An institution-wide algorithm for direct-stick embolization of peripheral venous malformations

Nassiri, Naiem; Huntress, Lauren A.; Simon, Mitchell; Murphy, Susan

doi:10.1016/j.jvsv.2017.12.011

Cited by 13 publications

(10 citation statements)

References 17 publications

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“…Meanwhile, there is no high level of evidence in the literature to support the method of EST, and the choice and concentration of agents, hence experience and familiarity with techniques remains the most reliable determinants of clinical outcomes. 10,12 For example, foam sclerotherapy with STS is often used to treat LFVM, whereas ethanol is used for both HFVM and LFVM. 13–15 The overall complication rate of ethanol sclerotherapy of AVM has been reported to be relatively high, ranging from 10% to 52%; with the use of absolute ethanol to be associated with the highest complication rates.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study reported a complication rate of 12.3% from sclerotherapy of intramuscular venous malformation of the upper and lower extremity 9 . Post-operative death including from pulmonary embolism following EST of peripheral VM has also recently been reported 10 .…”

Section: R E V I E W C O P Y Introductionmentioning

confidence: 98%

“…9 Post-operative death including from pulmonary embolism following EST of peripheral VM has also recently been reported. 10…”

Section: Introductionmentioning

confidence: 99%

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Incidence of major complication following embolo-sclerotherapy for upper and lower extremity vascular malformations

et al. 2020

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Objective The current literature on the major complications of embolo-sclerotherapy of upper and lower extremity vascular malformations is scarce. Evaluating and understanding the rates and types of potential major complications of embolo-sclerotherapy of vascular malformations help treatment planning and informed consent. Therefore, this study reviewed major complications following embolo-sclerotherapy of all upper and lower extremity vascular malformations in a single specialized multidisciplinary vascular malformation center over a 5-year period. Methods All patients with vascular malformations underwent multidisciplinary directed intervention. Demographic, procedural, follow-up, and complication data were collected prospectively in a dedicated database, and reviewed retrospectively. Major complications for upper and lower extremity vascular malformations from 1 January 2013 to 31 December 2017 were analyzed. All embolo-sclerotherapies of high-flow vascular malformations (HFVMs) were performed under selective catheter angiography and direct injection, but low-flow vascular malformations (LFVM) with direct injection only. Major complications were defined as any tissue or functional damage caused by direct injection, distal embolization, or tissue reaction. Results Seventy patients (median age of 25 years; 44 males and 26 females) had 150 embolo-sclerotherapy procedures for upper extremity vascular malformation. Of these, 28 patients had embolo-sclerotherapy for HFVM and 42 patients for LFVM; total 78 and 72 procedures, respectively. A total of 107 patients (median age of 26 years; 42 males and 65 females) had 160 embolo-sclerotherapy interventions for lower extremity vascular malformations. Of these, 18 patients had embolo-sclerotherapy for HFVM and 89 patients for LFVM; total of 30 and 130 procedures, respectively. The overall major complication rates following embolo-sclerotherapy of upper and lower extremity vascular malformations were 14.3% and 4.7%, respectively ( P = 0.030). In the upper extremity HFVM group, major complications from embolo-sclerotherapy occurred in five patients; three ischemic fingers requiring amputation and two skin ulcerations. Meanwhile, in the upper extremity LFVM group, major complications occurred in five patients; one median nerve injury requiring nerve grafting and hand therapy, one hand contracture requiring tendon release, and three skin ulcerations. There was only one major complication, which was cellulitis in the lower extremity HFVM group. In the lower extremity LFVM group, major complications occurred in four patients; two skin ulcerations, one cellulitis, and one deep vein thrombosis. Conclusions Embolo-sclerotherapy is relatively safe for upper and lower extremity vascular malformations in a high-volume experienced center where our major complication rates were 14.3% and 4.7%, respectively, which compare favorably or similar to those reported in most recent literature. These outcomes will direct treatment strategies to avoid local and systemic toxic complications in the upper and lower extremity, for both HFVM and LFVM, and to improve informed consent.

