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Panda SK, Nikhila GP, Kavya PS. Propranolol in Congenital Hepatic Arteriovenous Malformation. Indian J Pediatr 2023; 90:952. [PMID: 37264277 DOI: 10.1007/s12098-023-04707-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/26/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Santosh Kumar Panda
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT DU, Bhubaneswar, Odisha, India.
| | | | - Palnati Sai Kavya
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT DU, Bhubaneswar, Odisha, India
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Khurana A, Mathachan SR, Paliwal P. Treatment of Acquired Digital Arteriovenous Malformation With Intralesional Bleomycin: An Effective Modality for a Lesser Known Condition. Dermatol Surg 2023; 49:809-811. [PMID: 37184505 DOI: 10.1097/dss.0000000000003830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Ananta Khurana
- Department of Dermatology, Venereology and Leprosy, ABVIMS & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Sinu Rose Mathachan
- Department of Dermatology, Venereology and Leprosy, ABVIMS & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Purnima Paliwal
- Department of Pathology, ABVIMS & Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Affiliation(s)
- Sarah Chastanet
- Maxillofacial and Facial Plastic Surgery Department, University of Tours, Trousseau Hospital, CHRU Tours, FR-37000 Tours, France.
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Goda M, Suzuki T, Adachi H. Placental polyp with arteriovenous malformation treated with a gonadotoropin-releasing hormone antagonist. BMJ Case Rep 2021; 14:14/9/e244664. [PMID: 34497058 PMCID: PMC8438750 DOI: 10.1136/bcr-2021-244664] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 35-year-old woman (gravida 1, para 0) underwent termination of pregnancy (ToP) at 12 weeks of gestation. One month after ToP, she experienced significant vaginal bleeding and the mass with blood flow was identified on imaging. The presence of a placental polyp with arteriovenous malformation (AVM) was suspected on transvaginal sonography and MRI. Since the bleeding had ceased when she visited our hospital, we decided to treat the placental polyp with AVM with gonadotropin-releasing hormone (GnRH) antagonist therapy instead of surgery. Two months after GnRH antagonist treatment, the mass and blood flow in the uterus disappeared. Menstruation resumed 1 month after the completion of treatment. In our case, we were able to successfully treat placental polyps with AVM using GnRH antagonist therapy.
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Affiliation(s)
- Mayuko Goda
- Obstetrics and gynaecology, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka, Japan
| | - Takashi Suzuki
- Obstetrics and gynaecology, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka, Japan
| | - Hiroshi Adachi
- Obstetrics and gynaecology, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka, Japan
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Eisa-Beygi S, Vo NJ, Link BA. RhoA activation-mediated vascular permeability in capillary malformation-arteriovenous malformation syndrome: a hypothesis. Drug Discov Today 2020; 26:1790-1793. [PMID: 33358701 DOI: 10.1016/j.drudis.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/19/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
Capillary malformation-arteriovenous malformation (CM-AVM) syndrome is a class of capillary anomalies that are associated with arteriovenous malformations and arteriovenous fistulas, which carry a risk of hemorrhages. There are no broadly effective pharmacological therapies currently available. Most CM-AVMs are associated with a loss of RASA1, resulting in constitutive activation of RAS signaling. However, protein interaction analysis revealed that RASA1 forms a complex with Rho GTPase-activating protein (RhoGAP), a negative regulator of RhoA signaling. Herein, we propose that loss of RASA1 function results in constitutive activation of RhoA signaling in endothelial cells, resulting in enhanced vascular permeability. Therefore, strategies aimed at curtailing RhoA activity should be tested as an adjunctive therapeutic approach in cell culture studies and animal models of RASA1 deficiency.
