scholarly journals Preoperative Cyanoacrylate Embolization of Venous Malformations

2018 ◽  
Vol 02 (01) ◽  
pp. 042-050 ◽  
Author(s):  
Eric Monroe ◽  
Rush Chewning ◽  
Kevin Koo ◽  
Giri Shivaram
Keyword(s):  
Blood Loss ◽  
Surgical Margin ◽  
Surgical Excision ◽  
High Volume ◽  
Definitive Treatment ◽  
Incomplete Resection ◽  
Venous Malformations ◽  
Cyanoacrylate Glue ◽  
Multiple Treatment ◽  
Percutaneous Sclerotherapy

AbstractPercutaneous sclerotherapy and standalone surgical excision have historically been the mainstay of treatment for pediatric venous malformations (VMs). However, both approaches have significant limitations. Sclerotherapy often requires multiple treatment sessions, with each round adding additional procedural and anesthetic risks as well as radiation exposure. Standalone surgical excision of VMs can be complicated by high-volume blood loss, and indistinct lesion margins can lead to incomplete resection, resulting in recurrence. An alternative to these approaches is percutaneous cyanoacrylate glue embolization followed by immediate surgical excision, a single-stage procedure that allows for better surgical margin definition and reduced intraoperative blood loss, potentially leading to more definitive treatment. The authors describe the interventional radiology aspects of this combined procedure, emphasizing materials preparation and embolization technique.

Percutaneous sclerotherapy for spongiform venous malformations – analysis of patient-evaluated outcome and satisfaction

VASA ◽  
2017 ◽  
Vol 46 (6) ◽  
pp. 477-483
Author(s):  
Robert Karl Clemens ◽  
Frederic Baumann ◽  
Marc Husmann ◽  
Thomas Oleg Meier ◽  
Christoph Thalhammer ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Medical Records ◽  
Venous Malformation ◽  
Primary Treatment ◽  
Venous Malformations ◽  
Treated Area ◽  
Item Questionnaire ◽  
Percutaneous Sclerotherapy ◽  
Multiple Treatments ◽  
Pain Improvement

Abstract. Background: Congenital venous malformations are frequently treated with sclerotherapy. Primary treatment goal is to control the often size-related symptoms. Functional impairment and aesthetical aspects as well as satisfaction have rarely been evaluated. Patients and methods: Medical records of patients who underwent sclerotherapy of spongiform venous malformations were reviewed and included in this retrospective study. The outcome of sclerotherapy as self-reported by patients was assessed in a 21 item questionnaire. Results: Questionnaires were sent to 166 patients with a total of 327 procedures. Seventy-seven patients (48 %) with a total of 159 procedures (50 %) responded to the survey. Fifty-seven percent of patients were male. The age ranged from 1 to 38.1 years with a median age of 16.4 years. The lower extremities were the most common treated area. Limitations caused by the venous malformation improved in the majority of patients (e.g. pain improvement 87 %, improvement of swelling 83 %) but also worsening of symptoms occurred in a minority of cases. Seventy-seven per cent would undergo sclerotherapy again. Conclusions: Sclerotherapy for treatment of venous malformations results in significant reduction of symptoms. Multiple treatments are often needed, but patients are willing to undergo them.

Influence of Fluid Infusion Associated with High-volume Blood Loss on Plasma Propofol Concentrations

2004 ◽  
Vol 100 (4) ◽  
pp. 871-878 ◽  
Author(s):  
Tadayoshi Kurita ◽  
Tomiei Kazama ◽  
Koji Morita ◽  
Shunsuke Fujii ◽  
Masahiro Uraoka ◽  
...  
Keyword(s):  
Steady State ◽  
Blood Loss ◽  
Hydroxyethyl Starch ◽  
High Volume ◽  
Fluid Infusion ◽  
Ringer’S Solution ◽  
Group A ◽  
Volume Blood ◽  
Lactated Ringer's Solution ◽  
Common Clinical Practice

