Sclerotherapy of face and oral cavity low flow vascular malformations: our experience.

We have reviewed our experience (15 patients during the period 2008-2012) in the treatment of low flow vascular malformations (LFVMs) of the face and oral cavity with polidocanol foam sclerotherapy. They were diagnosed clinically and with the help of Doppler ultrasound and magnetic resonance imaging. The maximum dose recommended for each session was 20mg/day and the minimum interval between sessions was 4 weeks. Embolisation was repeated as many times as needed until the size of the lesions and the symptoms had been reduced sufficiently. Patients were followed up 1, 6, and 12 months after treatment had finished, and the size of the lesions was assessed objectively. The 8 men and 7 women were aged between 18 and 71 (mean 44) years. The lesions had reduced and symptoms had improved in all cases. During the follow-up period, one patient relapsed and developed further symptoms. The pain and postoperative inflammation were successfully controlled with an analgesic and an anti-inflammatory drug. There was only one complication (superficial necrosis), which healed completely by second intention. Direct puncture and sclerosis with polidocanol foam are an effective treatment for LFVM of the face and oral cavity.

[Percutaneous treatment of peripheral vascular malformations with a mixture of polidocanol and CO(2). Initial experience]. / Tratamiento percutáneo de las malformaciones vasculares periféricas con una mezcla de polidocanol y CO2. Experiencia inicial.

OBJECTIVE: The percutaneous treatment of peripheral vascular malformations is currently the first treatment option for these processes. We describe our initial experience using a mixture of polidocanol and CO(2) as an embolizing agent; we analyze the efficacy and complications of the treatment. MATERIAL AND METHODS: Between April 2005 and December 2006, we treated a total of 18 patients, comprising 11 women (61%) and 7 men (39%), with ages ranging from 11 to 80 years. One (5%) vascular malformation was hemodynamically active and the remaining 17 (95%) were hemodynamically inactive. We performed a total of 56 embolizations (mean per patient, 3; range, 1-7) using a mixture of polidocanol and CO(2) (mean, 8 cm(3); range, 1-28 cm(3)). The malformations were studied with Doppler ultrasonography, magnetic resonance imaging, and direct puncture angiography and/or arteriography. Specific approaches and treatments were used in each case in function of the location, size, and characteristics of the malformation. RESULTS: Technical success, defined as the possibility of embolizing the malformation, was achieved in all cases. No technical complications occurred. The mean follow-up period was 9 months (range, 1-20). All patients, except one woman who refused to continue treatment, improved objectively and subjectively, and all were able to return to normal daily activities. After embolization, all patients presented edema, pain, and increased functional incapacity that ceased with medical treatment. CONCLUSION: Percutaneous embolization of vascular malformations using a mixture of polidocanol and CO(2) is efficacious and has a low rate of complications. Our initial results are promising but larger studies are necessary to reach definitive conclusions.

Tratamiento percutáneo de las malformaciones vasculares periféricas con una mezcla de polidocanol y CO2. Experiencia inicial / Percutaneous treatment of peripheral vascular malformations with a mixture of polidocanol and CO2. Initial experience

