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Background: Treatment of oropharyngolaryngeal venous malformations (VMs) remains challenging. This study evaluated the effectiveness and safety of fluoroscopy- and endoscopy-guided transoral sclerotherapy for oropharyngolaryngeal VMs in a hybrid operation room (OR). Methods: Patients with oropharyngolaryngeal VMs who underwent transoral sclerotherapy in a hybrid OR were enrolled. Results: Fourteen patients (six females, eight males; median age of 26 years; range, 4–71 years) were analyzed. The symptoms observed were breathing difficulties (n = 3), snoring (n = 2), sleep apnea (n = 1), and swallowing difficulties (n = 1). Lesions were extensive in the face and neck (n = 9) and limited in the oropharyngolarynx (n = 5). A permanent tracheostomy was performed on two patients, while a temporary tracheostomy was performed on five patients. The treated regions were the soft palate (n = 8), pharynx (n = 7), base of the tongue (n = 4), and epiglottis (n = 1). The median number of sclerotherapy sessions was 2.5 (range, 1–9). The median follow-up duration was 81 months (range, 6–141). Treatment outcomes were graded as excellent (n = 2), good (n = 7), or fair (n = 5). The post-treatment complication was bleeding (n = 1), resulting in an urgent tracheostomy. Conclusions: Fluoroscopy- and endoscopy-guided transoral sclerotherapy in a hybrid OR can be effective and safe for oropharyngolaryngeal VMs. [ABSTRACT FROM AUTHOR]

Venous malformations are low flow endothelial malformations with aberrant and ectatic venous channels. They are defects in vascular growth which causes functional and cosmetic impairment. Gradual growth in size of the lesion occurs due to venous congestion or thrombosis. Venous malformations in parapharyngeal space are a rare entity and are difficult to diagnose. Case Report. 13 year old boy presented with a history of hyposmia and progressive difficulty in breathing for a duration of 2.5 years. MRI face and neck with contrast showed a 4.5 × 4.3x3.6 cm lesion in the left parapharyngeal space. CT angiogram of brain and neck demonstrated a heterogeneously enhancing mass in the left parapharyngeal region. PET scan illustrated an ill-defined mass in the left pre styloid parapharyngeal space. Biopsy from the lesion showed features consistent with venolymphatic malformation. Flexible laryngoscopy showed a bulge over the left soft palate region with narrowing of nasopharyngeal lumen. Patient underwent transoral robotic surgery for complete excision of the mass. Post-operative period was uneventful. He has been on follow up for the past 1 year with no evidence of any residual or recurrent disease. Venolymphatic malformation is a rare lesion in the parapharyngeal space which is difficult to diagnose pre operatively. Surgical excision is the preferred modality of treatment for deep seated lesions in the parapharyngeal space. The advent of transoral robotic surgery have reduced the morbidity and improved clearance for such cases. [ABSTRACT FROM AUTHOR]

AIM: To evaluate the usefulness of handheld ultrasound in comparison with high-end ultrasound for lesion evaluation before and after sclerotherapy in pediatric patients with venous malformations (VMs). MATERIAL AND METHODS: 10 pediatric patients prior to and after sclerotherapy were scanned by an experienced examiner using handheld ultrasound (Vscan AirTM) and high-end ultrasound (LOGIQ E9/E10) as reference. Patients with associated venous thromboses and intralesional aneurysms had been excluded. Results were interpreted independently by two readers in consensus. RESULTS: 10 patients (4-17 years; 10.0±4.32 years; female n = 6, male n = 4) with 10 VMs (4 of the head and neck region, 4 of the upper and 2 of the lower extremities) were examined. 7 phleboliths were detected. The average rating score achieved by the high-end device never was less than 4, by Vscan AirTM never less than 3. An exception was the assessment of AV fistulas. In comparison with the evaluation of variables examined, we found a significant difference between the high-end scanner and the handheld device regarding the achieved image quality. CONCLUSION: Vscan AirTM ultrasound device allows new possibilities for procedure planning and post-procedural control of pediatric patients with VMs. [ABSTRACT FROM AUTHOR]

Cervical lymphangioma is a congenital malformation of the lymphatic system. They are most common in children between the ages of 3 and 5 years and rarely present in adults. It is most often present in the posterior triangle of the neck. The treatment of choice is complete surgical resection, although other treatment alternatives are reported; the most significant being sclerotherapy. We have included six cases with large neck lymphangiomas in the period of 2020–2023. Two lympangioma were located on the left side of neck, one over the midline of neck, one at the right side of the neck, one in the right submandibular space and one at the right side parotid region. All were surgically resected sucessfully. No recurrence was seen in any cases. [ABSTRACT FROM AUTHOR]

