Extracranial arteriovenous malformations in children: features of clinical course, diagnosis and treatment
Keywords:arteriovenous malformations, children, embolization, sclerotherapy
Background. Extracranial arteriovenous malformations are uncommon in children, but it remains challenging to accurately diagnose and treat them due to a high risk of recurrence. The purpose of the study is to analyze the clinical course and results of combined treatment of arteriovenous malformations in children. Materials and methods. Extracranial arteriovenous malformations are diagnosed in 9 children among 238 patients with vascular anomalies. Diagnosis and outcomes were based on clinical data, ultrasonography, computed tomography angiography. Arteriovenous malformations were localized in the head and neck region (n = 6), limbs (n = 3), and also there were multiple lesions (n = 2). The follow-up period was from 6 to 80 month. Results. The first clinical symptoms of arteriovenous malformations appeared in patients at the age from 0 to 9 years, the age of diagnosis ranged from 2 to 12 years, on average 7.67 ± 3.64 years. Previous treatment interventions were performed in 4 children, in particular, surgical removal (n = 3), ligation and cryodestruction of the nidus (n = 1), propranolol therapy (n = 2). The combined treatment of arteriovenous malformations was performed in all children in our investigation, in particular, embolization with one-stage sclerotherapy of the nidus — in 6, embolization and conservative treatment — in 1, embolization with subsequent sclerotherapy and surgical resection — in 2 patients. Treatment was started at the age from 1 to 14 years, on average 8.11 ± 3.85 years. Clinical result was achieved in 8 (88.89 %) patients with extracranial arteriovenous malformations, in one case (11.11 %), no treatment result was obtained. The best outcome has been achieved in patients treated by embolization with subsequent sclerotherapy. Conclusions. Combined treatment of arteriovenous malformations in children allowed achieving long-term remission.
Lee B.B., Antignani P.L., Baraldini V. et al. ISVI-IUA consensus document diagnostic guidelines of vascular anomalies: vascular malformations and hemangiomas // Int. Angiol. — 2015. — Vol. 34(4). — P. 333-74.
Greene A.K., Liu A.S., Mulliken J.B., Chalache K., Fishman S.J. Vascular anomalies in 5621 patients: guidelines for referral // J. Pediatr. Surg. — 2011. — Vol. 46(9). — P. 1784-1789.
Puttgen K.B., Pearl M., Tekes A., Mitchell S.E. Update on pediatric extracranial vascular anomalies of the head and neck // Childs Nerv. Syst. — 2010. — Vol. 26(10). — P. 1417-1433.
Mulliken J.B., Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics // Plast. Reconstr. Surg. — 1982. — Vol. 69(3). — P. 412-422.
Wassef M., Blei F., Adams D. et al. Vascular Anomalies Classification: Recommendations From the International Society for the Study of Vascular Anomalies // Pediatrics. — 2015. — Vol. 136(1). — P. e203-214.
Dasgupta R., Fishman S.J. ISSVA classification // Seminars in Pediatric Surgery. — 2014. — Vol. 23. — P. 158-161.
Kollipara R., Odhav A., Rentas K.E., Rivard D.C., Lowe L.H., Dinneen L. Vascular Anomalies in Pediatric Patients Updated Classification, Imaging, and Therapy // Radiol. Clin. North Am. — 2013. — 51(4). — 659-72.
Morgan P., Keller R., Patel K. Evidence-Based Management of Vascular Malformations // Facial Plast. Surg. — 2016. — Vol. 32(2). — P. 162-76.
Uller W., Alomari A., Richter G.T. Arteriovenous malformations // Semin. Pediatr. Surg. — 2014. — Vol. 23(4). — P. 203-207.
Lee B.B., Lardeo J., Neville R. Arterio-venous malformation: how much do we know? // Phlebology. — 2009. — Vol. 24. — P. 193-200.
Gloviczki P., Duncan A., Kalra M., Oderich G., Ricotta J., Bower T. Vascular malformations: an update // Perspect. Vasc. Surg. Endovasc. Ther. — 2009. — Vol. 21. — P. 133-148.
