Feasibility of vessel sealing devices in surgical excision of vascular malformations– novel approach

Abstract

Introduction: Vascular malformations are localized defects in vascular morphogenesis that are believed to be caused by dysfunction in embryogenesis and vasculogenesis. However, with the development of new vessel sealing devices, surgical removal of the vascular malformations can be safely undertaken. The aim of this study was to test the feasibility of vessel sealing devices in the complete excision of vascular malformations. Methods: We retrospectively analyzed medical records of all patients with vascular malformation who underwent a surgical excision of vascular malformations at our institution from January 2015 to June 2018. All patients were followed up after 1 week; 1, 3, 6 months; and 1 year. Results: We assessed 14 patients with vascular malformation (median age, 21 years; malformation: arteriovenous, n = 5; venous, n = 7; lymphatic, n = 1; and combined, n = 1). These vascular malformations were localized in the right lower (n = 5) and left upper (n = 3) limbs, right upper limb (n = 2), head and neck (n = 3), and chest wall (n = 1). Using vessel sealing instruments, the nidus in AVM was excised, and complete excision of vascular malformations was achieved without depriving the skin of dermal blood supply. One patient died three weeks later due to secondary hemorrhage. Complication related to gangrenous skin over the patella was healed by vacuum-assisted closure therapy. Post-excision MRI after 18 months suggested recurrence in one patient. Conclusion: The use of vessel sealing devices was found to be feasible, for surgical excision of vascular malformations. However, further evidence from larger studies, prefereably randomized controlled trials, is required to support the routine use of these devices. Highlights:

Safe and Efficient Removal of Massive Head and Neck Vascular Malformations Using Vessel Sealing Energy Devices

“…The complications were not felt to be related to the energy devices, in fact, the authors stated that these devices will improve the safety and broaden the role of surgical management of large VMs. 8 We agree with the authors' comments that vascular clamps and suture ligation of vessels can be difficult and tedious, and traditionally, VMs are resected with laborious suture ligation which can put both blood vessels and lymphatic channels at risk of tearing during dissection for proximal and distal vascular control. Vessel sealing devices have the advantage of gaining hemostasis during dissection of vessels 8 mm and larger, 9 and reliably seal surrounding lymphatic channels that may be at risk during traditional dissection/suture ligation techniques.…”

“…Two major complications were seen in their review including stroke/TIA and 1 death, demonstrating the occasional severity of these lesions. The complications were not felt to be related to the energy devices, in fact, the authors stated that these devices will improve the safety and broaden the role of surgical management of large VMs 8 . We agree with the authors’ comments that vascular clamps and suture ligation of vessels can be difficult and tedious, and traditionally, VMs are resected with laborious suture ligation which can put both blood vessels and lymphatic channels at risk of tearing during dissection for proximal and distal vascular control.…”