management has failed. Pain and edema were the most common presenting symptoms. Presenting symptoms may be related to pathology of anomalous veins, orthotopic superficial veins or deep veins. Venous claudication can be present in those with KTS despite patency of the deep venous system. Magnetic resonance imaging and duplex US are frequently used modalities for venous assessment. The complications of endovascular treatment are rare but include localized intravascular coagulopathy.
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Tole S, Price V, Pope E, Powell J, David M, Zwicker K, Kendrick V, Malic C, John PR, Somers GR, Dubois J, Brandão LR. Abnormal hemostasis in children with vascular anomalies, part I: Thrombocytopenias among different vascular anomalies. Thromb Res 2019; 196:626-634. [PMID: 31221393 DOI: 10.1016/j.thromres.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/31/2019] [Accepted: 06/09/2019] [Indexed: 12/18/2022]
Abstract
Long before the classification of vascular anomalies from the International Society for the Study of Vascular Anomalies (ISSVA) provided a framework to differentiate vascular anomalies, otherwise known as vascular birthmarks, it was recognized that patients with such lesions can present with acute life-threatening hemostatic and/or thrombotic complications, as well as chronic long-standing bleeding or thrombotic issues. Scenarios such as a rapidly growing vascular lesion with severe acute thrombocytopenia, a visceral hemorrhagic lesion, a lesion associated with repetitive and painful superficial thrombosis, and cases of unprovoked or post-procedural fatal pulmonary embolism highlight the wide spectrum of manifestations of abnormal coagulation in patients with vascular anomalies. The separation of vascular anomalies into two distinct groups, vascular tumors and vascular malformations, was followed by the characterization that their respective coagulopathies were due to either a derangement of platelets or to a disequilibrium of the patient's coagulation/fibrinolytic process. This configuration of coagulopathies will be the foundation for this two-chapter review series. In the initial review, coagulopathies where thrombocytopenia is the main feature will be characterized, whereas the second review will focus on vascular malformations that have a coagulation disorder secondary to some degree of coagulation consumption and/or fibrinolytic pathway derangement.
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Affiliation(s)
- Soumitra Tole
- Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Victoria Price
- Department of Paediatrics, Division of Haematology-Oncology, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Elena Pope
- Department of Paediatrics, Section of Dermatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Julie Powell
- Department of Pediatrics, Division of Dermatology, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
| | - Michèle David
- Department of Pediatrics, Division of Hematology, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
| | - Kelley Zwicker
- Department of Paediatrics, Division of Community Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Victoria Kendrick
- Department of Pediatrics, Division of Community Pediatrics, Calgary, AB, Canada
| | - Claudia Malic
- Division of Plastic Surgery, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Philip R John
- Department of Diagnostic Imaging, Division of Interventional Radiology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gino R Somers
- Department of Paediatric Laboratory Medicine, Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Josée Dubois
- Department of Medical Imaging, CHU Sainte-Justine Mother and Child University Hospital Center, University of Montreal, Montreal, QC, Canada
| | - Leonardo R Brandão
- Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
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Leung YCL, Leung MWY, Yam SD, Hung JWS, Liu CSW, Chung LY, Tang MY, Fung HS, Poon WL, Chao NSY, Liu KKW. D-dimer level correlation with treatment response in children with venous malformations. J Pediatr Surg 2018; 53:289-292. [PMID: 29221638 DOI: 10.1016/j.jpedsurg.2017.11.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/08/2017] [Indexed: 01/19/2023]
Abstract
AIM Localized intravascular coagulopathy is present in children with venous malformations (VMs) as evidenced by elevated D-dimer levels. Few studies have looked into the changes in D-dimer after sclerotherapy and its correlation with treatment outcome and complications. Our study aims to investigate changes in D-dimer in children with VMs undergoing alcohol sclerotherapy. METHODS A prospective cohort study from 2014 to 2016, which included children (<18years) with VM undergoing alcohol sclerotherapy, was completed. Demographics and lesion characteristics were recorded. Perioperative D-dimer levels were collected 2weeks prior to treatment (baseline) and on postoperative days 1, 2, 5, and 14, respectively. A raised postoperative D-dimer was defined as a peak level of at least 50% increase of baseline D-dimer. Children were followed up with documentation of lesional size at 6months and long-term recurrence beyond 6months of treatment. RESULTS Eighteen children were identified (10 females, 8 males) with a median follow up of 21months. Overall, 15 patients (83%) had a satisfactory outcome. Baseline D-dimer levels were high in 8 patients (44%). Postoperative D-dimer level was raised in 12 patients irrespective of their baseline levels, with 92% peaking on postoperative day one (n=11). In the elevated D-dimer group, 11 patients had a satisfactory outcome, and 10 patients did not have long-term recurrence. We did not encounter any complications in our cohort. CONCLUSION Changes in perioperative D-dimer levels may predict early treatment response and long-term recurrence after alcohol sclerotherapy. With a standardized protocol, alcohol sclerotherapy for venous malformation is safe with minimal complications. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yvonne Chi-Lun Leung
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China.
