DOI: https://doi.org/10.22141/1997-2938.4.35.2017.118895

Extracranial arteriovenous malformations in children: features of clinical course, diagnosis and treatment

I.M. Benzar

Abstract


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.


Keywords


arteriovenous malformations; children; embolization; sclerotherapy

References


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.




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