Abstract
While infantile hemangiomas are very common, congenital hemangiomas are rare and less understood. Congenital hemangiomas are present at birth. They fall into 2 major categories: rapidly involuting congenital hemangioma and noninvoluting congenital hemangioma. Noninvoluting congenital hemangioma is the rarer of the 2 entities. If not recognized and treated appropriately, noninvoluting congenital hemangioma can lead to considerable morbidity. There is a paucity of literature regarding noninvoluting congenital hemangiomas. In this article, we will outline our experience with this condition, focusing on clinical and angiographic features. There is a distinct angiographic appearance of noninvoluting congenital hemangiomas involving an arterial-capillary web, a dense tumor blush with identifiable feeding arteries, no arteriovenous shunting, and variably present draining veins. Our experience with endovascular embolization and direct percutaneous treatment is the largest for this entity to date. Endovascular embolization and/or direct percutaneous sclerotherapy of this lesion may obviate subsequent surgical resection.
Highlights
Superselective injections with the microcatheter along the arcade of the vascular lesion would be performed to confirm an angiographic appearance of the noninvoluting congenital hemangiomas (NICHs)
Our study is the largest case series of embolization and/or direct sclerotherapy for NICH and the most thorough evaluation of angiographic features associated with these lesions
Alejandro Berenstein— RELATED: Grant: MicroVention; Consulting Fee or Honorarium: MicroVention, Mivi Neuroscience, Scientia Vascular, Endostream Medical LTD, Bendit Technologies, Magneto Thrombectomy Solutions; UNRELATED: Royalties: AngioDynamics; Stock/Stock Options: Mivi Neuroscience, Endostream Medical LTD, Scientia Vascular, Bendit Technologies, Magneto Thrombectomy Solutions. *Money paid to the institution
Summary
Superselective injections with the microcatheter along the arcade of the vascular lesion would be performed to confirm an angiographic appearance of the NICH. We report our experience with this entity and demonstrate that endovascular embolization and/or direct percutaneous sclerotherapy can be an effective treatment strategy in well-selected cases. Direct Percutaneous Sclerotherapy Patients presenting with very large hemangiomas undergoing direct percutaneous sclerotherapy were reviewed This technique was used more frequently across time as the practice of our primary operator evolved. Case Series direct percutaneous puncture of the lesion of interest at multiple locations was performed. Clinical scenario, patient age, angiographic features, embolization technique, postembolization angiography, need for multiple treatments (if applicable), complications, and long-term clinical follow-up were recorded.
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