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Section: Discussionmentioning

confidence: 99%

Section: R E V I E W C O P Y Introductionmentioning

confidence: 98%

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Incidence of major complication following embolo-sclerotherapy for upper and lower extremity vascular malformations

et al. 2020

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“…21,22 Low potent but less toxic alternative preparations cover sodium tetradecyl sulfate (STS), polidocanol, sodium morrhuate, bleomycin, and cyanoacrylate adhesives. 22 The satisfactory result of sclerotherapy is defined as more than 75% reduction in lesion volume 6 months after sclerotherapy, and recurrence signifies that the lesion area rebound by more than 50% beyond 6 months compared with presclerotherapy size. 17 Sirolimus (rapamycin) has been successfully used as an antiangiogenic agent, 7 and investigators have identified that it can reduce pain, bleeding, lesion size, functional, and esthetic impairment.…”

Section: Treatmentmentioning

confidence: 99%

“…10 Other documented complications consist of central cardiopulmonary toxicity, neurotoxicity, local tissue injury, skin necrosis, and peripheral nerve paralysis, as well as potentially fatal pulmonary embolism. 21,22 Low potent but less toxic alternative preparations cover sodium tetradecyl sulfate (STS), polidocanol, sodium morrhuate, bleomycin, and cyanoacrylate adhesives. 22 The satisfactory result of sclerotherapy is defined as more than 75% reduction in lesion volume 6 months after sclerotherapy, and recurrence signifies that the lesion area rebound by more than 50% beyond 6 months compared with presclerotherapy size.…”

Section: Treatmentmentioning

confidence: 99%

Localized intravascular coagulation in venous malformations: A system review

2020

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Venous malformation is one of the slow-flow vascular malformations. Dysfunction of coagulation often occurs in most venous malformations, especially the diffuse and multifocal lesions, referred to as localized intravascular coagulopathy. It is characterized by the elevation of D-dimers and fibrin degradation products, low levels of fibrinogen, FV, FVIII, FXIII, and antithrombin III, and sometimes minor-to-moderate thrombocytopenia. Here we reviewed the clinical manifestations, pathogenesis, diagnosis, and treatment of localized intravascular coagulopathy in venous malformations.

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Peri‐procedural Anticoagulation in Patients with Head and Neck Versus Extremity Venous Malformations

et al. 2020

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Objective (1) Review a multidisciplinary vascular anomalies center's practice regarding periprocedural anticoagulation for venous malformations (VM) and the associated risk of thromboembolic and disseminated intravascular coagulation (DIC) events. (2) Compare the risk of thromboembolic events and DIC post‐procedure between head and neck (H&N) and extremity VM patients. Methods An Institutional Review Board (IRB)‐approved, retrospective chart review was performed on 120 VM patients. A thromboembolic event was defined as a thrombus formation post‐sclerotherapy or post‐surgery within 2 months in a distant or local venous structure not directly addressed by the procedure. Results There were 39 cases involving the H&N and 81 cases based at the extremities. There were eight cases of post‐procedure thrombus formation within the extremity VM group (8/71; 11.3%) as opposed to 0 cases in the H&N group (OR: 0, 95% CI .00–.09), p = .049. There was no difference in incidence of post‐procedure thromboembolic events between those with elevated D‐dimer (H&N: 0%, extremity: 22.7%, 5/22) and normal D‐dimer values (H&N: 0%, extremity: 6.3% [1/16], P = .370). There was no difference in incidence of post‐procedure thromboembolic events between those who received periprocedural anticoagulation (H&N: 0%, extremity: 21%, 4/19) and those who did not (H&N: 0%, extremity: 8.2%, 4/49), (Extremity: OR: 3.00, .67–13.50, P = .206). Conclusion Post‐procedure thromboembolism is rare in the treatment of venous malformations, especially in the head and neck subsite. Regardless of anticoagulation use, there were no thromboembolic events for H&N VM patients. Such events are rare, and the odds may approach zero, especially with small sample size. Level of Evidence 4 Laryngoscope, 131:1163–1167, 2021

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An institution-wide algorithm for direct-stick embolization of peripheral venous malformations

Cited by 13 publications

References 17 publications

Incidence of major complication following embolo-sclerotherapy for upper and lower extremity vascular malformations

Incidence of major complication following embolo-sclerotherapy for upper and lower extremity vascular malformations

Localized intravascular coagulation in venous malformations: A system review

Peri‐procedural Anticoagulation in Patients with Head and Neck Versus Extremity Venous Malformations

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