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Department of Pediatric Surgery and Oncology Laboratory for Vascular Anomalies Medical University of Lodz Foam sclerotherapy in treatment of venous malformations.

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Presentation on theme: "Department of Pediatric Surgery and Oncology Laboratory for Vascular Anomalies Medical University of Lodz Foam sclerotherapy in treatment of venous malformations."— Presentation transcript:

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

2 International Society for the Study of Vascular Anomalies ISSVA Classification V A S C U L A R A N O M A L I E S TUMORSMALFORMATIONS Infantile haemangioma Low-flowFast-Flow Venous malformation (VM) Arterial malformation (AM) Capillary malformation (CM) Arteriovenous fistula (AVF) Lymphatic malformation (LM) Arteriovenous malformation (AVM)

3 Venous malformation lesion composed of abnormal collections of veins mostly localized in the skin 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

4 Venousmalformations

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

6 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 http://t1.gstatic.com/images?q=tbn:ANd9GcStEyuOGqnD3vcw qhnLdVN_pYvKmkvw9erHjOG9omc-1rQv_xV9 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. Foam sclerotherapy

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

8  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 – 6ml  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) Material & Methods

9 VM Localization

10 Demonstrative pictures 4 years old boy VM of right hand

11 MRI

12 Phlebography Approach to the VM

13 BEFORE AFTER

14 BEFORE AFTER 03.03.2011 12.09.2011

15 Foam sclerotherapy

16 Indications Function impairment Distortion of anatomical landmarks Thrombosis Pain Cosmetic

17 Results  4 grade scale of clinical assessment

18 Results 26% 53% 15% 6%

19 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.

20 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.

21 http://www.dphotographer.co.uk/users/7252/thm1024/blockislandheaven.jpg


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