Soft-tissue Venous Malformations Research Articles

Ultrasound-guided microwave ablation of soft tissue venous malformations

ObjectiveTo assess the feasibility, safety, and effectiveness of microwave ablation (MWA) for soft tissue venous malformations (VMs). MethodsWe retrospectively analyzed 20 patients with symptomatic VMs in the lower extremities and trunk. MWA was performed in all 20 patients. Contrast-enhanced ultrasound (CEUS) was performed immediately and 1 month after ablation. The data on the complete ablation rate, symptom improvement, and patient satisfaction were collected. Follow-up examinations began 1 month after ablation and continued for 2 to 19 months. ResultsMWA was performed on 20 patients. The overall complete ablation rate was 75% (15/20). The complete ablation rate for the 11 patients with lesions <5 cm and the 9 patients with lesions >5 cm were 100% (11/11) and 44% (4/9), respectively. The complete ablation rate for the 14 patients with localized and 6 patients with extensive lesions was 93% (13/14) and 33% (2/6), respectively. Five patients had experienced incomplete ablation; 1 had a lesion >5 cm with ectopic drainage vessels, one had multiple lesions adherent to blood vessels and nerves, and three had large and extensive lesions. Thirteen patients had experienced significant improvements in clinical symptoms; 6 showed slight improvement; and 1 showed no change in symptoms. No complications or recurrences were observed. All 20 patients were satisfied with the therapeutic effect (100%). Twelve patients were significantly satisfied and 8 were slightly satisfied. ConclusionsMWA with ultrasound guidance is a safe, effective, and minimally invasive therapy for symptomatic soft tissue VMs and may be a promising approach in the future.

Percutaneous Cryoablation of Lower Limb Soft-Tissue Venous Malformations: Preliminary Results of Long-Term Efficacy.

To retrospectively evaluate long-term efficacy of percutaneous cryoablation for lower limb soft-tissue venous malformations. Nine patients (mean age, 36.6years) with lower limb soft-tissue venous malformations were included. Cryoablation was performed percutaneously using an argon-based system. Adverse events (AE) using the Common Terminology Criteria for AEs version 4.0 were evaluated. The visual analog scale (VAS) scores and lesion volumes measured on magnetic resonance imaging were also evaluated at 12months and 5-6years. Technical success (i.e., complete coverage of the lesion by an iceball) was achieved in eight of the nine patients. All patients developed a total of 14 grade 1 or 2 adverse events. The mean (± standard deviation) VAS score was 6.0 (± 1.7) before therapy, whereas it was 0.14 (± 0.27) at 12months and 0.97 (± 1.3) at 5-6years (58-78months). Complete pain relief was obtained in 6 and 5 patients at 12months and 5-6years, respectively. The median lesion volume was 2.49mL before therapy, whereas it was 0.26mL at 12months and 0.35mL at 5-6years. Percutaneous cryoablation of lower limb soft-tissue venous malformations achieved considerable pain relief and lesion shrinkage for 5-6years in this small preliminary study. Level 4, Case Series.

Visualization of Soft Tissue Venous Malformations of Head and Neck with 4D Flow Magnetic Resonance Imaging.

Evaluation of hemodynamics in venous malformation (VM) in the head and neck area is done by direct puncture venography before alcohol sclerotherapy, but it is difficult due to a variable degree of filling in from the artery and filling out into the draining vein. We present our preliminary experience of 4D MRI to evaluate VM hemodynamics. Four patients with venous malformation in the maxillofacial area underwent both 4D MRI and direct puncture venography before alcohol sclerotherapy. To find out appropriate velocity encoding (VENC) for VM, we applied 5-50 cm/sec VENC. Significant high-flow foci demonstrated by phase changes in magnitude images were compared with lesion types shown on a direct puncture venogram. Detection of flow in VM was possible in magnitude images or phase-difference images when VENC was set to less than 30 cm/sec. Appropriate VENC for VM was regarded as less than 5 cm/sec. High-flow areas in the dilated venous sac demonstrated focal spots or linear band-like areas on phase changes of 4D MRI. Appropriate VENC application was mandatory to detect flow in VM. Flow information on 4D MRI provided flow information in VM which was not detected on a direct puncture venogram in the compartmentalized lesion and thus can make alcohol sclerotherapy safer.