A cross-sectional study was performed to evaluate health-related quality of life (HRQOL) in children with congenital vascular malformations (CVM) and to investigate factors associated with an impaired HRQOL. Children (2–17 years) with CVMs who visited the HECOVAN expertise center between 2016–2018 were included. The PedsQL 4.0 Generic Core Scales were used and a score ≥ 1.0 SD below the normative mean was defined as an impaired HRQOL. Factors associated with impairment were investigated using univariate and multivariate logistic regression analysis. The median overall HRQOL was 84.8/100 (n = 207; 41% boys, 59% girls; self-reported IQR 73.9–92.4 and parent-reported IQR 71.4–92.4). Patients aged 13–17 years reported significantly worse physical functioning than those aged 8–12 years (median 84.4, IQR 71.1–93.8 versus median 90.6, IQR 81.3–96.9; p = 0.02). Parents reported a significantly lower overall HRQOL than their children (median 80.4, IQR 70.7–90.8 versus median 85.9, IQR 76.1–92.4; p = 0.001). HRQOL was impaired in 25% of patients. Impairment occurred significantly more often in lower extremity CVMs (38%, p = 0.01) and multifocal CVMs (47%, p = 0.01) compared to CVMs in the head/neck region (13%). Other associated factors included invasive management (31% versus 14%; p = 0.01), age at first treatment ≤ 5 years (48% versus 25%; p = 0.02) and ongoing treatment (38% versus 18%; p = 0.004). After correction for other factors, significance remained for lower extremity CVMs and ongoing invasive treatment. Conclusions: Overall median HRQOL was reasonable and not significantly different from the norm sample. Parental ratings were significantly lower than their children's ratings. A quarter of the patients had an impaired HRQOL, which seemed to worsen with age. Independently associated factors included a lower extremity CVM and invasive management. What is Known: • Congenital vascular malformations could affect health-related quality of life (HRQOL). • Studies on pediatric patients are limited and either very small or in combination with adult patient series. What is New: • This study raises awareness of an impaired HRQOL in 25% of pediatric patients with congenital vascular malformations. • Associated factors included a lower extremity CVM and invasive management. [ABSTRACT FROM AUTHOR]

Background: Vascular malformation are congenital lesions with complex clinical presentations and management. Their classification and treatment options have considerably changed throughout the years, with conflicting evidence in the literature. Vascular malformations occur due to errors during vasculogenesis. They are present since birth, though they may not be apparent until later in life. These malformations are most frequently found in the head and neck, but can occur in any part of the body. Methodology- The study was carried out in the department of General Surgery of Tertiary care center teaching hospital from September 2018 to September 2020. The sample size taken for this study was 30 patients who were diagnosed as having vascular malformations and undergoing treatment. Patients were examined thoroughly and baseline findings were recorded. All the patients were subjected to either injection sclerotherapy, surgery or wait and watch treatment depending upon the vascular malformation and condition of patient. Sodium tetradecyl sulfate was used as sclerosing agent. Follow up of each patient was scheduled every 2 weeks, and therapy was repeated after 4 weeks, if there was no response or only a partial response. Result- The most commonly affected age group was 0-10 years. Cosmetic problems (63.33%)was the commonest symptom of presentation. Most common type of malformation was venous malformation (83.33%)/truncular malformation (70%). The most common location of vascular malformation was lower extremity (36.66%). A good response was achieved in majority of the patients (50%) treated with sclerotherapy in our study. Conclusion- Injection sclerotherapy is a relatively cost-effective procedure with low complications. Embolization is another treatment useful in cases of large AVMs where sclerotherapy and surgery are not possible. [ABSTRACT FROM AUTHOR]

Klippel-Trénaunay syndrome is typically a complex combined capillary-lymphatic-venous malformation in lower limb. Gastrointestinal involvement is not infrequent in Klippel-Trénaunay syndrome. Rectal bleeding is the most common complication. In recent years, this condition has been increasingly reported. However, most authors simply described extreme manifestations or various combinations of clinical observations. The underlying pathophysiology of gastrointestinal involvement in Klippel-Trénaunay syndrome has been underrecognized. Pathophysiologically, some seemingly adequate managements are pitfalls in treatment. Anorectosigmoid vascular malformations in KTS have distinct and more complicated pathophysiologies than anorectal vascular malformation. Once understanding the pathophysiology, some patients can be successfully managed with a staged plan in our practice. Therefore, recognizing the pathophysiologies of gastrointestinal involvement is needed to evaluate, prevent pitfalls, and determine adequate managements for practitioners. Because of the complexity and rarity of this condition, prospective controlled study or a large cohort of patients is impossible. Based on literature review and our practice, we discuss pathophysiologies, evaluation, pitfalls, and treatment strategies for gastrointestinal involvement in Klippel-Trénaunay syndrome. [ABSTRACT FROM AUTHOR]

BACKGROUND Sclerotherapy has achieved great success in treating most venous malformation (VM) lesions. OBJECTIVE To compare the effects of foam sclerotherapy on infantile hemangioma and pyogenic granuloma (PG). In addition, we analyzed the data and outcomes of foam sclerotherapy for the VM. MATERIALSAND METHODS Thirty-nine patients with hemangiomas and 83 patients with VMs were treated, and clinical outcomes, resolution, and complication rates were compared. Sclerotherapy data from the VM group were also analyzed. RESULTS The average age of the patients and the distribution and tissue involvement of lesions among the 3 groups were significantly different (p<.001). The average amount of sclerosing foam administered per session in VMs was significantly higher than that in the other 2 groups (p < .0001) (whereas that in the PG group was lower than that in the infantile hemangioma group [p < .0001]). However, the overall therapeutic efficacy and side effects in the 3 groups were not significantly different. For VMs, the frequency of ultrasound guided foam sclerotherapy and use of 3% polidocanol increased from superficial to deep lesions, whereas the use of 1% POL decreased (p < .0001). CONCLUSION Infantile hemangioma and PG treatments presented good results and minor adverse reactions comparable with those of VMs. [ABSTRACT FROM AUTHOR]

