Venous malformations in children: controversies of the diagnosis and treatment
Background. The characteristics of venous malformations are the progressive course, high risk of complications and unstable results of treatment. The purpose of the study is to determine the informative diagnostic methods and effective and safe methods for the treatment of venous malformations in children. Materials and methods. The study included 27 children with venous malformations aged 2 months to 17.5 years. The main method of visualization was magnetic resonance imaging. For the diagnosis of coagulation disorders, the level of fibrinogen, D-dimer s in the blood plasma was determined. Sclerotherapy was carried out under real-time ultrasound guidance using Tessari method. The statistical analysis was performed using the SPSS Statistics program. Results. Coagulation disorders are diagnosed in 55.56 % of patients, with increased levels of D-dimers in all cases and a decrease in the fibrinogen content in 11.12 % of children. The study found that the increase of D-dimers correlates with the presence of phleboliths and the size of the lesion. Sclerotherapy alone and in combination with surgical resection was performed in 74.07 % of patients; the number of sessions was from 1 to 12. We didn’t observe any complication after sclerotherapy, however, recanalization was diagnosed in 80 % of children in the period from 8 months to 2 years. In order to correct coagulopathy, low molecular weight heparin was used in a daily dose of 100 U/kg body weight for 5–14 days before and after main treatment. A comparison between the level of D-dimers before and after the treatment was performed using a Wilcoxon test, indicating a significant decrease in the level of D-dimers. The result of venous malformations treatment in children is the disappearance or reduction of pain (73.07 %), increase in daily activity (26.92 %), bleeding stop (11.54 %), improvement of cosmetic outcome (19.23 %), no changes (3.84 %), deterioration due to increased edema after removal (3.84 %). Conclusions. Sclerotherapy is an effective and safe method for treating venous malformations in children, but its disadvantage is potential recanalization.
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Legiehn GM, Heran MK. Venous malformations: classification, development, diagnosis, and interventional radiologic management. Radiol Clin North Am. 2008 May;46(3):545-97, vi. doi: 10.1016/j.rcl.2008.02.008.
Wassef M, Blei F, Adams D, et al. Vascular Anomalies Classification: Recommendations From the International Society for the Study of Vascular Anomalies. Pediatrics. 2015 Jul;136(1):e203-14. doi: 10.1542/peds.2014-3673.
Gulsen F, Cantasdemir M, Solak S, Gulsen G, Ozluk E, Numan F. Percutaneous sclerotherapy of peripheral venous malformations in pediatric patients. Pediatr Surg Int. 2011 Dec;27(12):1283-7. doi: 10.1007/s00383-011-2962-9.
McCafferty I. Management of Low-Flow Vascular Malformations: Clinical Presentation, Classification, Patient Selection, Imaging and Treatment. Cardiovasc Intervent Radiol. 2015 Oct;38(5):1082-104. doi: 10.1007/s00270-015-1085-4.
Martin L, Russell S, Wargon O. Chronic localized intravascular coagulation complicating multifocal venous malformations. Australas J Dermatol. 2009 Nov;50(4):276-80. doi: 10.1111/j.1440-0960.2009.00558.x.
Rodriguez-Manero M, Aguado L, Redondo P. Pulmonary arterial hypertension in patients with slow-flow vascular malformations. Arch Dermatol. 2010 Dec;146(12):1347-52. doi: 10.1001/archdermatol.2010.379.
Guevara CJ, Gonzalez-Araiza G, Kim SK, Sheybani E, Darcy MD. Sclerotherapy of Diffuse and Infiltrative Venous Malformations of the Hand and Distal Forearm. Cardiovasc Intervent Radiol. 2016 May;39(5):705-10. doi: 10.1007/s00270-015-1277-y.
Clemens RK, Baumann F, Husmann M, et al. Percutaneous sclerotherapy for spongiform venous malformations - analysis of patient-evaluated outcome and satisfaction. Vasa. 2017 Oct;46(6):477-483. doi: 10.1024/0301-1526/a000650.
Lee BB, Baumgartner I, Berlien P, et al. Diagnosis and Treatment of Venous Malformations. Consensus Document of the International Union of Phlebology (IUP): updated 2013. Int Angiol. 2015 Apr;34(2):97-149. PMID: 24566499.
Wohlgemuth WA, Müller-Wille R, Teusch V, Hammer S, Wildgruber M, Uller W. Ethanolgel sclerotherapy of venous malformations improves health-related quality-of-life in adults and children - results of a prospective study. Eur Radiol. 2017 Jun;27(6):2482-2488. doi: 10.1007/s00330-016-4603-0.
Ali S, Weiss CR, Sinha A, Eng J, Mitchell SE. The treatment of venous malformations with percutaneous sclerotherapy at a single academic medical center. Phlebology. 2016 Oct;31(9):603-9. doi: 10.1177/0268355516633380.
Wieck MM, Nowicki D, Schall KA, Zeinati C, Howell LK, Anselmo DM. Management of pediatric intramuscular venous malformations. J Pediatr Surg. 2017 Apr;52(4):598-601. doi: 10.1016/j.jpedsurg.2016.08.019.
Léauté-Labrèze C, Hoeger P, Mazereeuw-Hautier J, et al. A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med. 2015 Feb 19;372(8):735-46. doi: 10.1056/NEJMoa1404710.
Glade RS, Richter GT, James CA, Suen JY, Buckmiller LM. Diagnosis and management of pediatric cervicofacial venous malformations: retrospective review from a vascular anomalies center. Laryngoscope. 2010 Feb;120(2):229-35. doi: 10.1002/lary.20715.
Lee BB, Antignani PL, Baraldini V, et al. ISVI-IUA consensus document diagnostic guidelines of vascular anomalies: vascular malformations and hemangiomas. Int Angiol. 2015 Aug;34(4):333-74. PMID: 25284469.
Redondo P, Aguado L, Marquina M, et al. Angiogenic and prothrombotic markers in extensive slow-flow vascular malformations: implications for antiangiogenic/antithrombotic strategies. Br J Dermatol. 2010 Feb 1;162(2):350-6. doi: 10.1111/j.1365-2133.2009.09513.x.
Stuart S, Barnacle AM, Smith G, Pitt M, Roebuck DJ. Neuropathy after sodium tetradecyl sulfate sclerotherapy of venous malformations in children. Radiology. 2015 Mar;274(3):897-905. doi: 10.1148/radiol.14132271.
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