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Affiliation(s)
- Shahram Eisa-Beygi
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Nghia Jack Vo
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Radiology, Pediatric Imaging and Interventional Radiology, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Brian A Link
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
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Li X, Sun W, Chen L, Jin M, Zhang Z, Gao J, Fei X. Cesarean scar pregnancy combined with arteriovenous malformation successfully treated with transvaginal fertility-sparing surgery: A case report and literature review. Medicine (Baltimore) 2020; 99:e21432. [PMID: 32756152 PMCID: PMC7402736 DOI: 10.1097/md.0000000000021432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION A cesarean scar pregnancy (CSP), when combined with an arteriovenous malformation (AVM), is a rare, but potentially life-threatening condition that may be associated with uncontrolled hemorrhage. Hysterectomy is indicated when conservative treatment fails. Preservation of fertility is challenging. PATIENT CONCERNS We reported a 33-year-old woman with a CSP combined with an AVM who failed methotrexate administration as conservative treatment. DIAGNOSES A CSP combined with an AVM was diagnosed via three-dimensional color Doppler angiogram and magnetic resonance imaging. INTERVENTIONS Transvaginal removal of the ectopic gestation and repair of the uterine defect was performed without incident. OUTCOMES The fertility of the patient was preserved and hysterectomy was avoided. CONCLUSION Transvaginal fertility-sparing surgery may be successfully performed to prevent hysterectomy when conservative treatment fails in patients with a CSP combined with an AVM.
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Affiliation(s)
- Xiangjuan Li
- Department of Female Pelvic Medicine and Reconstructive Surgery
| | | | | | - Mei Jin
- Department of Female Pelvic Medicine and Reconstructive Surgery
| | | | - Jiansong Gao
- Department of Ultrasonography, Hangzhou Women's Hospital, Hangzhou, China
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Gabeff R, Boccara O, Soupre V, Lorette G, Bodemer C, Herbreteau D, Tavernier E, Maruani A. Efficacy and Tolerance of Sirolimus (Rapamycin) for Extracranial Arteriovenous Malformations in Children and Adults. Acta Derm Venereol 2019; 99:1105-1109. [PMID: 31386166 DOI: 10.2340/00015555-3273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Managing extracranial arteriovenous malformations is challenging. Sirolimus (rapamycin) is increasingly being used when surgery and embolization are not advised. Because of its anti-angiogenic properties here we report all extracranial arteriovenous malformation cases treated with sirolimus in 2 French tertiary centers for vascular anomalies. The outcomes were efficacy (complete, partial, no response) based on arteriovenous malformation volume and necrosis/hemorrhage and side effects. We retrospectively included 10 patients (7 children). The sirolimus dose ranged from 0.6 to 3.5 mg/m2. Median (interquartile range [IQR]) treatment time was 24.5 (4.5; 35) months. Five patients showed no response and 5 showed partial response at a median (IQR) of 3 (1; 5) months followed in 2 cases by therapeutic resistance (i.e., progressive disease after 9 and 24 months of treatment). The most frequent side effect was mouth ulcers. This study shows poor efficacy of sirolimus for treating extracranial arteriovenous malformations.
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Affiliation(s)
- Romain Gabeff
- University of Tours, CHRU Tours, FR-37044 Tours, France
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Abstract
Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant disorder characterized by vascular dysplasia, including typically systemic telangiectases and arteriovenous malformations (AVMs). Due to its variable clinical manifestations, HHT patients often seek medical care from different medical subspecialties and thus experience delays in diagnosis and treatment.This study is designed to analyze the clinical features and treatment options for patients with HHT.Hospitalized patients with a definitive diagnosis of HHT from November 1973 to July 2016 in Peking Union Medical College Hospital were identified after reviewing medical records and electronic databases. Further follow-up data of these patients were collected from outpatient clinical visits and/or telephone interviews.We identified a total of 20 patients, 7 males and 13 females. The mean age was 42.4 ± 20.3 years. Epistaxis (18/20) was the most common presentation, followed by telangiectases of the oral buccal mucosa, tongue and/or lips (14/20), pulmonary AVMs (12/19), hepatic AVMs (9/17), gastrointestinal telangiectases (9/9), and encephalic AVMs (1/12). The correct diagnosis of HHT was delayed on average by about 26.4 ± 17.0 years from the onset of HHT-related clinical signs and symptoms. Although epistaxis is usually presented in childhood (mean age 11 ± 7.1 years), gastrointestinal telangiectasia was often encountered in late middle age (mean age 55.4 ± 12.8 years). Bleeding and anemia were the most common complications. Molecular analysis was conducted in 4 patients. Only 1 patient was found to have a single-base deletion in ENG gene. The mean duration of follow-up of the patients was 41.8 months. The efficacy of locoregional therapy was of limited value and short-lived. Two patients were treated systemically with thalidomide, and their symptoms of epistaxis, melena, and anemia were notably improved.Patients with HHT have variable clinical characteristics, and their diagnoses were delayed on average by about 26 years. An experienced multidisciplinary team is needed for the early diagnosis and optimal management of patients with HHT. Thalidomide may be an effective choice to alleviate the bleeding symptoms of patients with HHT.
