Novosti
Khirurgii
This journal is
indexed in Scopus

Year 2014 Vol. 22 No 5

REVIEWS

DOI: http://dx.doi.org/10.18484/2305-0047.2014.5.601   |  

G.A. POPEL

THE DIAGNOSTIC AND SURGICAL TREATMENT OF ANGIODYSPLASIA OF EXTERNAL LOCALIZATION

SBE Belarusian Medical Academy of Postgraduate Education, Minsk,
The Republic of Belarus

Today angiodysplasia of the external localization is considered to be rather difficult field of clinical angiology as it is relatively rare and insufficiently familiar pathology for practitioners. The magnitude of the problem is determined by the real risk of complications: venous ulcers, thrombosis, major bleeding from the transformed tissues, and disorders of the central hemodynamics due to abnormal arteriovenous reset. Furthermore, for angiodysplasias is characterized by the significant functional and anatomical disorders, cosmetic defects, and progressive course, that in aggregate are know to cause disability and disability in relatively young age. To treat angiodysplasia the staged surgeries are carried out in some cases, which are traumatic and invalidity in a great number of complications such as bleeding, trophic ulcers, hypertrophic and keloid scars in 7,4-20% of patients. The frequency of postoperative recurrence reaches 30-48% due to the objective (prevalence of the process) and subjective (underestimation of lesion) causes.
The review provides historical information about congenital vascular malformations; the characteristic of the classification systems is presented; different methods of diagnosis and treatment of angiodysplasia are analyzed as well as complications. Despite significant progress in this area, associated with the introduction of the modern instrumental methods in the diagnostics algorythm of current instrumental methods, literature data are of contradictory nature and there is no consensus concerning the choice of the most optimal methods and term of surgical treatment. The conducted analysis indicates need for further research of this pathology. Introduction of minimally invasive surgical techniques for angiodysplasia surgical treatment seems to be promising.