Background It is common clinical practice to use fluid infusion to manage high-volume blood loss until a blood transfusion is performed. The authors investigated the influence of fluid infusion associated with blood loss on the pseudo-steady state propofol concentration. Methods Twenty-seven swine were assigned to a lactated Ringer's solution group, a hydroxyethyl starch group, or a threefold lactated Ringer's solution group (n = 9 in each group). After 180 min of steady state infusion of propofol at a rate of 2 mg.kg(-1).h(-1), hemorrhage and infusion were induced by stepwise bleeding followed by fluid infusion every 30 min. In each of the first two steps, 400 ml blood was collected; thereafter, 200 ml was collected at each step. Just after each bleeding step, fluid infusion was rapidly performed using a volume of lactated Ringer's solution or hydroxyethyl starch equivalent to the blood withdrawn, or a threefold volume of lactated Ringer's solution. Hemodynamic parameters and the plasma propofol concentration were recorded at each step. Results Although the plasma propofol concentration in the lactated Ringer's solution group increased with hemorrhage and infusion, it decreased in both the hydroxyethyl starch and the threefold lactated Ringer's solution groups. The propofol concentration in the hydroxyethyl starch group could be expressed by the following equation: Plasma Propofol Concentration Decrease (%) = 0.80 x Hematocrit Decrease (%) (r2 = 0.83, P < 0.0001). Conclusions When high-volume blood loss is managed by isovolemic hemodilution, the plasma propofol concentration during continuous propofol infusion decreases linearly with the hematocrit decrease.

Percutaneous Sclerotherapy for Congenital Venous Malformations in the Extremities

Orthopedics ◽  
2001 ◽  
Vol 24 (1) ◽  
pp. 45-51
Author(s):  
Yuki Yao ◽  
Nick N T Lomis ◽  
Steven M Scott ◽  
Hyo-Chun Yoon ◽  
Franklin J Miller
Keyword(s):  
Venous Malformations ◽  
Percutaneous Sclerotherapy

scholarly journals Does preoperative transarterial embolization decrease blood loss during spine tumor surgery?

2015 ◽  
Vol 21 (1) ◽  
pp. 129-135 ◽  
Author(s):  
Zhihong Qiao ◽  
Ningyang Jia ◽  
Qian He
Keyword(s):  
Blood Loss ◽  
Transarterial Embolization ◽  
Surgical Excision ◽  
Spinal Tumor ◽  
Gelatin Sponge ◽  
Spinal Tumors ◽  
Control Group ◽  
Time Interval ◽  
Estimated Blood Loss ◽  
Spine Tumor Surgery

This paper aimed to evaluate the effect of preoperative transarterial embolization (TAE) on estimated blood loss (EBL) during surgical excision of the vertebral tumors. Three hundred and forty-eight patients with spinal tumors were retrospectively analyzed. The preoperative TAE group consisted of 190 patients and the control group consisted of 158 patients. Gelatin sponge particles mixed withy contrast agent were used in the TAE group to embolize the tumor-feeding artery. The factors evaluated included: the time interval between embolism and surgery; the number of vertebrae involved by the tumor; pathological type of tumor; surgical approach; extent of excision and instrumental fixation. The time interval (P = 0.4669)between embolism and surgery had no significant correlation with EBL during surgery. The pathological diagnosis of vertebral tumor such as plasma cell myeloma, giant cell tumor, chondrosarcoma, hemangioma and metastasis had no significant correlation with EBL between the TAE group and control group during surgery, while the EBL of chordoma in the TAE group was significantly higher than that in the control group (p = 0.0254). The number of vertebrae involved (p = 0.4669, 0.6804, 0.6677), posterior approach (p = 0.3015), anterior approach (p = 0.2446), partial excision (p = 0.1911) and instrumental fixation (p = 0.1789) had no significant correlation with EBL during surgery between the TAE group and the control group. This study showed that preoperative TAE of the spinal tumor had no significant effect on intra-operative blood loss during surgical excision of the spinal tumor. In view of the risk of embolism, this method should be carefully considered.

scholarly journals The effects of surgical treatment and sclerotherapy for intramuscular venous malformations: a comparative clinical study

