Slow-flow Venous Malformations Research Articles

Ulnar Neuropathy Caused by Repeated Thrombophlebitis of the Slow-flow Venous Malformation in the Cubital Tunnel: A Case Report

Cubital tunnel syndrome is the most common entrapment neuropathy of the ulnar nerve at the elbow. Although there are many primary and secondary causes of cubital tunnel syndrome, ulnar neuropathy secondary to recurrent thrombophlebitis of the slow- flow Venous Malformation (VM) in the vicinity of the cubital tunnel has not been reported. Hereby, authors discuss a case of 22- year-old female with slow-flow VM in the vicinity of the cubital tunnel causing symptoms of transient ulnar neuropathy, progressing to ulnar neuritis resulting in persistent ulnar neuropathy. This was successfully treated by direct Stick Sclerotherapy of the VM, leading to complete relief of the symptoms. Follow-up Magnetic Resonance Imaging (MRI) revealed near-total resolution of the VM with complete resolution of the ulnar neuritis. This was an atypical presentation of ulnar neuropathy secondary to recurrent thrombophlebitis of a slow-flow VM in the cubital tunnel, which was successfully managed by treating the malformation.

Effectiveness of Intralesional Cautery in Treatment of Vascular Malformations

Objective: to evaluate effectiveness of intralesional cautery in treatment of vascular malformations
 Methodology: Descriptive case series study was conducted at Pak Italian Modern Burn Center /plastic surgery department, Nishtar Medical University Multan during a period from January 2020 to December 2020. A total of 20 patients were enrolled with vascular malformation involving head and neck region.The average follow-up period was 06 months after completion of a multisession treatment. Advanced diagnostic technology, mostly noninvasive, was used on all 20 patients with vascularmalformation.
 Results: Majority of our study cases i.e. 18 (90%) reported with the venous vascular malformation followed by Arteriovenous malformation 02 (10%). Overall regression was better in venous malformations shown in six weeks and it was observed in 18 (90%) of the study cases.Arteriovenous malformations showed less regression with procedure and took three to four sessions (as compared to VM which took two sessions). Color matching was comparable to that of normal site in 18 (90%) of our study cases mostly seen in slow flow venous malformation, while Arteriovenous malformation showed less improvement 02 (10%) of our study cases. Normal healing was noted in 19 (95%) of our study cases while one (05%) oral vascular malformation case got burn wound near oral commissure.
 Conclusion: Intralesional cautery technique for vascular malformation particularly venous one is a reliable, safe and versatile technique. It provides a good aesthetic outcome in terms of color matching, regression and scarring. It results in restoration of normal form and function in critically challenging areas like head and neck and pinna.

Developmental venous malformation: A “Do-Not-Touch’’ lesion

The most common slow-flow venous malformation in the brain are Developmental Venous Anomalies (also known as DVAs).

Symptomatic Developmental Venous Anomaly: State-of-the-Art Review on Genetics, Pathophysiology, and Imaging Approach to Diagnosis.

Developmental venous anomalies (DVAs) are the most common slow-flow venous malformation in the brain. Most DVAs are benign. Uncommonly, DVAs can become symptomatic, leading to a variety of different pathologies. DVAs can vary significantly in size, location, and angioarchitecture, and imaging evaluation of symptomatic developmental venous anomalies requires a systematic approach. In this review, we aimed to provide neuroradiologists with a succinct overview of the genetics and categorization of symptomatic DVAs based on the pathogenesis, which forms the foundation for a tailored neuroimaging approach to assist in diagnosis and management.

A rare case of orbital and diffuse conjunctival venous malformation

Cavernous hemangiomas (CH) are slow-flow venous malformations (VMs), not true vascular tumors. Although these are the most common benign orbital tumors in adults, conjunctival VMs are a rarity and account for less than 1% of all conjunctival tumors. We herein report a case of a 25-year-old male patient who presented with a large violaceous mass involving the inferior bulbar conjunctiva that had been present for 10 years. It was painless, progressive, and gradually increased in size over 10 years, and was associated with occasional bleeding. Any syndromic association was ruled out. Contrast-enhanced magnetic resonance imaging (CEMRI) revealed the presence of slow-flow vascular malformations involving the right superior and inferior eyelids with intraconal and extraconal involvement. An incision biopsy and histopathology (H/P) confirmed the diagnosis of formerly-called cavernous hemangioma (slow-flow VMs). The conjunctival mass was further managed by surgical debulking with ocular surface reconstruction, whereas the intraorbital part was kept under observation owing to its small size. The postoperative period was uneventful.

