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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
A multi-disciplinary, multimodal approach for the management of vascular anomalies
Aqsa Mazhar1, Shazia Moosa2, Alizeh Abbas3
1Aqsa Mazhar, FCPS. Center for Essential Surgical and Acute Care, Global Health Directorate, Indus Health Network, Karachi, Pakistan.
Insights
A multi-disciplinary approach successfully diagnosed and treated diverse vascular anomalies in 187 patients. This approach facilitated managing complex cases, improving patient outcomes for vascular tumors and malformations.
Area of Science:
- Vascular Surgery
- Dermatology
- Pediatric Surgery
Background:
- Vascular anomalies encompass a spectrum of lesions, from simple to complex and disfiguring.
- Effective management requires a coordinated, specialized approach.
Purpose of the Study:
- To diagnose and comprehensively treat patients with vascular anomalies.
- To evaluate the efficacy of a multi-disciplinary team in managing these conditions.
Main Methods:
- Patients with vascular anomalies were enrolled from January 2017 to March 2019.
- A pre-defined questionnaire guided data collection, including assessment, diagnostics, and management.
- Clinical and photographic follow-up was maintained to monitor treatment outcomes.
Main Results:
- 187 patients (mean age 4.6 years, 62% female) were included.
- Diagnoses comprised vascular tumors (47.6%), lymphatic malformations (20.3%), capillary malformations (10%), venous malformations (8.5%), arteriovenous malformations (7.5%), and mixed anomalies (5.9%).
- Treatments included oral propranolol, topical timolol, pulsed dye laser, and sclerotherapy, with 27 patients completing treatment.
Conclusions:
- Vascular anomalies were successfully managed using single or multimodal treatments.
- A multi-disciplinary approach is effective for increasingly complex anomalies.
- The establishment of a Vascular Anomaly Center (VAC) addressed previously challenging diagnostic and therapeutic cases.
Objective:
Vascular anomalies are a diverse group of lesions, ranging from simple to complex, disfiguring anomalies. Our objective was to diagnose and provide comprehensive treatment to patients presenting with vascular anomalies, using a multi-disciplinary approach involving dermatologists, plastic surgeons, radiologists and pediatric surgeons.
Methods:
Patients presenting with vascular anomalies to The Indus Hospital, Karachi, from January 2017 to March 2019 were enrolled, using a pre-defined questionnaire. Assessment, diagnostic work up, management and clinical and photographic follow up was maintained to monitor outcomes.
Results:
One hundred eighty seven patients with a mean age of 4.6 years, (females 62%) were enrolled. Diagnoses included vascular tumors (n=89, 47.6%), lymphatic malformations (n=38, 20.3%), capillary malformations (n=19, 10%), venous malformations (n=16, 8.5%), arterio-venous malformations (n=14, 7.5%) and mixed anomalies (n=11, 5.9%). Treatment modalities, in isolation or combination, included oral propranolol, topical timolol, pulsed dye laser and intra-lesional sclerotherapy. Mean follow up was in 7.1 months, with 27 patients achieving treatment completion. 26 children were lost to follow-up.
Conclusions:
Vascular anomalies have mostly been managed successfully at VAC using single or multimodal treatment. Increasingly complex anomalies can be handled using a multi-disciplinary approach. Establishment of VAC has facilitated many patients who were earlier considered as diagnostic and therapeutic challenges.
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