Vascular malformations are congenital vascular anomalies that originate because of disorganized angiogenesis, most commonly from spontaneous somatic genetic mutations. The modern management of vascular malformations requires a multidisciplinary team that offers patients the gamut of medical, surgical, and percutaneous treatment options with supportive care. This manuscript discusses the standard and contemporary management strategies surrounding extracranial vascular malformations and overgrowth syndromes. [ABSTRACT FROM AUTHOR]

Percutaneous sclerotherapy is a well-recognized treatment for management of low-flow vascular malformations. It is regarded as a safe and effective procedure, and there are very few reports of sight-threatening complications in the medical literature. We describe a case of a 12-year-old girl who developed severe orbital compartment syndrome due to a combination of orbital inflammation and hemorrhage, resulting in massive proptosis, severe chemosis, optic nerve compression, severe lagophthalmos, exposure keratitis and visual loss following bleomycin sclerotherapy for a right orbital and periorbital lymphaticovenous malformation. Despite presenting to the emergency eye clinic 5 days after the onset of her symptoms, when her vision was thought to be irretrievably lost, she had a surprisingly good visual outcome after medical and surgical intervention. Although sclerotherapy for low-flow vascular malformations of the orbit is generally safe, it can be complicated by severe sight-threatening orbital inflammation and hemorrhage for which urgent intervention is usually required. However, with adequate management, visual recovery may occur even after late presentation. [ABSTRACT FROM AUTHOR]

Background: Endovascular approaches have been widely applied in patients with brain arterio-venous malformations (AVM). However, little is known regarding the risk factors for complications or predictors of procedure success. Herein, we report our experience regarding the outcomes of endovascular embolization of posterior fossa AVM, focusing on how angioarchitectural and hemodynamic characteristics of the AVM affect the post-intervention outcomes. 17 patients diagnosed with posterior cranial fossa AVM were enrolled and scheduled for endovascular interventions by Onyx or Histoacryl. Results: Most patients had a single session (58.8%), while 29.4% had two sessions, 11.7% had three sessions. Total nidus obliteration was achieved in 52.9% of cases, while 35.3% and 11.8% of them had subtotal and partial occlusion, respectively. Postprocedural hematoma was encountered in 17.6% of cases. All preprocedural demographic characteristics did not have a significant impact on occlusion outcomes. However, some angioarchitecture criteria were associated with partial occlusion including large size, superficial or mixed drainage. No significant association was noted between patients criteria and the incidence of complications. Conclusion: Endovascular interventions could be curative for brain AVM, with an accepted periprocedural morbidity rate. Proper knowledge of the angioarchitectural characteristics of these lesions could help us to predict lesions that carry high risk for complications or high chance for cure. [ABSTRACT FROM AUTHOR]

Myopericytoma is a rare tumour which typically presents as a benign lesion that mimics features of other more common vascular tumours and malformations. We present a case of a symptomatic diffuse myopericytomatosis of the left abdomen presenting as multiple subcutaneous vascular tumours detected on ultrasound and treated with ultrasound‐guided sclerotherapy. [ABSTRACT FROM AUTHOR]

This report discusses the surgical treatment of a giant parotid venous malformation (VM) that had grown beyond the dimensions of the parotid gland, causing significant displacement. Special attention was paid to identifying the facial nerve, which was found to traverse the surface of the VM. Although, in our case, the facial nerve ran superficially on the VM, it is possible that a portion of it penetrated the mass. A two-stage excision and revision surgery strategy was employed due to the complexity of assessing deformities after removing the giant lesion. During the initial surgery, the displaced superficial lobe of the parotid gland was repositioned to its original location and carefully laid over the facial nerve, ensuring its safety during the subsequent procedure. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Sclerotherapy is a convenient modality for the treatment of venous malformation. Ethanol as a sclerosing agent is easily available and cheap. Sclerotherapy for venous malformations has both functional as well as aesthetic outcome. The incidence of VMS is estimated to be 0.5% for all newborns. Here we present a series of three patients with vascular malformations who underwent sclerotherapy using 98% ethanol injection as sclerosing agent. Sclerotherapy is a convenient modality for treatment of venous malformation for functional as well as aesthetic management. [ABSTRACT FROM AUTHOR]

Background: Facial and neck swellings are frequently encountered in pediatric medicine, and can present a diagnostic dilemma for the clinicians involved. Neck imaging has always been a diagnostic challenge. MultiDetector row Computed Tomography is an important imaging modality for characterization and presurgical evaluation of neck masses. The aim of the current study was to evaluate the Multi Detector Computed Tomography (MDCT) in diagnosis and interventional management of facial and neck swellings in children. Methods: This is a prospective study included 18 patients (7 males and 11 females) their age range from 8 months to up to 16 years, who were referred to radio diagnosis department from clinical departments at Zagazig University hospitals for assessment of facial and neck swellings by ultrasound (US) and computed tomography (CT) during the period from January 2019 to July 2019. Results: The CT diagnosis of this study was 16.6% Hemangioma, venous malformation and lymphatic malformation same percentage 11.11%, benign soft tissue tumor and facial bone tumor due to thalassemia same percentage 5.55%, congenital swelling 16.6% and infectious facial and neck swellings 22.22%.Sixty percentage of cases after sclerotherapy had complete lesion obliteration and 40 % of them had partial lesion obliteration. Sensitivity of MDCT 87.5%, specificity 100%, PPV 100%, NPV 50% and accuracy 90%. Conclusions: MDCT imaging is useful for quick and accurate assessment of facial and neck swelling and the possible improvement of any vascular territory in facial and neck swellings by minimal invasive technique of interventional radiology in facial and neck swellings by minimal invasive technique of interventional radiology. [ABSTRACT FROM AUTHOR]