Keywords: hemangioma, angiodysplasia, rteriovenous malformation, arteriovenous fistula, vascular malformation, venous malformation, vascular abnomalties, classification, sclerotherapy, diode lasers
p. 601-610 of the original issue
References
  1. Dan VN, Sapelkin CB. Angiodisplazii (vrozhdennye poroki razvitiia sosudov)[Angiodysplasia (congenital vascular malformations)] Moscow, RF: Verdana, 2008. 200 p.
  2. Pokrovskii AB, Moskalenko IuD, Golosovskaia MA. K patogenezu i klassifikatsii vrozhdennykh porokov krovenosnykh sosudov [Some aspects of pathogenesis and classification of blood vessels congenital malformations]. Vestn Khirurgii. 1971;(2):5964.
  3. Malan E, Tradito E. Vascular malformations (angiodysplasias). Milan, Carlo Erba Foundation, 1974. p. 213.
  4. Trelat U, Monod A. De l'hypertrophie unilaterale partielle ou totale du corps. Arch. Gen. Med. 1869.
  5. Klippel M, Trenaunay I. Du naevusvariqueux et osteohypertrophique. Arch Gen Med (Paris). 1900;185:64172.
  6. Parkes Weber F. Angioma formation in connection with hypertrophy of limbs and hemihypertrophy. Brit J DermSyph 1907;(19):231.
  7. Servelle M, Trinquecoste P. Des angiomes veineux. Arch Mal. Coeur 41, 436 (1948).
  8. Nakata Y, Shionoya S. Surgical treatment of peripheral congenital vascular dysplasia. J Vascular surgery. 1980;14(1):913.
  9. Tasnadi G. Epidemiology and etiology of congenital vascular malformations. Semin Vasc Surg. 1993;6:200203.
  10. Belov St, Loose DA, Weber J, eds. Vascular Malformations. Reinbek: EinhornPresseVerlagGmbH, 1989. p.205.
  11. Kim JY, Kim D, Do YS, Lee BB, Kim YW, Shin SW, Byun HS, Roh HG, Choo IW, Hyon WS, Shim JS, Choi JY. Surgical treatment for congenital arteriovenous malformation: 10 years' experience. Eur J Vasc Endovasc Surg. 2006 Jul;32(1):1016.
  12. Dan VN, Shchegolev SV, Sapelkin CB. Sovremennye klassifikatsii vrozhdennykh porokov razvitiia sosudov (angiodisplazii) [Modern classification of congenital vascular malformations (angiodysplasias)]. Agiologiia i Sosud Khirurgiia. 2006;12(4):2833.
  13. Pokrovskii AV, red. Klinicheskaia angiologiia [Clinical angiology ]. V 2 tomakh, Meditsina, RF: 2004. 1700 p.
  14. Mulliken J, Young A. Vascular birthmarks: hemangiomas ang malformations. WB Saunders, Philadelphia. 1988
  15. Belov S. Anatomopathological classification of congenital vascular defects. Semin Vasc Surg. 1993 Dec;6(4):21924.
  16. Ramesh Candamourty, Suresh Venkatachalam, M.R. Ramesh Babu, Vineela Katam Reddy, Low flow vascular malformation of the buccal mucosa treated conservatively by sclerotherapy (3% sodium tetradecyl sulfate), J Nat Sci Biol Med. 2012 Jul-Dec; 3(2):19598.
  17. Leonel Villavicencio J, Raul Mattassi, Dirk A Loose Massimo. Hemangiomas and vascular malformations: An Atlas of diagnosis and treatment. Vaghi Springer - Verlag Italia, 2009. 331 .
  18. Ruggieri M, Pavone V, Polizzi A, Falsaperla R, Fichera M, Pavone P. Klippel-Trenaunay syndrome in a boy with concomitant ipsilateral overgrowth and undergrowth. Am J Med Genet A. 2014 May;164A(5):1262-7
  19. Sabri S, Cotton LT. New test for the detection of peripheral arteriovenous fistulae. Br Med J. 1971 Sep 25;3(5777):76162.
  20. Laroche JP, Becker F, Khau-Van-Kien A, Baudoin P, Brisot D, Buffler A, Coupe M, Jurus C, Mestre S, Miserey G, Soulier-Sotto V, Tissot A, Viard A, Vignes S, Quere I. Quality standards for ultrasonographic assessment of peripheral vascular malformations and vascular tumors. J Mal Vasc. 2013 Feb;38(1):2942.
  21. Kuntsevich GI, Dan VN, Kusova FU. Ul'trazvukovaia diagnostika angiodisplazii konechnostei [Ultrasound diagnosis of angiodysplasia of extremities]. Ul'trazvukovaia Diagnostika 1997;(2):7884.
  22. Lee BB, Mattassi R, Choe YH, Vaghi M, Ahn JM, Kim DI, Huh SH, Lee CH, Kim DY. Critical role of duplex ultrasonography for the advanced management of a venous malformation. Phlebology March 1, 2005;(20):2837.
  23. Loose DA.Surgical management of venous malformations. Phlebology. 2007;22(6):27682.
  24. Karmazanovskii GG, Dan VN, Skuba ND. Komp'iuterno-tomograficheskaia kharakteristika angiodisplazii s angiomatozom v miagkikh tkaniakh [Computer-tomographic characterization of angiodysplasias with angiomatosis in the soft tissues]. Zhurn Vestn Rentgenologii i Radiologii. 1993;(2):3743.
  25. Sunagawa T, Ikuta Y, Ishida O, Ishiburo M, Yasunaga Y, Ochi M. Arteriovenous malformation of the ring finger. Pre- and postoperative evaluation using three-dimensional computed tomography angiography. J Comput Assist Tomogr 2003; (27):82023.
  26. Pykov MI, Sakovich EM, Vasil'eva OIu, Galkina IaA. Mul'tispiral'naia komp'iuternaia tomografiia gemangiom golovy i shei u detei [Multislice computed tomography of hemangiomas of the head and neck in children]. Vestn. RNTsRR MZ RF 2012;(12)1:1935.
  27. Kim EY, Ahn JM, Yoon HK, Suh YL, Do YS, Kim SH, Choo SW, Choo IW, Kim SM, Kang HS. Intramuscular vascular malformations of an extremity: findings on MR imaging and pathologic correlation. Skeletal Radiol. 1999 Sep;28(9):51521.
  28. Dagmara Wilmanska, Aneta Antosik-Biernacka, Przemyslaw Przewratil, Wojciech Szubert, Ludomir Stefanczyk, Agata Majos. The role of MRI in diagnostic algorithm of cervicofacial vascular anomalies in children. Pol J Radiol. 2013 Apr-Jun; 78(2):714.