2021 ◽  
Vol 48 (6) ◽  
pp. 622-629
Author(s):  
Yun Hyun Kim ◽  
Jeong Yeop Ryu ◽  
Joon Seok Lee ◽  
Seok Jong Lee ◽  
Jong Min Lee ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Clinical Outcomes ◽  
Vascular Malformations ◽  
Medical Center ◽  
Surgical Excision ◽  
Complication Rates ◽  
Venous Malformations ◽  
Treatment Groups ◽  
Comparative Clinical Study

Background Venous malformations (VMs) are the most common type of vascular malformations. Intramuscular venous malformations (IMVMs) are lesions involving the muscles, excluding intramuscular hemangiomas. The purpose of this study was to compare clinical outcomes between patients with IMVMs who were treated with sclerotherapy and those who were treated with surgical excision.Methods Of 492 patients with VMs treated between July 2011 and August 2020 at a single medical center for vascular anomalies, 63 patients diagnosed with IMVM were retrospectively reviewed. Pain, movement limitations, swelling, and quality of life (QOL) were evaluated subjectively, while radiological outcomes were assessed by qualified radiologists at the center. Complication rates were also evaluated, and radiological and clinical examinations were used to determine which treatment group (sclerotherapy or surgical excision) exhibited greater improvement.Results Although there were no significant differences in pain (P=0.471), swelling (P=0.322), or the occurrence of complications (P=0.206) between the two treatment groups, the surgical treatment group exhibited significantly better outcomes with regard to movement limitations (P=0.010), QOL (P=0.013), and radiological outcomes (P=0.017). Moreover, both duplex ultrasonography and magnetic resonance imaging showed greater improvements in clinical outcomes in the surgical excision group than in the sclerotherapy group.Conclusions Although several studies have examined IMVM treatment methods, no clear guidelines for treatment selection have been developed. Based on the results of this study, surgical excision is strongly encouraged for the treatment of IMVMs.

Transpedicular N-butyl cyanoacrylate–mediated percutaneous embolization of symptomatic vertebral hemangiomas

2013 ◽  
Vol 18 (5) ◽  
pp. 450-455 ◽  
Author(s):  
Kevin C. Yao ◽  
Adel M. Malek
Keyword(s):  
Blood Loss ◽  
Direct Injection ◽  
Transarterial Embolization ◽  
High Volume ◽  
Vascular Tumors ◽  
Intraoperative Blood Loss ◽  
Percutaneous Embolization ◽  
Direct Puncture ◽  
Tumor Embolization ◽  
Large Channel

Object The resection of spinal hemangiomas is often challenging because of characteristic high-volume and potentially prohibitive intraoperative blood loss. Although transarterial embolization can mitigate this risk, it can be suboptimal when tumor arterial supply is diffuse or poorly defined. The authors present their experience in the use of preoperative percutaneous direct injection of spinal hemangiomas with N-butyl cyanoacrylate (NBCA) as an effective preoperative adjunct that may reduce operative blood loss and facilitate resection of these vascular tumors. Methods Four patients with symptomatic spinal hemangiomas were treated using percutaneous transpedicular direct NBCA-Lipiodol injection; 2 patients had undergone prior spinal angiography, with suboptimal transarterial embolization in 1. Each patient underwent percutaneous bilateral transpedicular NBCA-assisted tumor embolization prior to resection. Retrospective analysis of operative times, blood loss, and clinical data is presented. Results There were no complications associated with the percutaneous NBCA embolization technique. The procedure was effective at facilitating tumor removal and minimizing intraoperative blood loss, especially at the vertebral body resection stage. Improved tumor filling was achieved as the filling characteristics of dilute NBCA-Lipiodol mixture within large-channel, high-flow hemangiomas were appreciated with experience. Conclusions Transpedicular NBCA direct-puncture embolization of spinal hemangiomas is an effective preoperative adjunct that facilitates resection of these highly vascular tumors. It is particularly useful when transarterial embolization is unsafe or suboptimal due to constraints imposed by the local angioarchitecture.

