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Published on: June 15, 2020
[High flow vascular malformations in children]
J C López Gutiérrez1, Z Ros, L Martínez
1Unidad de Cirugía Plástica Pediátrica, Hospital Infantil La Paz, Paseo de la Castellana, 261, 28046 Madrid.
Insights
Arterial vascular malformations in children are rare and difficult to diagnose. Radical surgical resection combined with embolization offers the best outcomes, while other treatments may worsen these high-flow vascular anomalies.
Area of Science:
- Pediatric vascular surgery
- Vascular anomalies
- Interventional radiology
Context:
- High-flow vascular malformations, specifically arterial anomalies, are uncommon in children compared to hemangiomas and low-flow malformations.
- Accurate diagnosis and treatment planning for these anomalies require specialized medical expertise and a multidisciplinary approach.
- Previous treatments for these conditions were often misdiagnosed as hemangiomas, leading to inappropriate therapies.
Purpose:
- To evaluate the treatment outcomes for pediatric high-flow vascular malformations.
- To identify effective therapeutic strategies and inappropriate treatments for arterial vascular malformations in children.
- To analyze the relationship between patient demographics, symptoms, and malformation characteristics.
Summary:
- Twenty-eight children with high-flow vascular malformations (excluding CNS lesions) were treated. Most presented with Stage I or II malformations and had prior misdiagnoses.
- Diagnostic tools included Doppler Ultrasound and Magnetic Resonance Imaging. Angiography and selective embolization were used selectively for surgical candidates.
- Sixteen patients underwent complete resection, and five had incomplete resections. Inappropriate therapies like laser, radiotherapy, and partial resection were noted to exacerbate malformations.
Impact:
- This study highlights that radical surgical resection following selective endovascular embolization is crucial for successful treatment of pediatric high-flow vascular malformations.
- Reconstructive surgery is recommended post-resection to ensure optimal aesthetic and functional results.
- Avoidance of inappropriate therapies is critical to prevent exacerbation of arteriovenous malformations (AVMs).
Abstract:
Unlike hemangiomas and low-flow vascular malformations which are very common in children, arterial anomalies have small incidence. Differential diagnosis is difficult, and needs a physician familiarized with vascular anomalies. Appropriate treatment must be planned by multidisciplinary team considering the patient's age, and anatomical location. Twenty-eight children with high flow vascular malformations have been treated since 1990 at La Paz Children's Hospital Vascular Anomalies Program. We excluded of the study group patients with central nervous system lesions. 85% of the patients had malformation in stage I or II (according the ISSVA accepted Schöbinger stating) and most of them were erroneously diagnosed as hemangioms with a variety of inappropriate treatments previously performed. Doppler Ultrasound and Magnetic Resonance confirmed malformation flow and extension. Angiography and selective embolization was only considered as therapeutic approach in candidates to surgical resection. 16 patients underwent complete resection of the malformation including one foot and two fingers amputation and five more incomplete resection of the ulcerate area. In conclusion, we did not find age at onset, sex and symptoms relationship. Laser, radiotherapy, surgical ligation or partial resection must be considered inappropriate therapies which may stimulate AVM exacerbation. Only radical surgical procedure after selective endovascular embolization will be successful but then reconstructive surgery should be performed to achieve good aesthetic and functional results.
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