  29. Iargiello T, Rakovski P, Zubilevich T, Terletski P, Grzhechnik B, Shcherbo-Troianovska M. Angiodisplazii verkhnikh konechnostei. Diagnostika i sravnenie dupleksnogo skanirovaniia s angiografiei [Angiodysplasia of the upper extremities. Diagnosis and comparison of duplex scanning with angiography]. Angiologiia i Sosud Khirurgiia. 2000;(6)1:3441.
  30. Vaisnyte B, Vajauskas D, Palionis D, Nevidomskyte D, Misonis N, Bilkis V, Sucila M, Gutauskas M. Complicated congenital gluteal arteriovenous malformation with hemorrhage in pregnancy. Ann Vasc Surg. 2013 Aug;27(6):803.e7803.e13.
  31. Jablecki J, Elsaftawy A, Kaczmarzyk J, Kaczmarzyk L. Surgical treatment of hemangiomas and arteriovenous malformations in upper extermity. Pol Przegl Chir. 2013 Mar 1;85(3):10713.
  32. Ek ET, Suh N, Carlson MG. Vascular Anomalies of the Hand and Wrist. J Am Acad Orthop Surg. 2014 Jun;22(6):352360.
  33. Raso AM, Rispoli P, Trogolo M, Sisto G, Castagno PL. Venous and arteriovenous vascular malformations: diagnostic and therapeutic considerations regarding 239 patients observed in the 1978-1991 period. J Cardiovasc Surg (Torino). 1993 Feb;34(1):6365.
  34. Ryzhkov VK, Granov AM, Anisimov VN. Ispol'zovanie metallicheskikh spiralei dlia endovaskuliarnoi okkliuzii krupnykh sosudov [The application of metal coils for endovascular occlusion of large vessels]. Khirurgiia. 1985;(6):11720.
  35. Lee BB, Bergan JJ. Advanced management of congenital vascular malformations: a multidisciplinary approach. Cardiovasc Surg. 2002 Dec;10(6):52333.
  36. Jacob AG, Driscoll DJ, Shaughnessy WJ, Stanson AW, Clay RP, Gloviczki P. Klippel-Trenaunay syndrome: spectrum and management. Mayo Clin Proc. 1998 Jan;73(1):2836.
  37. Ndzengue A, Rafal RB, Balmir S, Rai DB, Jaffe EA. Klippel-trenaunay syndrome: an often overlooked risk factor for venous thromboembolic disease. Int J Angiol. 2012 Dec;21(4):23336
  38. Kumbhar Sachin, Saraf Rashmi, Shrivastava Manish, Wuppalapati Siddhartha, and Limaye Uday. Haemangiomas and venous malformations of the head and neck: A retrospective analysis of endovascular management in 358 patients. Indian J Plast Surg. 2013 Jan-Apr; 46(1):10916
  39. Wiedman A. [Sclerosing therapy of cavernous hemangiomas].Hautarzt. 1965 Jul;16(7):2948. [Article in German]
  40. Berenguer B, Burrows PE, Zurakowski D, Mulliken JB.Sclerotherapy of craniofacial venous malformations: complications and results. Plast Reconstr Surg. 1999 Jul;104(1):111.
  41. Jin Y, Lin X, Li W, Hu X, Ma G, Wang W.Sclerotherapy after embolization of draining vein: a safe treatment method for venous malformations. J Vasc Surg. 2008 Jun;47(6):12929.
  42. Yakes WF, Luethke JM, Parker SH, Stavros AT, Rak KM, Hopper KD, Dreisbach JN, Griffin DJ, Seibert CE, Carter TE, et al. Ethanol embolization of vascular malformations. Radiographics. 1990 Sep;10(5):78796.
  43. Svendsen P, Wikholm G, Fogdestam I, Naredi S, Eden E. Instillation of alcohol into venous malformations of the head and neck. Scand J Plast Reconstr Surg Hand Surg. 1994 Dec;28(4):27984.
  44. Chen H, Lin X, Jin Y, Li W, Ma G, Hu X.Patients with intralesional hemorrhage in venous malformations: diagnosis and embolosclerotherapy. J Vasc Surg. 2009 Feb;49(2):42933.
  45. Yamaki T, Nozaki M, Fujiwara O, Yoshida E.Duplex-guided foam sclerotherapy for the treatment of the symptomatic venous malformations of the face. Dermatol Surg. 2002 Jul;28(7):61922.
  46. Cabrera J, Cabrera J Jr, Garcia-Olmedo M, Redondo P. Treatment of venous malformations with sclerosant in microfoam form. Arch Dermatol 2003;(139):140916.
  47. Van der Linden E, Overbosch J, Kroft LJ. Radiofrequency ablation for treatment of symptomatic low-flow vascular malformations after previous unsuccessful therapy. J Vasc Interv Radiol. 2005 May;16(5):74750.
  48. Sokolov AL, Liadov KV, Stoiko IuM. Endovenoznaia lazernaia koaguliatsiia v lechenii varikoznoi bolezni [Endovenous laser photocoagulation in the treatment of varicose veins]. Moscow, RF: ID MEDPRAKTIKA-M, 2007. 220 p.
  49. Ma LW, Levi B, Oppenheimer AJ, Kasten SJ. Intralesional Laser Therapy for Vascular Malformations. Ann Plast Surg. 2013 Apr 18.
  50. Derby LD, Low DW.Laser treatment of facial venous vascular malformations. Ann Plast Surg. 1997 Apr;38(4):37178.
  51. Lapidoth M, Yaniv E, Ben Amitai D, Raveh E, Kalish E, Waner M, David M.Treatment of facial venous malformations with combined radiofrequency current and 900 nm diode laser. Dermatol Surg. 2005 Oct;31(10):130812.
  52. Sidhu MK, Perkins JA, Shaw DW, Bittles MA, Andrews RT. Ultrasound-guided endovenous diode laser in the treatment of congenital venous malformations: preliminary experience. J Vasc Interv Radiol. 2005 Jun;16(6):87984.
  53. Burrows PE, Mason KP. Percutaneous treatment of low flow vascular malformations. J Vasc Interv Radiol. 2004 May;15(5):43145.
Address for correspondence:
220013, Respublika Belarus,
g. Minsk, ul. P. Brovki d. 3, k. 3,
GUO Belorusskaya akademiya poslediplomnogo obrazovaniya,
kafedra khirurgii,
tel. office: 375 29 175-93-36,
e-mail: hpopel@mail.ru,
Popel Gennadiy Adolfovich
Information about the authors:
Popel G.A., assistant of the surgery chair of SBE Belarusian Medical Academy of Postgraduate Education.
Contacts | ©Vitebsk State Medical University, 2007