A study of duplex ultrasound examination in peripheral vascular malformations

Vascular malformations belong to wide spectrum of disease involving all vascular segments- arteries, veins as well as lymphatics. Being Ultrasound as the primary diagnostic modality, all peripheral vascular malformation diagnosis can be made by clinical examination and duplex ultrasound examination.A study of 50 patients was carried over a period of 1 year from 1 May 2021 to 1 May 2022 on the patient who came with complain of slow growing, superficial swelling which is painless in nature. The machine used is Affinity Philips 70 G.With help of duplex ultrasound, various types of vascular malformations were diagnosed with incidence such as Slow Flow Venous malformation (60%- 30 patients), High flow Arterio-venous malformations (16%- 8 patients), Capillary malformations (12%- 6 patients) and Lymphatic malformations (12%- 6 patients).Vascular malformations have been classified into venous, arterial, capillary, combined and lymphatic malformations types. Besides age presentations, detailed history and clinical examination, ultra-sound imaging plays an important role in correct diagnosis and classification of vascular malformations. It assesses exact flow dynamics in order to differentiate between Slow flow v/s High flow vascular malformations. MRI is most valuable diagnostic tool for comprehensive assessment of vascular malformationsUltrasound are first imaging modality in peripheral vascular malformations. It has plays crucial role in proper treatment planning of the lesion as it describes the extent, type, flow pattern within the lesion.

Radiological Pearls in Imaging of Maffucci Syndrome- A Case Report

Maffucci syndrome is a congenital mesodermal dysplasia. The disease is characterised by the presence of multiple soft tissue haemangiomas or slow flow venous malformations and enchondromas and was first described in 1881. This report aims to discuss the clinical and radiological findings of Maffucci syndrome in a 29-year-old female patient who presented with swelling in the right foot and foot deformity. The subsequent history taking and different imaging modalities helped to reach the diagnosis. On Ultrasonography (USG), phleboliths were visible and on Computed Tomography (CT), few calcific foci were noted in planter aspect of right foot in subcutaneous and intermuscular plane with soft tissue enhancement. Hence this case report showed that Maffucci syndrome can present as deformity of limb, multiple soft tissue swellings or with cranial nerve palsy which may suggest an intracranial lesion and close follow-up of patients is required as there are high chances of malignant transformation. Patient in this case was referred to the Neurosurgery Department and later on lost to follow-up.

Iatrogenic preauricular arteriovenous fistula in underlying slow-flow venous malformation and its endovascular management

Arteriovenous fistula (AVF) is direct abnormal communication with the shunting of blood from an artery to a vein without intervening capillary network. AVF in preauricular location is uncommon, and most of the cases are posttraumatic or iatrogenic. The endovascular route is the preferred approach for treating such a lesion with better cosmetic outcome, however surgical excision may be required for complex cases.

Venous malformation (Cavernous Hemangioma) of the supraorbital nerve

Cavernous hemangiomas are not true vascular tumors, but rather are slow-flow venous malformations (VMs). They are present at birth as nonproliferating vascular birthmarks composed of anomalous ectatic venous channels. VMs have often been incorrectly called cavernous hemangiomas and cavernous angiomas. These terms have for a long time lead to confusion with the more common proliferating or true hemangioma of infancy. VM has been reported to arise at all sites including skin and subcutaneous layers of the head and neck, face, extremities, liver, gastrointestinal tract, and even the thymus. Although VMs are common intraocular tumors and are involved within intracranial, extraaxial cranial nerves within the cavernous sinus has been sporadically reported, and less often in the supraorbital nerve, an extraocular and extracranial division of the trigeminal nerve has not been reported. The authors present an extremely rare occurrence of VM involving the supraorbital nerve in an 80-year-old female.

Low dose time-resolved CT-angiography in pediatric patients with venous malformations using 3rd generation dual-source CT: Initial experience

ObjectivesTo prospectively evaluate the diagnostic value and radiation dose of time-resolved CT-Angiography (4D-CTA) in pediatric patients with venous malformations using 3rd generation dual-source CT (DSCT) at 70kVp tube voltage. MethodsBetween November 2014 and August 2015, seven children (2 male, 5 female; median age, 9 years; range 3–12 years) with suspected peripheral, non-cerebral, venous malformations were included in this feasibility study and underwent US, MRI and 4D-CTA. All three imaging modalities were analyzed and compared individually by an experienced interventional radiologist and a pediatric surgeon using a 5-point Likert scale, with regard to diagnosis of the vascular anomaly, additional information like presence of thrombophlebitis and lesion extension, flow dynamics, localization, volume and significance for treatment planning. For quantitative statistical analysis, an unifactorial analysis of variance was performed for every parameter and all three imaging modalities. Radiation dose values as expressed by the volume CT dose index (CTDIvol) and dose-length product (DLP) were recorded for of all patients. ResultsThree out of six patients had isolated type I venous malformations without peripheral venous drainage which could be demonstrated on MRI and CT. In two out of six patients a type II venous malformation with drainage into normal veins was diagnosed. In one case, 4D-CT was the only imaging modality that revealed a slow-flow venous malformation with shunting supply by a hypodynamic arterial feeder. Treatment planning4D-CTA was rated as the best imaging modality for treatment planning with agreement between radiologist and surgeon, especially with respect to the hemodynamics of the venous malformation. Conclusions4D-CTA at 70kVp is a fast imaging modality that provides comprehensive diagnostic information of venous malformations in pediatric patients and is very valuable for therapy planning. Radiation dose of 4D-CTA must be weighted against the diagnostic information as well as the potential risk for sedation and contrast administration during MRI.