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Handa T, Okano Y, Nakanishi N, Morisaki T, Morisaki H, Mishima M. BMPR2 gene mutation in pulmonary arteriovenous malformation and pulmonary hypertension: a case report. Respir Investig 2014; 52:195-198. [PMID: 24853021 DOI: 10.1016/j.resinv.2013.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 07/14/2013] [Accepted: 08/02/2013] [Indexed: 06/03/2023]
Abstract
The transforming growth factor-β superfamily signaling pathway is thought to be involved in the pathogenesis of pulmonary arteriovenous malformation (PAVM). However, the association between bone morphogenetic protein receptor type 2 (BMPR2) gene mutations and PAVM remains unclear. We present a case of concurrent PAVM and pulmonary arterial hypertension (PAH), with a deletion mutation in exon 6 and exon 7 of the BMPR2 gene. Drug treatment for PAH improved the patient's hemodynamics and exercise capacity, but worsened oxygenation. This case suggests that BMPR2 gene mutation may be associated with the complex presentation of PAVM combined with PAH.
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Affiliation(s)
- Tomohiro Handa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Yoshiaki Okano
- Department of Internal Medicine, Hanwa Daini Senboku Hospital, Sakai, Japan.
| | - Norifumi Nakanishi
- Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Takayuki Morisaki
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.
| | - Hiroko Morisaki
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.
| | - Michiaki Mishima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Kamata K, Hayashi M, Muragaki Y, Iseki H, Okada Y, Ozaki M. How to control propofol infusion in pediatric patients undergoing gamma knife radiosurgery. Acta Neurochir Suppl 2013; 116:147-50. [PMID: 23417472 DOI: 10.1007/978-3-7091-1376-9_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Although Gamma Knife radiosurgery (GKS) is commonly performed under local anesthesia, general anesthesia is sometimes required. The authors previously reported a remote-controlled patient management system consisting of propofol-based general anesthesia with a target-controlled infusion (TCI) that we designed for pediatric GKS. However, a commercially available propofol TCI system has age and weight limitations (<16 years and <30 kg). We examined a manually controlled regimen of propofol appropriate for pediatric GKS. METHODS A pharmacokinetic model of the TIVA Trainer© with Paedfusor's parameter was used. A manually controlled infusion scheme to achieve a sufficient level of propofol for pediatric GKS was examined in five models ranging from 10 to 30 kg. RESULTS Following a loading dose of 3.0 mg/kg, the combination of continuous infusion of 14, 12, 10, and 8 mg/kg/h resulted in a target concentration of 3.0-4.0 μg/ml, the required level for pediatric GKS. CONCLUSION Propofol titration is a key issue in GKS. Manual infusion is less accurate than TCI, but the combination of a small bolus and continuous infusion might be a substitute. Considering the characteristics of propofol pharmacokinetics in children, co-administration of opioids is recommended.
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Affiliation(s)
- Kotoe Kamata
- Department of Anesthesiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Crampsey DP, Cochrane L, Roebuck D, Hartley BE. Chronic facial pain following injection of sodium tetradecyl sulphate into an intraparotid haemolymphangioma. J Laryngol Otol 2007; 122:1002-4. [PMID: 17625033 DOI: 10.1017/s0022215107009590] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We report a rare case of chronic facial pain following sclerotherapy for intraparotid haemolymphangioma, thereby highlighting an important clinical consideration when advising this treatment option as an alternative to surgery in the head and neck.Method:Case report, with a review of relevant literature.Results:Sclerotherapy of lymphangiomata is well reported in the literature. Unusually, our young patient with an intraparotid haemolymphangioma experienced severe, chronic pain following intralesional injection of sodium tetradecyl sulphate, which required management by a specialist pain service. We discuss the technique of sclerotherapy for such lesions, and also discuss the potential side effects of two agents commonly used in our centre: OK 432 and sodium tetradecyl sulphate.Conclusion:Non-surgical treatments of lymphangiomata and venous vascular malformations are not without complication. Both patient and clinician should be aware of this, and of the other potential side effects of sclerotherapy, prior to its use in the head and neck.