Lee B.B., Baumgartner B., Berlien H.P. et al. Consensus Document of the International Union of Angiology (IUA)-2013. Current concepts on the management of arterio-venous malformations // Int. Angiol. — 2013. — Vol. 32(1). — P. 9-36.
Liu A.S., Mulliken J.B., Zurakowski D., Fishman S. J., Greene A.K. Extracranial Arteriovenous Malformations: Natural Progression and Recurrence after Treatment // Plast. Reconstr. Surg. — 2010. — Vol. 125(4). — P. 1185-94.
Lin N., Smith E.R., Scott R.M., Orbach D.B. Сomplication analysis of 697 consecutive procedures in 394 patients // J. Neurosurg. Pediatr. — 2015. — Vol. 16(4). — P. 432-438.
Jeong H.S., Baek C.H., Son Y.I., Kim T.W., Lee B.B., Byun H.S. Treatment for extracranial arteriovenous malformations of the head and neck // Acta Otolaryngol. — 2006. — Vol. 126(3). — P. 295-300.
Wang D., Su L., Han Y., Wang Z., Zheng L., Fan X. Absolute Ethanol Embolisation of Mandibular Arteriovenous Malformations Following Direct Percutaneous Puncture and Release of Coils via a Microcatheter // Eur. J. Vasc. Endovasc. Surg. — 2017. — Vol. 53(6). — P. 862-869.
Vaišnytė B., Vajauskas D., Palionis D., Misonis N., Kurminas M., Nevidomskytė D., Matačiūnas M., Gutauskas M., Laucevičius A. Diagnostic Methods, Treatment Modalities, and Follow-up of Extracranial Arteriovenous Malformations // Medicina (Kaunas). — 2012. — Vol. 48(8). — P. 388-398.
Greene A.K., Orbach D.B. Management of arteriovenous malformations // Clin. Plast. Surg. — 2011. — Vol. 38(1). — P. 95-106.
Berwald C., Salazard B., Bardot J., Casanova D., Magalon G. Port wine stains or capillary malformations: surgical treatment // Ann. Chir. Plast. Esthet. — 2006. — Vol. 51. — P. 369-372.
Mattassi R., Vaghi M. Vascular bone syndrome — angio-osteodystrophy: current concepts // Phlebology. — 2007. — Vol. 22. — P. 287-290.
Alomari A., Dubois J. Interventional management of vascular malformations // Tech. Vasc. Interv. Radiol. — 2011. — Vol. 14. — P. 22-31.
Kim J.Y., Kim D.I., Do Y.S., Kim Y.W., Lee B.B. Surgical treatment for congenital arteriovenous malformation: 10 years’ experience // Eur. J. Vasc. Endovasc. Surg. — 2006. — Vol. 32. — P. 101-106.
Richter G.T., Suen J.Y. Pediatric extracranial arteriovenous malformations // Current Opinion in Otolaryngology & Head and Neck Surgery. — 2011. — Vol. 19. — P. 455-461.
Huang Z., Zhang D., Chen Y., Wang Y., Chen W., Huang Z. Treatment of the recanalization of maxillary and mandibular arteriovenous malformations in children // Oral Surg. Oral Med. Oral Pathol. Oral Radiol. — 2016. — Vol. 122(5). — P. 530-536.
White R.I. Jr., Pollak J., Persing J., Henderson K.J., Thomson J.G., Burdge C.M. Long-term outcome of embolotherapy and surgery for high-flow extremity arteriovenous malformations // J. Vasc. Interv. Radiol. — 2000. — Vol. 11. — P. 1285-1295.
Takemae T., Kobayashi S., Sugita K. Perinidal hypervascular network on immediate postoperative angiogram after removal of large arteriovenous malformation located distant from the arterial circle of Willis // Neurosurgery. — 1993. — Vol. 33. — P. 400-405.
Henkes H., Gotwald T.F., Brew S., Kaemmerer F., Miloslavski E., Kuehne D. Pressure measurements in arterial feeders of brain arteriovenous malformations before and after endovascular embolization // Neuroradiology. — 2004. — Vol. 46. — P. 673-677.
Copyright (c) 2018 UKRAINIAN JOURNAL OF SURGERY
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
- The rights to the article are deemed transferred by the authors to the edition (the publisher) since the moment of the publication of the article in the printed or electronic version of journal.