The main aspects of diagnostics and treatment of diffuse arteriovenous forms of congenital vascular malformations of extremities with the presence of microfistulas

Chernukha, Larysa; Kashyrova, O. V.; Vlaykov, G. G.; Guch, A. O.; Власенко, О. А.; Kondratyuk, Vadim

doi:10.23736/s1593-232x.18.00418-6

Cited by 6 publications

(4 citation statements)

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“…Also, AVMs can have a mechanical influence on the surrounding tissues. The severity of clinical manifestations depends on the number of shunts, their localization, and the volume of arteriovenous shunting of blood [3,13].…”

Section: Discussionmentioning

confidence: 99%

“…The scientific data from the literary sources regarding the structural bone state in patients with AVMs are quite generalized, limited only by the description of radiological features; and with regard to the metabolism of bone tissue in this nosology, they are absent at all [14]. According to various data, the frequency of radiological changes in bone tissue ranges from 20 to 74 % [15].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with AVMs have some features of chronic vascular insufficiency which appears in the distal parts of the limb due to venous hypertension, insufficiency of the valve apparatus of deep and superficial veins. It is caused by a violation of microcirculation in the tissues as a result of the "steal syndrome", which is manifested by trophic disorders in the distal parts of the limb [3].…”

Section: Introductionmentioning

confidence: 99%

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Structural and functional state of bone in patients with arteriovenous malformations of the lower extremities

Zyma,

Vyderko,

Kincha-Polishchuk

et al. 2023

PJS

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Background. Disruption of regional blood flow in patients with arteriovenous malformations (AVMs) of the lower extremities changes the conditions of bone tissue functioning. The purpose was to study the structural and functional state of bone tissue and its metabolism in patients with AVMs of the lower extremities using dual-energy X-ray absorptiometry and the markers of bone turnover. Materials and methods. Fifteen patients with AVMs had been examined. The clinical class of chronic venous disease (CVD) was evaluated according to CEAP; patients were divided into 2 subgroups: the first one was with CVD C1-C3 and the second one was with CVD C4-C6. Bone mineral density (BMD) was studied based on the X-ray absorptiometry. The level of bone metabolism markers, such as procollagen type 1 N-terminal propeptide (P1NP), C-terminal cross-linking telopeptide of type 1 collagen (β-CTx) and osteocalcin, 25-hydroxyvitamin D (25(ОН)D) and parathyroid hormone were studied. Results. Disturbances of the bone tissue indices of the affected limb were found in 70 % of the patients. Also, the statistically significant difference in BMD of the affected limb compared to the healthy limb was established (р = 0.005). A multidirectional level of P1NP was detected; β-CTx exceeded norm in 80 % of the patients; osteocalcin exceeded norm in 33 % of the cases. In 67 % of the patients, a decrease in serum level of 25(OH)D was noted. Increase of the β-CTx level in the first subgroup and its decrease in the second one was associated with stabilization of the AVMs course and age-related changes in the hormonal background of the patients. Conclusions. Disturbances in the structural state of bone tissue of the affected limb were found in 70 % of the patients; statistically significant difference between the BMD of the affected and healthy limb obviously caused by the influence of regional hemodynamic disturbances. Various deviations of the metabolism markers were found, which indicates the need to develop a system of drug therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Structural and functional state of bone in patients with arteriovenous malformations of the lower extremities

Zyma,

Vyderko,

Kincha-Polishchuk

et al. 2023

PJS

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“…Патологічне шунтування крові призводить до явищ судинного обкрадання та тканинної гіпоксії у дистальних по відношенню до рівня шунтування відділів кінцівки, виникає вторинна гіпертензія у венозній системі. Ступінь вираженості клінічних проявів залежить від кількості шунтів, їх локалізації та об'єму артеріовенозного шунтування крові [12]. У випадку ВМ патологічні зміни судинного русла первинно обмежуються венозною системою, виникає порушення венозного відтоку ураженої кінцівки та формуються застійні явища у венозній системі [13].…”

Section: вступunclassified

Ultrasound Duplex Scanning of Vessels in the Diagnosis of Limb Length Discrepancy in Pediatric Patients with Congenital Vascular Malformations

Vyderko,

Zyma,

Chernukha

et al. 2024

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Summary. Background. Congenital vascular malformations (СVM) of the lower extremities can affect the longitudinal growth of the affected limb in pediatric patients. The influence of the regional blood flow disturbance on the formation of the limb length discrepancy (LLD) in CVM remains insufficiently studied. Objective: to study changes in regional blood flow based on color duplex angioscanning (CDA) of the main arteries of the lower extremities and to establish their influence on the formation of LLD in pediatric patients with CVM of the lower extremities. Material and Methods. The study included 36 pediatric patients with CVM of the lower extremities. The patients were divided according to the working classification scheme for the CVM (“VASC+T”): 23 arteriovenous, 7 venous, 4 capillary, and 2 lymphatic. The length of the lower extremities was assessed to determine the LLD. CDA of the main arteries of the lower extremities and soft tissues in the area of the knee joint was performed; blood flow velocity and pulsatility index (Pi) were evaluated. Results. LLD was diagnosed in 26 (72.2%) patients, while lengthening of the affected limb was observed in 21 (58.3%) patients and shortening was noted in 5 (13.8%) patients. In patients with a diffuse form of an arteriovenous malformation (AVM), the elongation of the affected limb was 2.76±1.54 cm, at the expense of the femur of 1.13±0.55 cm and at the expense of the tibia of 1.62±1.2 cm; LLD due to the elongation of individual segments of the affected limb was statistically insignificant (p = 0.192). In the case of diffuse form of AVM, an increase in blood flow velocity of the posterior tibial artery and a decrease in Pi in the popliteal and posterior tibial arteries of the affected limb were detected (p = 0.05). An increase in the total elongation of the affected limb with increased blood flow velocity on the superficial femoral artery was found, as well as an increase in the elongation of the affected limb with a decrease in Pi on the superficial femoral, popliteal, and posterior tibial arteries (p = 0.05). Conclusions. The study of regional blood flow of the lower extremities and LLD, which is the main orthopedic manifestation in patients with AVM, allows to establish the influence of hemodynamic disorders on the formation of orthopedic pathology in this category of patients. CDA in patients with diffuse form of AVM revealed a statistically significant increase in blood flow velocity in the posterior tibial artery, a decrease in the peripheral resistance (Pi) of the popliteal and posterior tibial arteries on the affected limb. Elongation of the affected limb with an increase in blood flow velocity on the superficial femoral artery, as well as a decrease in Pi on the superficial femoral, popliteal and posterior tibial arteries suggests a relationship between changes in regional blood circulation and LLD in patients with AVM.

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Orthopedic manifestations in patients with arteriovenous malformations of the lower limbs

GUK¹,

Чернуха²,

Zyma³

et al. 2023

Acta Phlebol

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The main aspects of diagnostics and treatment of diffuse arteriovenous forms of congenital vascular malformations of extremities with the presence of microfistulas

Cited by 6 publications

References 6 publications

Structural and functional state of bone in patients with arteriovenous malformations of the lower extremities

Structural and functional state of bone in patients with arteriovenous malformations of the lower extremities

Ultrasound Duplex Scanning of Vessels in the Diagnosis of Limb Length Discrepancy in Pediatric Patients with Congenital Vascular Malformations

Orthopedic manifestations in patients with arteriovenous malformations of the lower limbs

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