3:00 PMAbstract No. 296 - ▪ FEATURED ABSTRACT Percutaneous image-guided cryoablation of soft-tissue venous vascular malformations: a study of safety and efficacy

3:00 PMAbstract No. 296 - ▪ FEATURED ABSTRACT Percutaneous image-guided cryoablation of soft-tissue venous vascular malformations: a study of safety and efficacy

Clinical validation of semi-automated software for volumetric and dynamic contrast enhancement analysis of soft tissue venous malformations on Magnetic Resonance Imaging examination

To evaluate venous malformation (VM) volume and contrast-enhancement analysis on magnetic resonance imaging (MRI) compared with diameter evaluation. Baseline MRI was undertaken in 44 patients, 20 of whom were followed by MRI after sclerotherapy. All patients underwent short-tau inversion recovery (STIR) acquisitions and dynamic contrast assessment. VM diameters in three orthogonal directions were measured to obtain the largest and mean diameters. Volumetric reconstruction of VM was generated from two orthogonal STIR sequences and fused with acquisitions after contrast medium injection. Reproducibility (interclass correlation coefficients [ICCs]) of diameter and volume measurements was estimated. VM size variations in diameter and volume after sclerotherapy and contrast enhancement before sclerotherapy were compared in patients with clinical success or failure. Inter-observer ICCs were similar for diameter and volume measurements at baseline and follow-up (range 0.87-0.99). Higher percentages of size reduction after sclerotherapy were observed with volume (32.6 ± 30.7%) than with diameter measurements (14.4 ± 21.4%; P = 0.037). Contrast enhancement values were estimated at 65.3 ± 27.5% and 84 ± 13% in patients with clinical failure and success respectively (P = 0.056). Venous malformation volume was as reproducible as diameter measurement and more sensitive in detecting therapeutic responses. Patients with better clinical outcome tend to have stronger malformation enhancement. • Magnetic resonance imaging readily demonstrates diameters and volumes of venous malformations • MRI diameter calculations are reproducible in estimating the size of venous malformations • But volumetric models of malformations are more sensitive in detecting therapeutic response • Dynamic enhancement is also better assessed with automated volumetric software • Volumetric analysis of malformations offers promise to guide therapy and assess response.

Commentary on Preliminary Experience with Intraoperative Near-Infrared Fluorescence Imaging in Percutaneous Sclerotherapy of Soft-Tissue Venous Malformations

Commentary on Preliminary Experience with Intraoperative Near-Infrared Fluorescence Imaging in Percutaneous Sclerotherapy of Soft-Tissue Venous Malformations

Preliminary Experience With Intraoperative Near-infrared Fluorescence Imaging in Percutaneous Sclerotherapy of Soft-Tissue Venous Malformations

It has recently been demonstrated that near-infrared (NIR) fluorescence imaging can be used to visualize the blood vasculature. Although sclerotherapy has been successfully used in treating venous malformations, the spread of sclerosant is difficult to monitor during sclerotherapy. To evaluate the safety and efficacy of NIR fluorescence imaging in percutaneous sclerotherapy of soft-tissue venous malformations. The use of NIR fluorescence imaging after administration of indocyanine green (ICG) was evaluated in duplex-guided sclerotherapy performed on 15 patients with venous malformations. The lower extremities were involved in seven, the upper extremities in four, and the face in four. In 13 of the 15 procedures, spotty fluorescence images were obtained, and in eight procedures, linear fluorescence images were obtained. In two patients with intramuscular venous malformations in the lower extremities, no fluorescence images were obtained. Observational depth seemed to be <1cm below the skin surface with an ICG concentration of 0.01mg/mL. No complications associated with ICG were observed. Adjacent tissue ulceration occurred in one patient. NIR fluorescence imaging with ICG can be a useful additional monitor for percutaneous sclerotherapy of venous malformations, especially in the face and hands, enabling noninvasive assessment of real-time spread of sclerosant.

Venous Malformation

Venous malformations (VMs) can cause significant morbidity, particularly because they enlarge over time and become symptomatic. The purpose of this study was to determine the natural progression of VMs to facilitate patient counseling, gain insight into pathophysiology, and guide therapy. Our Vascular Anomalies Center database was reviewed for patients with cutaneous and soft-tissue VMs. Predictive variables were age, gender, location, pregnancy, and size. The outcome variable was natural progression of the malformation defined by expansion of the lesion or the onset/worsening of symptoms. The study included 614 patients. Children had a 26.1% risk of progression prior to adolescence, 74.9% before adulthood, and 93.2% over their lifetime. Progression was more likely in adolescence (60.9%) than in childhood (22.5%); the relative risk was 2.6 (95% confidence interval, 2.1-3.2) (P = 0.0001). Diffuse VMs progressed more often than localized lesions (P = 0.002); extremity and trunk VMs worsened more frequently than head/neck lesions (P = 0.03). VMs have a higher risk of progression in adolescents than in children; pubertal hormones may contribute to expansion. Because of their high rate of progression, early treatment of asymptomatic VMs should be considered.

