New approaches to the treatment of congenital vascular malformations (CVMs)--a single centre experience

Abstract

Objective: A retrospective review of the results of management of congenital vascular malformation (CVM) patients was made to assess the efficacy of newly introduced approaches.

Methods: CVMs were categorised according to the Hamburg classification on the basis of minimally invasive tests. Invasive studies such as angiography are used to provide a road map for treatment. A new multidisciplinary approach was adopted, which accepts the integration of embolisation and sclerotherapy with traditional surgical therapy. Embolo-sclerotherapy was used as an independent therapy and as an adjunctive therapy to surgery.

Results: Ninety-nine out of a total of 294 venous malformation patients underwent ethanol sclerotherapy with an immediate success rate of 98.8%, requiring 419 sessions of treatment. Interim results were excellent with no evidence of recurrence (mean follow-up 18.2 months). Most of the 25 patients treated surgically received pre-operative embolo-sclerotherapy, each with excellent interim results and minimum morbidity (mean follow-up 21.2 months). Forty-eight patients among 76 arteriovenous malformation patients underwent embolo-sclerotherapy independently (32/48) or adjunctively (16/48). Independent therapy on 32 produced excellent interim results (25/32) requiring a total of 171 sessions (mean follow-up 19.2 months). Eighty-nine extratruncal (ET) forms of lymphatic malformations received multiple sessions of sclerotherapy with OK-432 (108/120 sessions) or ethanol (12/20 sessions). OK-432 was used in 51 paediatric patients with the ET form and produced an excellent response in cystic type lesions (40/45) requiring 61 sessions with no evidence of recurrence (mean follow-up 24.2 months), whereas a mixed result was obtained in the cavernous type (3/6). OK-432 sclerotherapy was used as a pre-operative adjunctive therapy in 7 patients requiring 21 sessions with 17 cavernous type of the ET form, and produced good to excellent results after surgical excision of 14 lesions.

Conclusion: New approaches to the treatment of CVMs based on a multidisciplinary approach can improve results by fully combined surgical treatment with embolo-sclerotherapy.