Interventional Treatment Options in Children with Extracranial Vascular Malformations

Schmidt, Volker J.; Olivieri, Martin; Häberle, Beate; Masthoff, Max; Deniz, Sinan; Sporns, Peter; Wohlgemuth, Walter A.; Wildgruber, Moritz

doi:10.1055/a-1728-5686

Cited by 8 publications

(4 citation statements)

References 109 publications

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“…Surgical management involves excision, laser treatment or both (11). Sclerotherapy and embolization as well as drugs like sirolimus are non-surgical options (12)(13)(14). In this series, the most common used options were conventional surgery, laser, and sclerotherapy; however, many patients required multiple treatment sessions and modalities especially patients with VM and LM.…”

Section: Discussionmentioning

confidence: 95%

Vascular Malformations of the Head and Neck in Children

Plettendorff

Werner

Wiegand

2023

In Vivo

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Background/Aim: Vascular malformations are congenital abnormalities that result from disturbances in the embryologic development of the vascular system. A retrospective study at a single institution was performed to determine the localization and treatment patterns for vascular malformations in children. Patients and Methods: A total of 198 pediatric patients were identified. Age at diagnosis and presentation, sex, localization, diagnostics, and therapy were described. Results: The most common diagnosis was lymphatic malformation (LM, 58.6%), followed by venous (VM, 31.8%) and arteriovenous malformation (AVM, 4.5%). The mean age at diagnosis was 2.2 years, while the mean age at presentation at our hospital was 7.2 years. The sex ratio showed a female predominance (1.44:1), which was most evident in children with AVM. The neck, cheek/parotid gland and oral cavity were the most predominant locations. Half of the patients required at least one intervention at our hospital. Especially, CM and LM were managed by watch-and wait, whereas lymphovenous malformation (LVM) and AVM were most often treated. Treatment differed between the various malformation types, the most common used treatment was conventional surgery followed by laser therapy. In case of treatment, the average number of procedures in our hospital was 1.58 for VM, 1.53 for LM, 1.33 for AVM, and 1.0 for LVM. Conclusion: In children with vascular malformations interventional treatment is often necessary, in many cases more than one treatment step is needed. Correct identification of the malformation type is important for optimal treatment and appropriate care of patients with vascular malformations.

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Section: Discussionmentioning

confidence: 95%

Vascular Malformations of the Head and Neck in Children

Plettendorff

Werner

Wiegand

2023

In Vivo

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“…Fluoroscopic and/or ultrasound-guided percutaneous sclerotherapy is considered the first-line treatment for VM [ 26 , 27 ]. Initially, contrast agents are commonly used to delineate the full extent and volume of the lesion.…”

Section: Neurointerventional Procedures In the Pediatric Populationmentioning

confidence: 99%

Pediatric Interventional Neuroradiology: Opportunities and Challenges

2023

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Pediatric interventional neuroradiology (PINR) is a relatively new field of diagnostic and therapeutic care in the pediatric population that has seen considerable advances in recent decades. However, it is still lagging behind adult interventional neuroradiology due to a variety of reasons, including the lack of evidence validating pediatric-specific procedures, the relative absence of pediatric-specific equipment, and the challenges in establishing and maintaining PINR competencies in a relatively small number of cases. Despite these challenges, the number and variety of PINR procedures are expanding for a variety of indications, including unique pediatric conditions, and are associated with reduced morbidity and psychological stigma. Continued technological advances, such as improved catheter and microwire designs and novel embolic agents, are also contributing to the growth of the field. This review aims to increase awareness of PINR and provide an overview of the current evidence base for minimally invasive neurological interventions in children. Important considerations, such as sedation, contrast agent use, and radiation protection, will also be discussed, taking into account the distinct characteristics of the pediatric population. The review highlights the usefulness and benefits of PINR and emphasizes the need for ongoing research and development to further advance this field.

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“…They result from an abnormal connection between arteries and veins without a capillary bed in between [8][9][10], continuously expanding over time. Due to the fast-flow shunting, hemodynamic effects such as local hypervascularity, increased venous pressure, and steal phenomenon occur, which can result in peripheral ischemia distal to the malformation [1,11,12]. Thus, the patients may present with local pain, bleeding, hyperemia, ulceration, and gangrene up to high-output cardiac failure [13,14].…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcome and Quality of Life of Multimodal Treatment of Extracranial Arteriovenous Malformations: The APOLLON Study Protocol

Schmidt

Masthoff²,

Vielsmeier³

et al. 2022

Cardiovasc Intervent Radiol

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Purpose Arteriovenous malformations (AVMs) as rare diseases are diagnostically and therapeutically challenging. Due to the limited evidence regarding treatment outcome, prospective data are needed on how different treatment regimens affect outcome. The aims of this prospective trial are to determine effectiveness, safety, and clinical outcome of multimodal treatment in patients with extracranial AVMs. Materials and Methods After clinical and magnetic resonance imaging (MRI)-based diagnosis and informed consent, 146 patients (> 4 years and < 70 years) undergoing multimodal therapy in tertiary care vascular anomalies centers will be included in this prospective observational trial. Treatment options include conservative management, medical therapy, minimally invasive image-guided procedures (embolization, sclerotherapy) and surgery as well as combinations of the latter. The primary outcome is the patient-reported QoL 6 months after completion of treatment using the short form-36 health survey version 2 (SF-36v2) and the corresponding short form-10 health survey (SF-10) for children. In addition, clinical presentation (physician-reported signs), MRI imaging (radiological assessment of devascularization), recurrence rate, and therapeutic safety will be analyzed. Further follow-up will be performed after 12, 24, and 36 months. Moreover, liquid biopsies are being obtained from peripheral blood at multiple time points to investigate potential biomarkers for therapy response and disease progression. Discussion The APOLLON trial is a prospective, multicenter, observational open-label trial with unequal study groups to generate prospective evidence for multimodal treatment of AVMs. A multicenter design with the potential to assess larger populations will provide an increased understanding of multimodal therapy outcome in this orphan disease. Trial Registration German Clinical Trials Register (identification number: DRKS00021019) https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021019.

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Interventional Treatment Options in Children with Extracranial Vascular Malformations

Cited by 8 publications

References 109 publications

Vascular Malformations of the Head and Neck in Children

Vascular Malformations of the Head and Neck in Children

Pediatric Interventional Neuroradiology: Opportunities and Challenges

Clinical Outcome and Quality of Life of Multimodal Treatment of Extracranial Arteriovenous Malformations: The APOLLON Study Protocol

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