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Affiliation(s)
- D P Crampsey
- Department of Paediatric Otolaryngology and Head and Neck Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Affiliation(s)
- Robert Listernick
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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13
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Abstract
Vascular malformation (AVM) in the gastrointestinal tract is an uncommon, but not rare, cause of bleeding and iron deficiency anemia, especially in an aging population. While endoscopic coagulative therapy is the method of choice for controlling bleeding, a substantial number of cases require additional therapy. Adjunctive or even primary phamacotherapy may be indicated in recurrent bleeding. However, there is little evidence-based proof of efficacy for any agent. The bulk of support is derived from anecdotal reports or case series. The present review compares the outcome of AVM after no intervention, coagulative therapy or focus on pharmacological agents. Most of the literature encompasses two common AVMs, angiodysplasia and hereditary hemorrhagic telangiectasia. Similarly, the bulk of information evaluates two therapies, hormones (estrogen and progesterone) and the somatostatin analogue octreotide. Of these, the former is the only therapy evaluated in randomized trials, and the results are conflicting without clear guidelines. The latter therapy has been reported only as case reports and case series without prospective trials. In addition, other anecdotally used medications are discussed.
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Affiliation(s)
- Andrew Szilagyi
- Division of Gastroenterology, Department of Medicine, Sir Mortimer B Davis Jewish General Hospital, McGill University School of Medicine, Montreal, Quebec.
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Abstract
Venous angiomata, or venous malformations, are often present at birth, although they may not be evident until later. They consist of a spongy tangle of veins, and these lesions usually vary in size. Treatment of venous angiomata is often requested for cosmetic reasons, but painful ulcerations, nerve compression, functional disability can command care. This presentation describes management using sclerosant foam as the treating agent. During a 30-month period ending March 2004, 1,321 patients were investigated for venous disorders at the Vein Institute of La Jolla. Fourteen (incidence 1%) were found to have venous angiomata (: nine women). The age range was 15-76 years (mean 30.8 +/- 18.6). Lesions were classified by the Hamburg system and were primarily venous, extratruncular in 12 patients and combined extratruncular and truncular in two patients. Eight patients, three males, had manifestations of lower extremity Klippel-Trenaunay (syndrome; six had only venous angiomas. Only 10 of the 14 patients were treated. All patients were studied by Doppler duplex examination. Selected lesions were chosen for helical computed tomographic studies. Magnetic resonance venography was also used to image the lesions, define the deep circulation, note connections with normal circulation, identify vessels for therapeutic access, and determine infiltration of the lesion into adjacent soft tissue. Foam was produced by the Tessari two syringes one three-way stopcock teclinique, with the air to Polidocanol ratio being 4 or 5 to 1. This was used at 1% or 2% concentration, specific for each patient. The SonoSite 190 plus Duplex Doppler was used for ultrasound guidance, whenever deep access was required and to monitor progress and effects of treatment. A goal was set for each patient before treatment was begun. Ten patients were treated, and four await treatment. The mean number of treatments was 3.6 +/- 2.8 (range 1-10). A primary goal of pain-free healing was set in patients with nonhealing, painful ulceration or symptomatic varicose veins. This was achieved in all treated patients. Cosmetically, all of the patients were improved, and symptomatic patients were relieved of pain. The single complication was formation of a cutaneous ulcer following injection of telangiectasias. Sclerosant foam is a satisfactory tool to use in treating venous angiomata including the Klippel-Trenaunay syndrome. Use of foam sclerotherapy in this experience has proven the technique to be effective, essentially pain-free, and durable in the short term.
