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

Abstract

A retrospective review of the results of management of congenital vascular malformation (CVM) patients was made to assess the efficacy of newly introduced approaches. 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. 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. New approaches to the treatment of CVMs based on a multidisciplinary approach can improve results by fully combined surgical treatment with embolo-sclerotherapy.