Introduction: Venous malformations affect around 2 per 10,000 newborn and are the most common type of congenital vascular malformation. They are always present at birth and are often misdiagnosed with hemangiomas. Accurate diagnosis and adequate targeted therapy through a multidisciplinary approach is advocated for a successful treatment, considering a combination of modalities in complex cases. We present here the workup and treatment of a venous malformation in a 14 month old child by combining a preoperative sclerotherapy with sodium tetradecyl sulfate (STS) followed by complete surgical excision respecting the calvarium. Case presentation. A large right extracranial fronto-parietal venous malformation and scalloping of the underlying calvarium, attached to the pericranium, surgically excised after preoperative sclerotherapy with STS in a 14-month-old child. Results: The patient had an uneventful postoperative course with complete resection of the lesion, satisfying cosmetic appearance and no complications. Histopathological examination confirmed a venous malformation. Conclusion: We demonstrated the workup and the rationale of the combined sclerotherapy followed by surgical resection of a large growing extracranial venous malformation. Preoperative direct contrast injection and sclerotherapy allowed to rule out significative extracranial to intracranial venous inflow and reduce blood loss for the surgical procedure, respectively. Complete removal of the malformation minimized the impact on future growth of the calvarium. [ABSTRACT FROM AUTHOR]

Background: Vascular malformations represent a wide spectrum of disorders in children. Recently, interstitial bleomycin sclerotherapy has been shown to be a safe and effective treatment for selected cases of vascular malformation in children and adults. Aim: To evaluate the short‐term outcome and safety of interstitial bleomycin sclerotherapy in children with vascular malformations. Methods: This is a retrospective study in which patients under 18 years old with vascular malformation undergoing bleomycin sclerotherapy between August 2019 and January 2022 in Hong Kong were included. Relevant demographics of the included patients were collected. Short‐term outcomes including clinical response, immediate and early complications were evaluated. Results: Four patients who aged from 4 to 8 years old were identified, three with lymphatic malformation and one with arteriovenous malformation. A total of eight sessions of interstitial bleomycin sclerotherapy were performed. Three of them reported clinical response with either reduction in lesion size or reduction in discomfort or disfigurement. No immediate complication was reported. However, one of them experienced post‐operative hyperpigmentation with scratch marks. Conclusion: The experience in the use of interstitial bleomycin sclerotherapy in children with vascular malformations is still limited in our locality. Further study with larger cohorts and longer follow‐up is required to further establish its efficacy and safety profile in paediatric patients. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVE: Oral malformations of the tongue are exceedingly rare. The aim of this study was to evaluate the effectiveness of individualized treatment for patients with vascular malformations of the tongue. METHODS: This retrospective study is based on a consecutive local registry at a tertiary care Interdisciplinary Center for Vascular Anomalies. Patients with vascular malformations of the tongue were included. Indications for therapy of the vascular malformation were macroglossia with the impossibility to close the mouth, bleeding, recurrent infection and dysphagia. Size regression of the malformation (volume measurement) and symptom improvement were investigated. RESULTS: Out of 971 consecutive patients with vascular malformations, 16 patients suffered from a vascular malformation of the tongue. Twelve patients had slow-flow malformations and 4 fast-flow malformations. Indications for interventions were bleeding (4/16, 25%), macroglossia (6/16, 37.5%), and recurrent infections (4/16, 25%). For two patients (2/16, 12.5%), there was no indication for intervention due to absence of symptoms. Four patients received sclerotherapy, 7 patients Bleomycin-electrosclerotherapy (BEST) and 3 patients embolization. Median follow-up was 16 months (IQR 7–35.5). In all patients, symptoms had decreased after two interventions at a median (IQR 1–3.75). Volume reduction of the malformation of the tongue was 13.3% (from median 27.9 cm3 to median 24.2 cm3, p = 0.0039), and even more pronounced when considering only patients with BEST (from 86 cm3 to 59.1 cm3, p = 0.001). CONCLUSION: Symptoms of vascular malformations of the tongue are improved after a median of two interventions with significantly increased volume reduction after Bleomycin-electrosclerotherapy. [ABSTRACT FROM AUTHOR]

Background: Venous malformations (VMs) are slow-flow vascular anomalies present at birth that enlarge during adolescence, subsequently causing thrombosis, hemorrhage, and pain. Case presentation: We describe a case of an adolescent male presenting with a large scalp venous malformation. Given the size and location of the lesion, a hybrid approach employing both sclerotherapy and surgical resection was utilized. The VM was successfully removed without complication. Conclusion: A hybrid approach is a safe and effective treatment consideration for immediate management of large venous malformation in higher-risk locations. [ABSTRACT FROM AUTHOR]