| | - Michael Wai-Yip Leung
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
| | - Shi-Da Yam
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
| | - Judy Wing-Suet Hung
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
| | - Clarence Sze-Wai Liu
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
| | - Lap-Yan Chung
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
| | - Man-Yee Tang
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
| | - Hon-Shing Fung
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong, China
| | - Wai-Lun Poon
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong, China
| | - Nicholas Sih-Yin Chao
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
| | - Kelvin Kam-Wing Liu
- Division of Paediatric Surgery, Queen Elizabeth Hospital and United Christian Hospital, Hong Kong, China
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Koo KS, Dowd CF, Mathes EF, Rosbe KW, Hoffman WY, Frieden IJ, Hess CP. MRI phenotypes of localized intravascular coagulopathy in venous malformations. Pediatr Radiol 2015; 45:1690-5. [PMID: 26143286 DOI: 10.1007/s00247-015-3389-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 03/23/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The incidence of localized intravascular coagulopathy (LIC) in venous malformations varies with lesion size and location, as well as the presence of palpable phleboliths. The development of LIC can cause pain and hemorrhage and can progress to disseminated intravascular coagulopathy (DIC) and thromboembolic disease resulting in death in some cases. Early recognition of LIC can relieve symptoms and prevent progression to life-threatening complications. OBJECTIVE The aim of this work was to identify MRI features of venous malformation associated with LIC. We hypothesized that venous malformations with larger capacitance, slower flow and less physiological compression (greater stasis) were more likely to be associated with LIC. MATERIALS AND METHODS In this HIPAA-compliant and IRB-approved study, we retrospectively reviewed clinical records and MRI for consecutive patients undergoing evaluation of venous malformations at our multidisciplinary Birthmarks and Vascular Anomalies Center between 2003 and 2013. Inclusion required consensus diagnosis of venous malformation and availability of laboratory data and MRI; patients on anticoagulation or those previously undergoing surgical or endovascular treatment were excluded. LIC was diagnosed when D-dimer exceeded 1,000 ng/mL and/or fibrinogen was less than 200 mg/dL. Two board-certified radiologists assessed the following MRI features for each lesion: morphology (spongiform vs. phlebectatic), presence of phleboliths, size, location (truncal vs. extremity), and tissue type(s) involved (subcutis, muscle, bone and viscera). Univariate logistic regression analyses were used to test associations between LIC and MRI findings, and stepwise regression was applied to assess the significance of the individual imaging predictors. RESULTS Seventy patients, 37 with LIC, met inclusion criteria during the 10-year study period (age: 14.5 +/- 13.6 years [mean +/- standard deviation]; 30 male, 40 female). Both elevated D-dimer and low fibrinogen were associated with the presence of phleboliths, larger lesion sizes and visceral involvement on MRI (all P < 0.05). In stepwise regressions, lesion size (P < 0.001), the presence of phleboliths (P = 0.005) and lesion morphology (P = 0.006) were all significant predictors of LIC. CONCLUSION LIC is associated with larger lesion size, visualized phleboliths, truncal location and spongiform morphology on MRI in venous malformations, suggesting that lesions with larger capacitance, slower flow and less physiological compression are more likely to be associated with coagulopathy.
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