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Affiliation(s)
- Luigi Pascarella
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
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Lee CH, Chen SG. Direct percutaneous ethanol instillation for treatment of venous malformation in the face and neck. ACTA ACUST UNITED AC 2005; 58:1073-8. [PMID: 16055097 DOI: 10.1016/j.bjps.2005.04.014] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2004] [Revised: 02/14/2005] [Accepted: 04/18/2005] [Indexed: 11/21/2022]
Abstract
Venous malformations of the face and neck involve multiple anatomical spaces and encase critical neuromuscular structures, making surgical treatment difficult; high recurrence rates and high morbidity are well documented. Various methods of treatment of uncertain value and risk of complications have been advocated. We present our experience in treating five patients with venous malformation in the face and neck by using direct percutaneous ethanol sclerotherapy. Four patients had large lesions (> or = 3 cm; one patient had two large lesions in the low eyelid), and the other had a mid-sized lesion (1.5-3 cm). Under general or local anaesthesia, one-third to one-quarter cavity volume of ethanol was injected percutaneously, directly into the malformation with under fluoroscopy [de Lorimier AA. Sclerotherapy for venous malformations. J Pediatr Surg 1995;30:188-93; Johnson PL, Eckard DA, Brecheisen MA, Girod DA, Tsue TT. Percutaneous ethanol sclerotherapy of venous malformations of the tongue. Am J Neuroradiol 2002;23:779-82; Pappas DC Jr, Persky MS, Berenstein A. Evaluation and treatment of head and neck venous vascular malformations. Ear Nose Throat J 1998;77:914-22; Lee CH, Chen SG. Direct percutaneous ethanol sclerotherapy for treatment of a recurrent venous malformation in the periorbital region. ANZ J Surg. 2004;74(12):1126-7.]. Four patients required two injections. All patients had remission and alleviation of their symptoms, with no major complications. Direct percutaneous injection of absolute ethanol provides a simple and reliable alternative treatment for venous malformation in the face and neck.
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Affiliation(s)
- Chih-Hsien Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, National Defense Medical Center, Tri-Service General Hospital, No. 325, Section 2, Taipei 100, Taiwan, ROC
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Menkü A, Akdemir H, Durak AC, Oktem IS. Successful Surgical Excision of Juvenile-Type Spinal Arteriovenous Malformation in Two Stages Following Partial Embolization. ACTA ACUST UNITED AC 2005; 48:57-62. [PMID: 15747219 DOI: 10.1055/s-2004-830184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The case of a 24-year-old man with a juvenile-type spinal arteriovenous malformation is reported. Spinal angiography and magnetic resonance image revealed a juvenile (Type III) AVM at the cervical spine. This spinal malformation was successfully resected with a posterior and anterior surgical approach in two stages following partial embolization.
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Affiliation(s)
- A Menkü
- Department of Neurosurgery, Erciyes University School of Medicine, Kayseri, Turkey.
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Charabi BW, Nielsen LH, Bretlau P. [Intralesional treatment of vascular lesions in the head-neck region]. Ugeskr Laeger 2004; 166:710-1. [PMID: 15042824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Abstract
BACKGROUND Transcatheter arterial embolization has been the therapy of choice for uterine arteriovenous malformations, whereas medical therapy has not been popular because of patient propensity to bleed. CASE A 29-year-old woman, gravida 3, para 0, was diagnosed with uterine arteriovenous malformation. Because initial treatment with uterine artery embolization was unsuccessful, she was ultimately treated with danazol. Resolution of the lesion after 2 weeks of danazol therapy was observed. As of follow-up at 16 months, she has remained free from further abnormal bleeding episodes and recurrence of the lesion. CONCLUSION Danazol has the potential for medical management of uterine arteriovenous malformations in hemodynamically stable patients who do not respond to embolization.
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Affiliation(s)
- Kyousuke Takeuchi
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan.
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Onoyama I, Fukuhara M, Okuma A, Watanabe Y, Nakamura G. Successful pregnancy after the noninvasive management of uterine arteriovenous malformation. Acta Obstet Gynecol Scand 2001; 80:1148-9. [PMID: 11846717 DOI: 10.1034/j.1600-0412.2001.801216.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- I Onoyama
- Department of Obstetrics and Gynecology, Hamanomachi Hospital, Fukuoka, Japan
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Abstract
Although liquid adhesives or glue have been used as embolic agents for nearly three decades, experience with them outside of neurointerventional indications is generally limited. Cyanoacrylates are the main liquid adhesives used in the vascular system and have an important role in managing vascular abnormalities, especially arteriovenous malformations. Vascular occlusion results as these agents polymerize on exposure to the ions in blood. A description of the properties, biologic interactions, techniques of use, and indications for acrylic embolization in the peripheral circulation is especially pertinent at this time because of the recent approval of n-butyl cyanoacrylate by the United States Food and Drug Administration.