Objective To explore the application of ROADMAP function in endovascular sclerotherapy of venous malformations guided by digital subtraction angiography (DSA). Methods From May 2019 to July 2020, 11 patients underwent endovascular sclerotherapy of venous malformations guided by DSA. The ROADMAP function was used to monitor the administration of sclerosant in real time during the operation. Postoperative follow-up and efficacy evaluation were performed. Results Eleven patients received sclerotherapy of 25 times for 13 lesions, with an average of (2.1±0.9) times. The average treatment period was (18.5±3.4) min, and the average use period of the ROADMAP function was (52.5±10.3) s. All patients were followed up for 24 months. Seven cases had complete response, 2 cases had significant response and 2 cases had partial response. No recurrence or progression was found. No serious complications such as bleeding, ulceration, infection or dysfunction occurred in all patients. Conclusion The ROADMAP function can improve the safety of treatment, grasp the structure of lesion, make the drug dose more accurate and does not significantly increase the operative duration. It should be considerable for clinical application. [ABSTRACT FROM AUTHOR]

Arteriovenous malformations (AVMs) are most commonly reported in the brain whereas in head and neck region they are rare i.e. incidence is 0.1% of the general population. Commonly managed by surgical excision, embolization, sclerotherapy. Here we present a case of 18-year-old female with AV malformation within buccinator muscle which was recurrent and was treated with compartmentalization followed by sclerotherapy and surgical excision. [ABSTRACT FROM AUTHOR]

Orbital venolymphatic malformations are rare vascular malformations that typically appear early in life and harbor acute and chronic threats to vision. Historically, there are four categories of management: observation, medication, sclerotherapy, and surgery. Currently, there is neither a gold standard for treatment nor randomized control trials comparing treatments. The authors present a 20-year-old male who presented with spontaneous hemorrhage of an orbital venolymphatic malformation occurring with increased frequency and involving more of the posterior orbit. Surgery and sclerotherapy were not feasible options due to the extensive intraorbital and intracranial involvement of the venolymphatic malformation. Systemic steroids treated symptoms but was not curative. To this end, a combination of sirolimus, an mTOR inhibitor, and rivaroxaban, a factor Xa inhibitor, were used to reduce the size of the lesion and minimize the risk of thromboembolic events. This treatment has successfully kept the patient's symptoms in remission for greater than 2 years. [ABSTRACT FROM AUTHOR]

Background. Vascular malformations are structural abnormalities which are formed by progressively enlarging aberrant and ecstatic vessels without endothelial cell proliferation and composed of the type of vessel involved, i.e., capillary, veins, and arteriovenous. Treatment of vascular malformations may involve many techniques like sclerotherapy, embolization, surgical resection, cryotherapy, laser treatment, or medical therapy. This observational prospective study is aimed at evaluating and comparing the effects and efficacy of diode laser and sclerotherapy in the treatment of oral vascular malformation. Materials and Methods. 40 patients presenting with oral vascular malformation were included in the present study. The patients were divided equally (20 in each) into two groups, i.e., the laser group and sclerotherapy group. Sclerotherapy was performed with 3% sodium tetradecyl sulfate while the laser group was treated with diode laser 980 nm with transmucosal thermophotocoagulation. The patients were assessed for the response, remission, and side effects. The results obtained were tabulated and compared with the chi-square test. Results. Side effects were found significantly lesser in the laser group compared to the sclerotherapy group (p < 0.05). Statistically significant difference was seen for postoperative pain between two groups. The laser group had mild to moderate pain compared to severe pain in the sclerotherapy group. Recurrence was observed more in the laser group compared to the sclerotherapy group. Conclusions. Laser and sclerotherapy with 3% sodium tetradecyl sulfate both are effective in the treatment of vascular malformations. Diode laser seems to be better than sclerotherapy given lesser side effects and comfort to the patients while sclerotherapy seems to be better in respect to recurrences. [ABSTRACT FROM AUTHOR]

Objective: To describe the use of 1% polidocanol as the sole treatment for a superficial orbital venous malformation in a horse. Animal: A 23‐year‐old Welsh Cobb cross gelding with a distensible swelling affecting the left lower eyelid, and secondary palpebral margin abnormalities and superficial keratitis. Procedure: Color flow Doppler ultrasonography revealed non‐pulsatile blood flow within the tortuous vascular network most consistent with a superficial orbital venous malformation appearing to involve the lateral palpebral and transverse facial veins. An intravenous catheter was placed within the lateral aspect of the venous malformation, and agitated saline was slowly injected into the vessel while simultaneously ultrasound imaging the medial aspect in which the bubbles were observed coursing across, consistent with lateral to medial flow. Contrast venography confirmed a corkscrew vessel along the ventral aspect of the orbital rim. Under standing sedation, 1% polidocanol solution was administered slowly through the intravenous catheter while manual pressure was applied on the medial and lateral aspects of the venous malformation. Results: Ultrasonography performed immediately after administration of polidocanol confirmed venous stasis, and formation of a thrombus. No adverse side effects were noted. The venous malformation and associated palpebral margin abnormalities and superficial keratitis resolved at the time of re‐examination at 4 months. Conclusion and Clinical Relevance: Polidocanol as the sole treatment for a superficial orbital venous malformation in a horse was well tolerated and led to clinical resolution. Sclerosant monotherapy may be a safe treatment option for superficial orbital venous malformations. [ABSTRACT FROM AUTHOR]