Surgical Management of Slow-flow Venous Malformation of External Jugular Vein

IntroductionCervicofacial venous malformation (VMs) arising from the external jugular vein (EJV) are very rare. These distinct clinical entities may be easily and optimally treated with surgical excision without any resultant morbidity. ReportThree adult patients underwent excision of the malformation after unsuccessful sclerotherapy. Lesions were excised after ligating multiple large feeders between the EJV and the malformation. DiscussionSclerotherapy failed due to small contact time of the sclerosant with the endothelium. Surgical excision of these lesions is simple and straightforward, and should be considered as the first line of treatment whenever this clinical entity is recognised.

Surgical Management of Slow-flow Venous Malformation of External Jugular Vein

Introduction: Cervicofacial venous malformation (VMs) arising from the external jugular vein (EJV) are very rare. These distinct clinical entities may be easily and optimally treated with surgical excision without any resultant morbidity. Report: Three adult patients underwent excision of the malformation after unsuccessful sclerotherapy. Lesions were excised after ligating multiple large feeders between the EJV and the malformation. Discussion: Sclerotherapy failed due to small contact time of the sclerosant with the endothelium. Surgical excision of these lesions is simple and straightforward, and should be considered as the first line of treatment whenever this clinical entity is recognised. Surgical Management of Slow-flow Venous Malformation of External Jugular VeinEJVES ExtraVol. 25Issue 2PreviewCervicofacial venous malformation (VMs) arising from the external jugular vein (EJV) are very rare. These distinct clinical entities may be easily and optimally treated with surgical excision without any resultant morbidity. Full-Text PDF Open Access

Three reactive compartments in venous malformations

Vascular malformations affect 3% of neonates. Venous malformations (VMs) are the largest group representing more than 50% of cases. In hereditary forms of VMs gene mutations have been identified, but for the large group of spontaneous forms the primary cause and downstream dysregulated genes are unknown. We have performed a global comparison of gene expression in slow-flow VMs and normal saphenous veins using human whole genome micro-arrays. Genes of interest were validated with qRT-PCR. Gene expression in the tunica media was studied after laser micro-dissection of small pieces of tissue. Protein expression in endothelial cells (ECs) was studied with antibodies. We detected 511 genes more than four-fold down- and 112 genes more than four-fold up-regulated. Notably, chemokines, growth factors, transcription factors and regulators of extra-cellular matrix (ECM) turnover were regulated. We observed activation and "arterialization" of ECs of the VM proper, whereas ECs of vasa vasorum exhibited up-regulation of inflammation markers. In the tunica media, an altered ECM turnover and composition was found. Our studies demonstrate dysregulated gene expression in tunica interna, media and externa of VMs, and show that each of the three layers represents a reactive compartment. The dysregulated genes may serve as therapeutic targets.

MR imaging of symptomatic peripheral vascular malformations.

We performed a retrospective study of symptomatic peripheral vascular malformations to determine if MR imaging can be used to distinguish slow-flow venous malformations from high-flow arteriovenous malformations and arteriovenous fistulas. Twenty-seven MR examinations in 25 patients with malformations outside the CNS were reviewed. Sixteen venous malformations, nine arteriovenous malformations, and two arteriovenous fistulas were included. In all cases, the MR findings were correlated with the results of angiography. The distinction between slow-flow venous malformations and high-flow arteriovenous malformations and arteriovenous fistulas was made primarily on T2-weighted MR images, which showed high signal intensity in venous malformations and flow voids in high-flow lesions. In addition to the previously described MR features of venous malformations (serpentine pattern with septations, associated muscle atrophy, and typical T1 and T2 signal intensities), several new MR features were apparent. Venous malformations had a propensity for multifocal involvement (37%), orientation along the long axis of extremities or affected muscles (78%), and adherence to neurovascular distributions (64%). Prominent subcutaneous fat was commonly seen adjacent to the malformation. MR images of arteriovenous malformations and arteriovenous fistulas also commonly showed muscle atrophy and subcutaneous fatty prominence. Our results show that slow-flow venous malformations can be distinguished from high-flow arteriovenous malformations and fistulas on the basis of spin-echo MR signal characteristics. The associated imaging characteristics help in the differential diagnosis in problematic cases.