Venous malformations with severe localized intravascular coagulopathy treated with microwave ablation

Abstract

Objectives To evaluate the safety and feasibility of microwave ablation for treating venous malformations (VMs) with severe localized intravascular coagulopathy (LIC). Patients and methods Data for patients with the diagnosis of VMs coupled with severe LIC who underwent color Doppler-guided microwave dynamic ablation between January 2017 and June 2019 were retrospectively reviewed and analyzed. All patients had previously received sclerotherapy or other treatments with poor outcomes and gradual aggravation of coagulation abnormalities. Microwave treatment with “dynamic ablation” was performed with real-time color Doppler monitoring and was repeated if necessary after 3 months. Low-molecular-weight heparin (LMWH) was used to control consumptive coagulopathy. The therapeutic efficacy including coagulation function and lesion size was evaluated using the four-level scale developed by Achauer. Results Among 15 patients with extensive diffuse or multiple VMs, 10 patients presented with lesions in a single lower extremity, one in both lower extremities and the perineum, one in both upper extremities and the trunk, and three with multiple lesions. The patients underwent a total of 74 microwave ablation sessions, with an average of 4.9 sessions per person. Coagulation abnormalities were temporarily aggravated in 59 sessions within the first seven days post-ablation but improved to grade II (fair) a week later. From six months to three years after the ablation, the lesions improved to grade IV (excellent) in one patient, grade III (good) in six patients, and grade II (fair) in eight patients. Moreover, the coagulation function improved to grade IV in four patients, grade III in eight patients, and grade II in three patients, resulting in an efficiency rate of 80% (12/15). Post-ablation complications included fever, hemoglobinuria, and elevations in aspartate aminotransferase, lactate dehydrogenase, and alanine aminotransferase. The patients with fever and hemoglobinuria recovered after specific therapeutic measures, but elevations in aspartate aminotransferase, lactate dehydrogenase, and alanine aminotransferase recovered spontaneously without further interventions. Conclusions Ablation coupled with anticoagulation can effectively treat VMs in patients with severe LIC and improve the long-term coagulation function.

Microwave ablation with hydrodissection used for the treatment of vascular malformations: effectiveness and safety study

“…used MWA to treat venous malformations with severe localized intravascular coagulopathy. Their efficiency rate was 80% ( 27 ).…”

“…Therefore, hydrodissection around the VMs was needed to protect the surrounding tissues. If the injection of protective saline was not satisfactory in the operation, high temperature will lead to nerve damage (27)(28)(29)(30). Therefore, it is particularly important to evaluate neural safety preoperatively and to make corresponding plan of safe injection routes and neuroprotective strategy.…”

Case report: Experience of a rare case of rebound of the Kasabach-Merritt phenomenon during sirolimus treatment in kaposiform hemangioendothelioma

“…Embolization may bridge the gap between the occurrence of the life-threatening KMP and the effects of systemic treatment, and when combined with the systemic administration of sirolimus in the treatment of KHE, embolization provides a more rapid resolution of the KMP (1). Thermal ablation is a minimally invasive surgical technique that has been widely adopted for the treatment of various solid tumors, and it has gradually become an important tool in the treatment of difficult vascular malformations (8). It can be used as an alternative treatment when other treatment methods are ineffective (9).…”