• MRI-based volumetric analysis can assess outcomes of PS in extremity VMs. • Volumetric assessment of volume and SI change on T2-WI after PS is feasible. • VM volume change is a reliable indicator of treatment response after PS. • VM volume and SI correlate with clinical outcomes in specific patient groups. To investigate quantitative changes in MRI signal intensity (SI) and lesion volume that indicate treatment response and correlate these changes with clinical outcomes after percutaneous sclerotherapy (PS) of extremity venous malformations (VMs). VMs were segmented manually on pre- and post-treatment T2-weighted MRI using 3D Slicer to assess changes in lesion volume and SI. Clinical outcomes were scored on a 7-point Likert scale according to patient perception of symptom improvement; treatment response (success or failure) was determined accordingly. Eighty-one patients with VMs underwent 125 PS sessions. Treatment success occurred in 77 patients (95 %). Mean (±SD) changes were –7.9 ± 24 cm3 in lesion volume and –123 ± 162 in SI (both, P <.001). Mean reduction in lesion volume was greater in the success group (–9.4 ± 24 cm3) than in the failure group (21 ± 20 cm3) (P =.006). Overall, lesion volume correlated with treatment response (ρ = –0.3, P =.004). On subgroup analysis, volume change correlated with clinical outcomes in children (ρ = –0.3, P =.03), in sodium tetradecyl sulfate–treated lesions (ρ = –0.5, P =.02), and in foot lesions (ρ = –0.6, P =.04). SI change correlated with clinical outcomes in VMs treated in 1 PS session (ρ = –0.3, P =.01) and in bleomycin-treated lesions (ρ = –0.4, P =.04). Change in lesion volume is a reliable indicator of treatment response. Lesion volume and SI correlate with clinical outcomes in specific subgroups. [ABSTRACT FROM AUTHOR]

Vascular malformations can be treated using sclerotherapy agents like alcohol, polidocanol, or sodium tetradecyl sulfate foam and embolization treatments. These endovascular treatments may cause severe complications as pulmonary embolism and thrombosis. 980-nm diode lasers (DLs) are common devices used by many specialties as plastic surgeons, dermatologists, and vascular surgeons. Laser energy is excellently absorbed in water and hemoglobin, which makes it ideal for adipose tissue and deep lesions. We treated our patient using a DL. Our surgical approach allowed total excision of the arteriovenous malformation (AVM), which decreased the size of the tumor allowing a smaller incision and eased the dissection plane. We believe that lasers will be used more frequently on AVM treatments. [ABSTRACT FROM AUTHOR]

Facial capillary malformations (CMs) become hypertrophic and nodular overtime and pose great therapeutic challenge. Here, we describe safe and effective use of tumescent‐assisted sclerotherapy (TAS) in conjunction with yellow vascular laser (577 nm) for the treatment of HFCMs. Three patients underwent TAS were included in the case series, and complete resolution in nodularity was achieved in all patients with TAS, with no major complications such as skin necrosis, distal embolisation, blindness and neurological adverse events such as stroke or TIA occurred in any patients. [ABSTRACT FROM AUTHOR]

Laryngeal venous malformations rarely but do cause airway obstruction resulting in life‐threatening events. The perioperative airway management for the patients with them has not been well established. We suggest a strategy for laryngeal venous malformations management in the patients who undergo surgery in addition to planning for airway management. [ABSTRACT FROM AUTHOR]

GLO:ETZ/01dec22:dth15904-fig-0001.jpg PHOTO (COLOR): 1 (A) 5-year-old female with venous malformation of lip measuring 2.1 cm × 1.1 cm. (B) Partial resolution of lesion after 1st session of combination of polidocanol sclerotherapy and radiofrequency ablation. Keywords: lip; polidocanol; radiofrequency; venous malformations EN lip polidocanol radiofrequency venous malformations 1 3 3 12/20/22 20221201 NES 221201 Venous malformations (VM) are the most common vascular malformations in clinical practice, 40% of VM occur in the head and neck region with lips being one of the common sites. In a study of 41 patients with high-return flow VM by Wang et al.[6] DSA-guided anhydrous ethanol injection sclerotherapy was given to the control group ( I n i = 22) and combination of sclerotherapy and RF ablation in the observation group ( I n i = 19). [Extracted from the article]

The article titled "A Novel Drug Self-Delivery System from Fatty Alcohol Esters of Tranexamic Acid for Venous Malformation Sclerotherapy" has been retracted by the Pharmaceutics Editorial Office. The authors of the article raised concerns about scientific and image errors after its publication. An investigation conducted by the Editorial Office and Editorial Board confirmed the presence of errors in the figures, incorrect association of subfigures to experimental animals, and writing errors in the Material and Method section. Due to the inability to confirm the reliability of the findings, the article has been retracted according to MDPI's retraction policy. The retraction was approved by the Editor-in-Chief of the journal Pharmaceutics, and the authors agreed to the retraction. [Extracted from the article]

Supplemental Digital Content is Available in the Text. BACKGROUND: Intralesional injection of a sclerosing agent is a standard treatment for vascular malformations, but many repeat treatments are often required to achieve a response. The temporary application of an electrical field to the treated area increases cellular membrane permeability and therefore augments drug delivery. OBJECTIVE: To report a case series of patients with vascular malformations who received bleomycin electrosclerotherapy (EST). MATERIALS AND METHODS: A prospective observational case series of patients with vascular malformations treated with bleomycin EST. Only patients who did not respond or had limited response to standard sclerotherapy were included. The response to the treatment was assessed using a global assessment score and patient-reported outcome measures. RESULTS: Thirty patients were treated with EST. Most of the patients had venous malformations (57%). Complete response or significant improvement was observed in 17 (57%) and 7 (23%) patients, respectively. Most of the patients were satisfied or very much satisfied with the outcome of the treatment. Most commonly reported complications were swelling, pain, and bleeding. CONCLUSION: Electrosclerotherapy is a promising method of augmenting the efficacy of intralesional bleomycin injections when treating vascular malformations. It can potentially lead to a reduction in the administered dose and number of treatment sessions needed. [ABSTRACT FROM AUTHOR]

