Micha Kowalczyk Tutor Assoc Prof Przemysaw Przewratil MD

Michał Kowalczyk Tutor: Assoc. Prof. Przemysław Przewratil MD, Ph. D Foam sclerotherapy in treatment of venous malformations in children. Department of Pediatric Surgery and Oncology Laboratory for Vascular Anomalies Medical University of Lodz

ISSVA Classification International Society for the Study of Vascular Anomalies VASCULAR ANOMALIES TUMORS Infantile haemangioma MALFORMATIONS Low-flow Fast-Flow Venous malformation (VM) Arterial malformation (AM) Capillary malformation (CM) Arteriovenous fistula (AVF) Lymphatic malformation (LM) Arteriovenous malformation (AVM)

Venous malformation • lesion composed of abnormal collections of veins • can affect any other tissue or organ • cutaneous and subcutaneous tissue • muscles • joints • intestines • most frequent low-flow vascular malformations • may cause cosmetic or functional defects as well as physical disability http: //www. hopkinsmedicine. org/sebin/w/u/malformation_2. gif • mostly localized in the skin

Venous malformations

Dubois and Puig Classification Orthop Clin N Am 2006, 37, 435 -474

http: //t 1. gstatic. com/images? q=tbn: ANd 9 Gc. St. Eyu. OGqn. D 3 vcw qhn. Ld. VN_p. Yv. Kmkvw 9 er. Hj. OG 9 omc-1 r. Qv_x. V 9 Foam sclerotherapy • A percutaneous injection of a sclerosing substance directly into a lesion. • Prior to injection the sclerosing agent is mixed with air to make a foam. • Sclerosant agent causes obliteration of the vessel, what effects in sealing off the blood flow. • It may be administered as an only procedure or in combination with surgical resection. • Multiple sessions are often required to achieve visual improvement or permanent results.

Aim of a study Analysis of the results of the treatment of venous malformations using foam sclerotherapy.

Material & Methods Retrospective analysis • 34 patients treated between June 2006 and December 2011 • 20 female (59%), 14 male (41%) • Age range: 1 -15 (average 7 years) Foam sclerotherapy • Polidocanol (Aethoxysclerol) 1% / 3% | 1 – 6 ml Assessment by US, MRI Phlebography • Performed prior to the sclerotherapy in 19 patients (56%) Surgical resection • Preceded by sclerotherapy - 6 patients (18%) Duration of hospital stay – ranged from 1 to 5 days (average 2, 5)

Ba ck Ea r Ha nd Or al Ca vit y Ne Ab ck do m en Br ea st Fo re ar m gh Th i et Fe Fa ce VM Localization 18 16 14 12 10 8 6 4 2 0

Demonstrative pictures • 4 years old boy • VM of right hand

MRI

Phlebography Approach to the VM

BEFORE AFTER

BEFORE 12. 09. 2011 03. 2011 AFTER

Foam sclerotherapy

Indications • Function impairment • Distortion of anatomical landmarks • Thrombosis • Pain • Cosmetic

Results 4 grade scale of clinical assessment Outcome Lesion regression Very good 80 -100% Good 60 -80% Moderate 20 -50% Without improvement <20%

Results 26% 53% 15% 6%

Results Temporary side effects were observed in 2 (6%) patients. • Vasculitis – 1 case • Skin necrosis – 1 case Initial phlebography increased significantly the effectiveness and safety of each sclerotherapy. In 6 patients (18%) sclerotherapy preceded the surgical resection improving their performance. Adopted method was rated by parents and patients as effective and hardly invasive.

Conclusions 1. VMs treatment is based on a proper diagnosis according to ISSVA classification, differentiating them from infantile hemangiomas. 1. Sclerotherapy with polidaconol used as foam is effective and safe managment of VMs.

Thank you for your attention. Any Questions? http: //www. dphotographer. co. uk/users/7252/thm 1024/blockislandheaven. jpg