Single‐Stage Excision of Localized Head and Neck Venous Malformations Using Preoperative Glue Embolization

“…After wound healing, reattempt at resection of the now decentralized lesion in scar can be even more challenging than the original surgery. 52 A combined purely embolic and surgical approach has been developed whereby the venous malformation is directly embolization with nÀbutyl cyanoacrylate (n-BCA) which permeates throughout the lesion. 53 An acute inflammatory reaction ensues soon after embolization creating a clear line of demarcation between the venous malformation and normal tissue facilitating complete and immediate resection with lower morbidity and recurrence rate.…”

Section: Nonsclerotherapeutic Glue Embolizationmentioning

confidence: 99%

Sclerotherapy with Adjunctive Stasis of Efflux (STASE) in Venous Malformations: Techniques and Strategies

Legiehn

2019

Techniques in Vascular and Interventional Radiology

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Venous malformations are very commonly encountered in interventional radiologic practice. Indications for therapy are clearly defined based on the lesion's impact on patient's quality of life. Screening laboratory coagulation studies in patients with historical or lesion morphologic risk factors often reveal abnormal coagulation parameters consistent with localized intravascular coagulation or more severe coagulopathic states. These may require chronic or periprocedural medical management to avoid potentially life-threatening disseminated intravascular coagulation or other thromboembolic phenomena. Once a multidisciplinary decision to treat a venous malformation is made, one must decide between percutaneous and/or surgical techniques. Sclerotherapy with adjunctive stasis of efflux (STASE) techniques have become the mainstay of therapy for most venous malformations as they are well-tolerated and effective. STASE techniques work primarily by (i) the administration of sclerosant(s) exerting an inhibitory and/or endotheliocidal effect on venous malformation endothelium leading to thrombosis, involution, and fibrosis, and secondarily via adjunctive outflow occlusion using any combination of local compression, balloons, gelatin, coils, laser, radiofrequency, or adhesives to improve sclerosant penetration and dwell-time in the lesion. Adhesives alone can fill the lesion to facilitate surgical resection in some cases. Common sclerosants in modern practice include sodium tetradecyl sulfate, bleomycin, polidocanol, ethanol, and hypertonic saline. Most agents can be given directly in unmodified or "neat" form or can be mixed with a gas to form a sclerofoam or embolic such as gelatin to form a sclerogel. Choice and method of sclerosant delivery in each patient is based on the intraluminal lesion volume, architecture, vital structure proximity, agent toxicity, viscosity, and level of experience of the interventional radiologist with that particular agent. Multi-session STASE therapy usually reduces symptoms of chronic pain or mass with low risk of known complications of skin or nerve impairment, compartment syndrome, hemoglobinuria, deep venous thrombosis, or pulmonary phenomena.

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“…79 Lesions that were large (> 5 cm), diffusely infiltrating, and less surgically accessible were associated with greater morbidity and functional deficits, and required the use of multiple treatment modalities. 76 The current literature that supports surgery for the treatment of VMs is mainly in the form of level III, case-control clinical trials 75,76,106 and level IV, retrospective case series, 88,97,104,[107][108][109][110][111] without any RCTs comparing surgical management to other modalities. As treatment of VMs is rapidly becoming a multidisciplinary challenge, the majority of newer evidence that discusses surgical management of VMs does so using multimodality approaches, combining surgery with other treatment options.…”

Section: Surgerymentioning

confidence: 99%

Evidence-Based Management of Vascular Malformations

2016

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Vascular malformations of the head and neck are complex lesions that are notoriously difficult to manage. Treatment of these lesions often requires a multispecialty and multimodal approach. In the modern era of evidence-based medicine, it has become imperative for clinicians to incorporate evidence-based treatment algorithms into their everyday practices. With general widespread inundation of the literature with levels IV and V clinical evidence, however, it is often difficult to draw meaningful conclusions that can be practically applied to the clinical question at hand. When asking how best to manage the most common vascular malformations, we are faced with this large volume of lower level studies conducted in drastically different ways without consistency in outcomes reporting, thus making direct comparison nearly impossible. Furthermore, much of the evidence shows mixed results, adding to confusion over what the optimal evidence-based treatment approaches truly are. In attempt to derive consensus from available literature discussing the management of vascular malformations, we reviewed the current literature detailing modern-day treatment approaches for lymphatic malformations, venous malformations, and arteriovenous malformations of the head and neck.

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Single‐Stage Excision of Localized Head and Neck Venous Malformations Using Preoperative Glue Embolization

Cited by 45 publications

References 23 publications

Strangling technique to treat large cervicofacial venous malformations: A preliminary report

Strangling technique to treat large cervicofacial venous malformations: A preliminary report

Sclerotherapy with Adjunctive Stasis of Efflux (STASE) in Venous Malformations: Techniques and Strategies

Evidence-Based Management of Vascular Malformations

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