Systemic bleomycin therapy is associated with pulmonary fibrosis and cutaneous side effects. While it is believed that there is little to no systemic distribution of bleomycin when utilized to treat vascular malformations (VMs), we present a case series in which cutaneous, adhesive‐related hyperpigmentation suggests that there is systemic egress of bleomycin following direct puncture sclerotherapy (DPS). This risk of hyperpigmentation after intralesional bleomycin should be discussed with patients, and steps to minimize the chances of it occurring should be implemented. [ABSTRACT FROM AUTHOR]

Purpose: It is challenging for radiologists to distinguish between venous malformations (VMs) and lymphatic malformations (LMs) using magnetic resonance imaging (MRI). Thus, this study aimed to differentiate VMs from LMs using non-contrast-enhanced MRI texture analysis. Material and methods: This retrospective case-control study included 12 LM patients (6 men and 6 women; mean age 43.58, range 7-85 years) and 29 VM patients (7 men and 22 women; mean age 53.10, range 19-76 years) who underwent MRI for suspected vascular malformations. LM and VM patients were identified by histopathological examination of tissues excised during surgery. The texture features of VM and LM were analysed using the open-access software MaZda version 3.3. Seventeen texture features were selected using the Fisher and probability of error and average correlation coefficient methods in MaZda from 279 original parameters calculated for VM and LM. Results: Among 17 selected texture features, the patients with LM and VM revealed significant differences in 1 histogram feature, 8 grey-level co-occurrence matrix (GLCM) features, and 1 grey-level run-length matrix feature. At the cut-off values of the histogram feature [skewness ≤ –0.131], and the GLCM features [S(0, 2) correlation ≥ 0.667, S(0, 3) correlation ≥ 0.451, S(0, 4) correlation ≥ 0.276, S(0, 5) correlation ≥ 0.389, S(1, 1) correlation ≥ 0.739, S(2, 2) correlation ≥ 0.446, S(2, –2) correlation ≥ 0.299, S(3, –3) correlation ≥ 0.091] had area under the curves of 0.724, 0.764, 0.773, 0.747, 0.733, 0.759, 0.730, 0.744 and 0.727, respectively. Conclusions: Non-contrast-enhanced MRI texture analysis allows us to differentiate between LMs and VMs. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the efficacy and safety of intralesional diode laser pretreatment for facilitating surgery for orbital venous malformations (OVMs). Methods: This is a retrospective, non-comparative, interventional cohort involving 23 consecutive OVM patients undergoing intralesional laser pretreatment followed by surgical excision. The main outcome measures included volumetric changes, exophthalmometry, cosmesis, and symptom scores as well as treatment-related adverse events. Results: Following intralesional diode laser, the mean volume dropped significantly from 2366 ± 1887 to 129 ± 119 mm3 (t = 5.716; p < 0.001). After a single treatment session, a mean 90 ± 13% volume shrinkage was achieved in all 23 OVM. The mean Hertel exophthalmometry decreased significantly from 14 ± 3 to 13 ± 1 mm (t = 2.515; P < 0.02). The resolution of periocular dyschromasia and swelling were evident in 20 patients (87%). Symptom scores improved significantly from 6.5 ± 1.4 (very intense discomfort or effect on daily living) to 1.2 ± 1.0 (very mild discomfort or effect on daily living; p < 0.001). Short-term bruises and swelling were reported in 20 patients (87%). Conclusion: Intralesional laser pretreatment is effective to facilitate surgery especially for the deep involving orbital venous malformations. [ABSTRACT FROM AUTHOR]

Background Venous malformations (VMs) are the most common type of vascular malformations. Intramuscular venous malformations (IMVMs) are lesions involving the muscles, excluding intramuscular hemangiomas. The purpose of this study was to compare clinical outcomes between patients with IMVMs who were treated with sclerotherapy and those who were treated with surgical excision. Methods Of 492 patients with VMs treated between July 2011 and August 2020 at a single medical center for vascular anomalies, 63 patients diagnosed with IMVM were retrospectively reviewed. Pain, movement limitations, swelling, and quality of life (QOL) were evaluated subjectively, while radiological outcomes were assessed by qualified radiologists at the center. Complication rates were also evaluated, and radiological and clinical examinations were used to determine which treatment group (sclerotherapy or surgical excision) exhibited greater improvement. Results Although there were no significant differences in pain (P=0.471), swelling (P=0.322), or the occurrence of complications (P=0.206) between the two treatment groups, the surgical treatment group exhibited significantly better outcomes with regard to movement limitations (P=0.010), QOL (P=0.013), and radiological outcomes (P=0.017). Moreover, both duplex ultrasonography and magnetic resonance imaging showed greater improvements in clinical outcomes in the surgical excision group than in the sclerotherapy group. Conclusions Although several studies have examined IMVM treatment methods, no clear guidelines for treatment selection have been developed. Based on the results of this study, surgical excision is strongly encouraged for the treatment of IMVMs. [ABSTRACT FROM AUTHOR]