scholarly journals Juvenile Nasopharyngeal Angiofibroma - Excision Through Lateral Rhinotomy and Sublabial Approach - A Case Report

1970 ◽  
Vol 20 (1) ◽  
pp. 78-81
Author(s):  
NK Sinha ◽  
MH Rashid ◽  
MM Shaheen ◽  
DC Talukder ◽  
MAY Fakir ◽  
...  
Keyword(s):  
Surgical Excision ◽  
Complete Removal ◽  
Definitive Treatment ◽  
Surgical Approaches ◽  
Complete Excision ◽  
Nasopharyngeal Angiofibroma ◽  
Male Adolescents ◽  
Large Size ◽  
Complete Surgical Excision ◽  
Sublabial Approach

Juvenile angiofibroma is a rare hypervascular, locally aggressive benign tumour which is exclusively found in the nose and paranasal sinuses of male adolescents. The definitive treatment for this tumour is complete surgical excision. Different surgical approaches are used for complete excision. Most recent development is excision of the tumour using endoscopes. But in certain cases with large size and different extensions, open transfacial approaches are the choice for complete removal and for less operative bleeding, which are the main challenges for surgical excision of this tumour. DOI: http://dx.doi.org/10.3329/jdmc.v20i1.8587 J Dhaka Med Coll. 2011; 20(1) :78-81

scholarly journals Fibrous dysplasia and cherubism

2015 ◽  
Vol 48 (03) ◽  
pp. 236-248 ◽  
Author(s):  
Surajit Bhattacharya ◽  
R K Mishra
Keyword(s):  
Optic Nerve ◽  
Fibrous Dysplasia ◽  
Fibrous Tissue ◽  
Genetic Research ◽  
Young Patients ◽  
Disease Process ◽  
Surgical Excision ◽  
Nerve Compression ◽  
Active Management ◽  
Definitive Treatment

ABSTRACTFibrous dysplasia (FD) is a non-malignant fibro-osseous bony lesion in which the involved bone/bones gradually get converted into expanding cystic and fibrous tissue. The underlying defect in FD is post-natal mutation of GNAS1 gene, which leads to the proliferation and activation of undifferentiated mesenchymal cells arresting the bone development in woven phase and ultimately converting them into fibro-osseous cystic tissue. Cherubism is a hereditary form of fibrous dysplasia in which the causative factor is transmission of autosomal dominant SH3BP2 gene mutation. The disease may present in two distinct forms, a less severe and limited monostotic form, and a more aggressive and more widespread polyostotic form. Polyostotic form may be associated with various endocrine abnormalities, which require active management apart from the management of FD. Management of FD is not free from controversies. While total surgical excision of the involved area and reconstruction using newer micro-vascular technique is the only definitive treatment available from the curative point of view, but this can be only offered to monostotic and very few polyostotic lesions. In polyostotic varieties on many occasions these radical surgeries are very deforming in these slow growing lesions and so their indication is highly debated. The treatment of cranio-facial fibrous dysplasia should be highly individualized, depending on the fact that the clinical behavior of lesion is variable at various ages and in individual patients. A more conservative approach in the form of aesthetic recontouring of deformed bone, orthodontic occlusal correction, and watchful expectancy may be the more accepted form of treatment in young patients. Newer generation real-time imaging guidance during recontouring surgery adds to accuracy and safety of these procedures. Regular clinical and radiological follow up is required to watch for quiescence, regression or reactivation of the disease process. Patients must be warned and watched for any sign of nerve compression, especially visual impairment due to optic nerve compression. Rather than going for prophylactic optic canal decompression (which does more harm than good), optic nerve decompression should be done in symptomatic patients only, and preferably be done via minimal invasive endoscopic neuro-surgical approach than the conventional more morbid open craniotomy approach. There is growing research and possibilities that newer generation bisphosphonate medication may change the management scenario, as these medications show encouraging response in not only reducing the osteoclastic activity, but simultaneously also stimulating the osteoblastic and osteocytic activities. The explosion of genetic research and stem cell therapy may lead to better understanding and subsequently better treatment of FD in future.

Sign in / Sign up

Export Citation Format

Share Document