Arteriovenous Malformations of the Head and Neck

Rosenberg, Tara L.; Suen, James Y.; Richter, Gresham T.

doi:10.1016/j.otc.2017.09.005

Cited by 41 publications

(45 citation statements)

References 30 publications

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“…AVM was diagnosed by clinical and MRI signs and by consensus of our multidisciplinary consultations dedicated to vascular anomalies (involving a dermatologist, a radiologist and a surgeon). Imaging criteria for diagnosing AVM included color Doppler ultrasonography showing arteriovenous waveforms and high vascular flow as well as MRI and magnetic resonance angiography, which were systematically performed and allowed for visualizing flow voids without parenchymal staining, enlarged feeding and draining veins and early contrast enhance (13). Sirolimus had been proposed to patients for pain, ulceration or evolution of the AVM and when embolization and/or surgical intervention were not possible or sufficiently effective or not accepted by patients.…”

Section: Participantsmentioning

confidence: 99%

Efficacy and Tolerance of Sirolimus (Rapamycin) for Extracranial Arteriovenous Malformations in Children and Adults

Gabeff¹,

Boccara²,

Soupre³

et al. 2019

Acta Derm Venerol

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Managing extracranial arteriovenous malformations is challenging. Sirolimus (rapamycin) is increasingly being used in all kinds of vascular anomalies. In this study, we report the largest series of arteriovenous malformations treated with sirolimus, which included 10 patients (7 children). Results suggest a poor efficacy of sirolimus for this condition, with only partial response in 50% of patients, which was transient and lasted several months in 2 of 5 patients, with further worsening. Managing extracranial arteriovenous malformations is challenging. Sirolimus (rapamycin) is increasingly being used when surgery and embolization are not advised. Because of its anti-angiogenic properties, here we report all extracranial arteriovenous malformation cases treated with sirolimus in 2 French tertiary centers for vascular anomalies. The outcomes were efficacy (complete, partial, no response) based on arteriovenous malformation volume and necrosis/hemorrhage and side effects. We retrospectively included 10 patients (7 children). The sirolimus dose ranged from 0.6 to 3.5 mg/m 2. Median (interquartile range [IQR]) treat ment time was 24.5 (4.5; 35) months. Five patients showed no response, and 5 showed partial response at a median (IQR) of 3 (1; 5) months, followed in 2 cases by therapeutic resistance (i.e., progressive disease after 9 and 24 months of treatment). The most frequent side effect was mouth ulcers. This study shows poor efficacy of sirolimus for treating extracranial arteriovenous malformations.

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Section: Participantsmentioning

confidence: 99%

Efficacy and Tolerance of Sirolimus (Rapamycin) for Extracranial Arteriovenous Malformations in Children and Adults

Gabeff¹,

Boccara²,

Soupre³

et al. 2019

Acta Derm Venerol

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“…The use of vascular laser for fast‐flow lesions has been classically contraindicated as there is a fear of accelerating the progression of the AVM, especially if residual vessels are left untreated. However, there are recent reports of good response to laser treatment in selected patients with Schöbinger stage I AVMs . Both Nd:YAG laser alone and a combination of PDL at 595 nm with Nd‐YAG at 1064 nm (Multiplex system, Cynosure Inc) have been used with up to 90% response rates and no recurrence in acquired digital AVMs .…”

Section: Discussionmentioning

confidence: 99%

“…However, there are recent reports of good response to laser treatment in selected patients with Schöbinger stage I AVMs . Both Nd:YAG laser alone and a combination of PDL at 595 nm with Nd‐YAG at 1064 nm (Multiplex system, Cynosure Inc) have been used with up to 90% response rates and no recurrence in acquired digital AVMs . To our knowledge, PDL monotherapy has not been previously reported.…”

Section: Discussionmentioning

confidence: 99%

Good response to pulsed dye laser in patients with capillary malformation‐arteriovenous malformation syndrome (CM‐AVM)

Iznardo

Roé

Puig

et al. 2020

Pediatric Dermatology

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Capillary malformation‐arteriovenous malformation syndrome (CM‐AVM) is an autosomal dominant disorder caused by heterozygous mutations in RASA1 and EPHB4. Capillary stains in CM‐AVM are compatible with Schöbinger's phase I AVMs. Vascular laser has been classically contraindicated for the treatment of AVMs, as there is a fear of accelerating their progression. In this study, we have treated capillary stains in five CM‐AVM patients with pulsed dye laser, with improvement and without worsening or recurrence of the lesions after 1 year of clinical and ultrasound follow‐up.

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“…2 Arteriovenous malformations can occur in different locations in the head and neck but are seen most commonly in the ear, oral cavity, lip, and midface. 2 Untreated AVMs expand due to vascular recruitment and collateralization. This may lead to complications such as disruption of adjacent normal tissue, hemorrhage, or high-output heart failure.…”

Section: Discussionmentioning

confidence: 99%

“…This may lead to complications such as disruption of adjacent normal tissue, hemorrhage, or high-output heart failure. 2,3 Histologically, AVMs arise from shunts between arteries and veins that lead to the formation of soft tissue masses. 2 Computed tomography angiography is the gold standard for the diagnosis of AVMs.…”

Section: Discussionmentioning

confidence: 99%