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Affiliation(s)
- J S Pollak
- Section of Vascular and Interventional Radiology, Department of Radiology, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042, USA.
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Goldberg RP, Flynn MK. Pregnancy after medical management of a uterine arteriovenous malformation. A case report. J Reprod Med 2000; 45:961-3. [PMID: 11127115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND The natural history of conservatively managed uterine arteriovenous malformations is largely unknown, and the risks associated with subsequent pregnancy and vaginal delivery have not been established. CASE A multiparous woman with a previously reported history of uterine arteriovenous malformation was monitored throughout pregnancy and vaginal delivery. Serial ultrasound studies were performed prior to a successful induction of labor for severe preeclampsia at 34 weeks' gestation. CONCLUSION To our knowledge, this is the first report of pregnancy and vaginal delivery in a woman with a prior history of a medically managed uterine arteriovenous malformation. Noninvasive treatment of uterine arteriovenous malformations is rare, and the potential long-term risks of this approach, including pregnancy, remain uncertain.
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Affiliation(s)
- R P Goldberg
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Donnelly LF, Bisset GS, Adams DM. Marked acute tissue swelling following percutaneous sclerosis of low-flow vascular malformations: a predictor of both prolonged recovery and therapeutic effect. Pediatr Radiol 2000; 30:415-9. [PMID: 10876829 DOI: 10.1007/s002470050775] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the significance of marked, acute swelling in patients after percutaneous sclerosis of low-flow vascular malformations, as a predictor of both prolonged recovery and likelihood of therapeutic effect. MATERIALS AND METHODS In 22 patients who underwent percutaneous ethanol sclerosis of low-flow vascular malformations, we compared the incidence of prolonged recovery and lasting therapeutic effect between those patients with and without marked soft-tissue swelling following the procedure. RESULTS Five patients exhibited marked swelling after sclerosis. Four of these five had causes of prolonged recovery. These four recovered and all five eventually had marked therapeutic effect. Seventeen patients did not meet criteria for severe swelling. Only one of these patients had prolonged recovery. Eighteen of the 22 total patients had therapeutic effect. All 4 of the 22 total patients who had no therapeutic effect were in the group without marked swelling. CONCLUSIONS Marked soft-tissue swelling, which occurs after percutaneous sclerosis of vascular malformations, is both a predictor of prolonged recovery and high likelihood of therapeutic effect.
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Affiliation(s)
- L F Donnelly
- Clinic for the Treatment of Vascular Malformations, Duke University Medical Center, Durham, NC 27710, USA
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Affiliation(s)
- M H Khatree
- Department of Obstetrics and Gynaecology, Logan Hospital, Meadowbrook, Queensland
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24
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Abstract
Recurrent bleeding from an obscure gastrointestinal source is a common but often frustrating clinical challenge. Frequently these bleeds can be attributed to vascular anomalies in the upper or lower gastrointestinal tract. Traditional management has included surgical resection and endoscopic fulguration. However, these methods are often ineffective when vascular lesions are diffuse, difficult to identify, or endoscopically inaccessible. Hormone therapy with a combination of oestrogen and progesterone represents a promising alternative. Since initial reports of success in patients with epistaxis from hereditary haemorrhagic telangiectasia, growing evidence supports its role in reducing bleeding from gastrointestinal vascular anomalies. Existing literature is critically reviewed and management strategies incorporating hormone therapy are suggested.
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Affiliation(s)
- J K Marshall
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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25
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Van Cutsem E, Piessevaux H. Pharmacologic therapy of arteriovenous malformations. Gastrointest Endosc Clin N Am 1996; 6:819-32. [PMID: 8899412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pharmacologic treatment of bleeding gastrointestinal arteriovenous malformations is difficult. These lesions should be treated pharmacologically only when endoscopic treatment is not successful and bleeding persists or when the lesions cannot be treated endoscopically due to their localization, mainly in the small bowel. These are only a limited number of studies available on the medical treatment of bleeding arteriovenous malformations. There is considerable evidence, however, that a combination of estrogens and progestagens significantly reduces the bleeding frequency and intensity and also the transfusion requirements in patients with high transfusion need. A few other drugs have been tried in patients with bleeding gastrointestinal arteriovenous malformations: danazol, octreotide, desmopressin, and aminocaproic acid. The experience with these drugs, however, is limited to case reports or to small series of patients.