Deep-seated brainstem cavernous malformations (BSCMs) pose a particular challenge for brainstem entry intraoperatively and their treatment can require comprehensive application of neuronavigation, electrophysiological brainstem mapping and monitoring, and full knowledge of safe brainstem entry zones. In the present report, we have introduced a supplementary technical trick for localizing a hidden tiny lesion inside the brainstem when a developmental venous anomaly (DVA) is present on the brainstem surface. A retrospective analysis of a 74-case cohort treated surgically from January 2011 to December 2019 was conducted. We identified 11 patients (14.9%) whose deep-seated BSCMs were exposed and removed following a brainstem surface DVA path as a supplementary technical trick. We have presented 2 typical cases to illustrate the operative nuances. Of the 11 patients, 5 were male and 6 were female. Their average age was 38.0 ± 14.0 years (range, 15–62 years). Most BSCMs were located in the pons (n = 5; 45.5%), followed by the pontomesencephalic area (n = 3; 27.3%), midbrain (n = 2; 18.2%), and medulla oblongata (n = 1; 9.1%). All BSCMs were successfully located and completely removed. In 5 cases, the DVA was impaired after lesion removal (45.5%). However, no aggravated postoperative brainstem edema occurred in any of the 11 patients. After 3.6 ± 2.0 years of follow-up (2 patients were lost to follow-up; follow-up rate, 81.8%), no rebleeding was found, and the modified Rankin scale score of the patients had improved from 2.7 ± 1.1 preoperatively to 1.7 ± 0.9 at follow-up (P = 0.031). The presented method could help surgeons trace deep-seated BSCMs with minimal brainstem parenchyma impairment, avoiding unnecessary aggressive exploration. [ABSTRACT FROM AUTHOR]

Background: Vascular malformations (VMs) involving the hand and forearm in children provide management challenges due to complex anatomy, indispensable functionality and developmental implications. Methods: The institution's Vascular Registry was searched for patients with hand and arm VMs, supplemented by chart review of included patients. Results: Twenty‐one patients were identified, 52% male, with mean presenting age 5.2 years. Venous malformations predominated (71%), followed by lymphatic‐venous (19%), lymphatic (5%) and glomuvenous (5%). Symptoms included pain (76%), swelling (71%), cosmetic concerns (81%), functional compromise (29%) and stiffness (5%). Imaging modality was ultrasound (100%), and magnetic resonance imaging (71%). Treatment included compression (62%), sclerotherapy (62%) and surgery (24%). Post‐sclerotherapy ultrasounds showed complete sclerosis (25%), near complete sclerosis (58%) and partial sclerosis (17%). Post‐surgery, patients reported improved cosmesis (80%), size (100%), pain (60%) and function (40%). Complications occurred in 24%, including bleeding, digital ischaemia and thrombosis. Mean follow‐up was 3.4 years. Conclusion: Children with low‐flow VMs of the hand and forearm experience significant symptoms and functional limitations. A multidisciplinary approach to management ensures optimal outcomes. [ABSTRACT FROM AUTHOR]

Lymphatic malformations (LMs) are the consequence of errors during embryological development of the lymphatic system. Large diffuse lymphatic malformations are troublesome. They can affect different tissue planes, and depending on the anatomic location, they can cause significant esthetic disturbance and interfere with normal function. LMs with skin involvement often manifest as multiple vesicles that ooze, bleed, itch, and get easily infected causing cellulitis with intense pain and fever, resulting in frequent hospital visits and impaired quality of life. We report one such case of a giant mixed type LM in the right lower extremity of an 11-year-old boy. The goal of this article is to discuss the currently available treatment modalities for these complex cases and to describe the successful outcome after an initial treatment with combined sclerotherapy and lasertherapy followed by a definitive surgical excision and coverage with Integra® and skin grafts. Level of evidence: Level V, therapeutic study. [ABSTRACT FROM AUTHOR]

An 11-year-old boy underwent every-5-mm Nd:YAG laser irradiation for endophytic VM of the glans penis, 12 mm in size. GLO:FRY/01nov21:iju14662-fig-0001.jpg PHOTO (COLOR): 1 Preoperative and postoperative appearance of VM of the glans penis. gl Because there were no relapses of VM after this irradiation therapy, additional treatments were unnecessary. Abbreviations & Acronyms Nd:YAG neodymium:yttrium-aluminum-garnet VM venous malformation Vascular anomalies of the male genitalia are rare, and there is no consensus on classification, cause, or treatment.1 Such anomalies include hemangiomas and vascular malformations. [Extracted from the article]

Management of tongue venous malformations can be challenging in the pediatric population due to their heterogeneity in presentation, extent of involvement and functional compromise. It is important to recognize the value of various treatment options in order to guide management of each patient in an individualized fashion. Here we describe a series of patients with tongue venous malformations that are managed using diverse modalities to illustrate the relative benefits and risks of each technique. The challenges of venous malformation treatment can be mitigated by tailoring the approach to each individual patient and malformation. This case series also emphasizes the need and importance of working in the setting of a multidisciplinary vascular anomalies team. [ABSTRACT FROM AUTHOR]

Histological examination of a representative nodule from the right thigh revealed venous cavernous malformation with glomus cells (Fig. Liquid sclerotherapy is a quick treatment option with few side effects and, compared with excision or laser ablation, does not cause any scars, especially if there are multiple nodules in visible body regions. Physiologically, they occur in glomus bodies and are associated with unmyelinated nerve fibres.6 This rare case of a patient with GVM and severe skin manifestation illustrates liquid sclerotherapy as a successful therapy option with very good responses. [Extracted from the article]