Sclérose percutanée des malformations veineuses superficielles : étude rétrospective de 68 cas

Purpose To evaluate the efficacy of percutaneous sclerotherapy for the treatment of venous malformations (VMs) with regards to cosmetic and functional outcome as a function of their size and to review the complications. Materials and Methods A retrospective study was performed between January 1997 and January 2002 on 68 patients (45 females and 23 males) ranging in age from 3 to 60 years at the CHRU of Tours. Results Percutaneous sclerotherapy was a very effective treatment for small and medium-size VMs, for which the aim was to achieve cure. Aetoxisclerol ® and Ethibloc ® are the sclerosing agents used. They were associated with minimal side effects and no major complication. For larger lesions, the treatment was more complex and combined stronger and also more dangerous agents like absolute ethanol and Histoacryl ®. The aim was then a decrease of cosmetic and functional problems. Conclusion Percutaneous sclerotherapy with Aetoxisclerol ®, Ethibloc ®, absolute ethanol or Histoacryl ®, either alone or before surgery, is a safe and effective method of managing soft-tissue venous malformations.

Soft-tissue venous malformations in adult patients: imaging and therapeutic issues.

Venous malformations are the most common vascular malformations. However, confusion with respect to terminology and imaging guidelines continues to result in improper diagnosis and treatment. An appropriate classification scheme for vascular anomalies is important to avoid the use of false generic terms. Adequate imaging in association with clinical findings is crucial to establishing the correct diagnosis. Doppler ultrasonography should be the initial imaging modality and demonstrates absence of flow or low-velocity venous flow. Computed tomography and magnetic resonance (MR) imaging are used primarily for pretreatment evaluation of lesion extension. These lesions are usually hypointense on T1-weighted MR images and markedly hyperintense on T2-weighted images with variable gadolinium enhancement. Direct phlebography helps confirm the diagnosis and exclude other soft-tissue tumors. Three distinct phlebographic patterns (cavitary, spongy, dysmorphic) have been identified. In most cases, conservative treatment is recommended. Sclerotherapy with or without surgery is useful in cases of functional impairment or significant aesthetic prejudice, even if recurrences are frequent. Direct phlebography is performed when a more detailed assessment of the vascular pattern is needed or as part of sclerotherapy. Use of the appropriate imaging technique is critical in establishing the diagnosis, evaluating extension, and planning appropriate treatment.

Percutaneous sclerotherapy for venous malformation of the lips: a retrospective study of 23 patients.

Labial venous malformations are relatively common. Depending on their size, they are responsible for functional and cosmetic handicap. When treatment is indicated, it will be based on percutaneous sclerotherapy, using Ethibloc or Aetoxysclerol, with surgery in some patients. Our purpose was to review 23 patients with soft-tissue venous malformations of the lips. Follow-up ranged from 6 months to 4 years. Sclerotherapy alone or with surgical resection achieved good results in 18 patients. In six patients mild improvement was obtained. No worsening of the initial clinical situation occurred, and no persistent complication was observed. We discuss the indications for treatment and the different types of sclerosing agent. Percutaneous sclerotherapy is safe and is effective for small and medium-size labial malformations. For larger lesions the treatment is more complex and combined long term sclerotherapy and surgery procedures may be required over several years.

Soft-tissue venous malformations in pediatric and young adult patients: diagnosis with Doppler US.

To describe the diagnostic features, appearance, and vascularization pattern of venous malformations (VMs) at Doppler ultrasonography (US). Between February 1991 and May 1997, 51 soft-tissue VMs were studied with Doppler US in patients between 1 day and 21 years of age (mean age, 9 years). These VMs were located in the maxillofacial region (n = 19), trunk (n = 5), and upper (n = 10) and lower (n = 17) extremities. Twenty-three VMs had venographic confirmation, seven had only histologic confirmation, and 21 had both venographic and histologic confirmation. US was performed with 7.5- or 7-10-MHz linear transducers, a low pulse repetition frequency (mean, 1,680 Hz), and the lowest wall filter (25-50 Hz). At gray-scale US, VMs appeared as hypoechoic, heterogeneous lesions in 82% of cases. All lesions displayed compressibility. In eight lesions (16%), phleboliths were identified, thus confirming the diagnosis of VM. Analysis of vascular flow revealed monophasic, low-velocity flow in 40 VMs (78%), with an average flow velocity of 0.22 kHz. Biphasic flow was noted at the periphery of three lesions, which is indicative of a mixed capillary-venous malformation. The remaining eight lesions did not display any flow. In pediatric patients, Doppler US is a noninvasive, easily available, and rapid mode of investigation of vascular lesions and can help confirm the diagnosis of VM when it shows a characteristic flow pattern.

Soft-tissue venous malformations in children: percutaneous sclerotherapy with Ethibloc.

Thirty-eight children with soft-tissue venous malformations (VMs) were treated with percutaneous injection of a new fibrosing agent (Ethibloc). The technique, results, side effects, and complications are detailed. Direct puncture of the VM allows evaluation of the draining venous system and direct injection of Ethibloc. This procedure alone or associated with surgery led to achievement of good or excellent results in 74% of the cases (complete cure in 50%), with minimal side effects and no major complications.