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Affiliation(s)
- E Van Cutsem
- Department of Gastroenterology, University Hospital Gasthuisberg, Catholic, University of Leuven, Belgium
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26
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Abstract
BACKGROUND Successful nonsurgical therapy of uterine arteriovenous malformations is rare, with most cases being diagnosed at hysterectomy. CASE A uterine arteriovenous malformation was diagnosed by Doppler ultrasound, and its resolution after 1 week of treatment with methylergonovine maleate was observed. CONCLUSION Although there are case reports regarding treatment of uterine arteriovenous malformations by embolization performed by interventional radiology, to our knowledge, the noninvasive long-term management of a uterine arteriovenous malformation has not been reported.
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Affiliation(s)
- M K Flynn
- Department of Obstetrics and Gynecology, Beth Israel Hospital, Boston, Massachusetts, USA
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27
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Abstract
BACKGROUND Congenital hepatic arteriovenous malformations complicated by high-output heart failure and hematologic derangements are associated with up to 90% mortality. Prenatal diagnosis alerts the pediatrician to the need for early neonatal intervention. CASE A fetal hepatic arteriovenous malformation with associated high-output cardiac failure was diagnosed at 29 weeks' gestation using real-time and color flow Doppler sonography. Hydrocortisone injected directly into the umbilical vein and the amniotic sac resulted in appreciable improvement in hemodynamic and hematologic indices. The pregnancy ended in a preterm delivery at 31 weeks with no evidence of heart failure at birth. CONCLUSION The compromised preterm fetus with a hepatic arteriovenous malformation can be treated in utero, avoiding early emergency delivery.
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Affiliation(s)
- A A Mejides
- Department of Obstetrics and Gynecology, University of Miami School of Medicine, Florida, USA
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28
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Abstract
Cutis marmorata teleangiectatica congenita (CMTC) is a rare congenital vascular disorder of the venous system. In 50% of cases there are associated anomalies of other organ systems. Clinical improvement of the cutaneous manifestations is noted in most cases and usually occurs during the first year of life. We present a patient with CMTC with a band-like pattern following the L3 dermatome. At the age of 13 years, the skin manifestations worsened, with ulcerations and intermittent claudication. Angiographic imaging revealed stenosis of the deep femoral artery, and the circumflex femoral artery and the first perforating arteries were not visualized. To our knowledge, this is the first reported case of CMTC with anomalies of the large arteries.
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Affiliation(s)
- A M Skaria
- Klinik und Poliklinik für Dermatologie und Venerologie, Hôpital Cantonal Universitaire de Genève
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29
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Abstract
The association between angiodysplasia and von Willebrand's disease was first reported in 1967. The cases reported to date have involved patients with type I and IIA von Willebrand's disease. We report a patient with type IIB von Willebrand's disease who suffered gastrointestinal bleeding attributable to gastric angiodysplasia. The patient underwent endoscopic electrocautery acutely and has been treated long-term with estrogen/progesterone therapy. She has suffered no recurrent gastrointestinal bleeding at over 11 months of follow-up. We suggest hormonal therapy as an alternative to repeated blood product transfusion or extensive surgical resection in patients with von Willebrand's disease and gastrointestinal bleeding from angiodysplasia.
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Affiliation(s)
- W D Chey
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor 48109-0362
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30
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Derauf BJ, Hunter DW, Sirr SA, Cardella JF, Castaneda-Zuniga W, Amplatz K. Peripheral embolization of diffuse hepatic arteriovenous malformations in a patient with hereditary hemorrhagic telangiectasia. Cardiovasc Intervent Radiol 1987; 10:80-3. [PMID: 3107830 DOI: 10.1007/bf02577971] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Ivalon particles were used for hepatic arterial embolization of diffuse arteriovenous malformation in a patient with hereditary hemorrhagic telangiectasia. The methods of the procedure and possible complications are discussed.
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Abstract
The embryology and the clinical management of congenital AV fistulas of the upper extremity are discussed. Early excisional surgery of asymptomatic lesions should be confined to ones of a very limited extent. Excisional surgery on extensive lesions should be limited to those which are symptomatic and have decreasing hand function. Possibly of limited effectiveness in some lesions may be the selective occlusion of vascular feeders by injecting cyanoacrylate glue through a catheter.
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