Objetivo. El tratamiento percutáneo de las malformaciones vasculares periféricas es hoy día aceptado como primera opción terapéutica en estos procesos. Describimos nuestra experiencia inicial con una mezcla de polidocanol y CO2 como agente embolizante, analizando su eficacia y complicaciones. Material y métodos. Entre abril de 2005 y diciembre de 2006 se han tratado 18 pacientes, 11 mujeres (61%) y 7 hom bres (39%) con edades comprendidas entre 11 y 80 años. Una malformación vascular era hemodinámicamente activa (5%) y 17 eran hemodinámicamente inactivas (95%). Se realizaron en total 56 embolizaciones (rango: 1-7; media: 3) con una mezcla de polidocanol y CO2 (rango: 1-28 cm3; media 8 cm3). Las malformaciones se estudiaron con ecografía-Doppler, resonancia magnética y angiografía por punción directa o arteriografía. En función de la localización, tamaño y características hemodinámicas, se realizaron abordajes y tratamientos específicos para cada caso. Resultados. Se obtuvo un éxito técnico, entendiendo como tal la posibilidad de embolizar la malformación en el 100% de los casos. No se produjeron complicaciones técnicas. El período medio de seguimiento fue de 9 meses (rango: 1-20). Todos los pacientes, excepto una que rechazó continuar con el tratamiento, mejoraron objetiva y subjetivamente, y todos recuperaron las actividades diarias normales. Todos los pacientes presentaron edema, dolor e incremento de su impotencia funcional tras la embolización, que cedieron con tratamiento médico. Conclusión. La embolización percutánea de malformaciones vasculares con una mezcla de polidocanol y CO2 es un método eficaz y con baja incidencia de complicaciones. Nuestros resultados iniciales son esperanzadores, aunque se precisan estudios más extensos para extraer conclusiones definitivas (AU)

Objective. The percutaneous treatment of peripheral vascular malformations is currently the first treatment option for these processes. We describe our initial experience using a mixture of polidocanol and CO2 as an embolizing agent; we analyze the efficacy and complications of the treatment. Material and methods. Between April 2005 and December 2006, we treated a total of 18 patients, comprising 11 women (61%) and 7 men (39%), with ages ranging from 11 to 80 years. One (5%) vascular malformation was hemodynamically active and the remaining 17 (95%) were hemodynamically inactive. We performed a total of 56 embolizations (mean per patient, 3; range, 1-7) using a mixture of polidocanol and CO2 (mean, 8 cm3; range, 1-28 cm3). The malformations were studied with Doppler ultrasonography, magnetic resonance imaging, and direct puncture angiography and/or arteriography. Specific approaches and treatments were used in each case in function of the location, size, and characteristics of the malformation. Results. Technical success, defined as the possibility of embolizing the malformation, was achieved in all cases. No technical complications occurred. The mean follow-up period was 9 months (range, 1-20). All patients, except one woman who refused to continue treatment, improved objectively and subjectively, and all were able to return to normal daily activities. After embolization, all patients presented edema, pain, and increased functional incapacity that ceased with medical treatment. Conclusion. Percutaneous embolization of vascular malformations using a mixture of polidocanol and CO2 is efficacious and has a low rate of complications. Our initial results are promising but larger studies are necessary to reach definitive conclusions (AU)

[Combined treatment of embolization followed by surgical resection in carotid paraganglioma]. / Tratamiento combinado de embolización seguido de resección quirúrgica en un paraganglioma carotídeo.

Carotid body tumors represent a relatively uncommon finding in vascular surgery. We present the case of a 62 years old man with a right carotid paraganglioma diagnosed by cervical ultrasound scanner, magnetic resonance imaging and carotid arteriography. We decided to treat the patient in two times. In a first approach the tumor was percutaneously embolized, later on in a second time the paraganglioma was surgically resected. The patient is doing well without echographic evidence of tumor 3 years after the operation. This modality of treatment, embolization followed by surgical excision is a useful and valuable alternative.

Tratamiento combinado de embolización seguido de resección quirúrgica en un paraganglioma carotídeo / Combined treatment of embolization followed by surgical resection in carotid paraganglioma

Los paragangliomas carotídeos son un diagnóstico poco frecuente en patología vascular. Presentamos el caso de un paciente varón de 62 años con un paraganglioma carotídeo derecho diagnosticado por ecografía, TAC, RMN y arteriografía cervical que fue tratado en dos tiempos. En una primera fase se efecúó embolización percutánea del tumor evidenciándose arteriograficamente la disminución en su irrigación arterial. En una segunda fase se procedió a la resección quirúrgica. El resultado ha sido excelente estando el paciente asintomático y si evidencia de tumor al tumor al estudio ecográfico cervical a los 3 años. En casos seleccionados, ésta aproximación terapéutica nos parece de utilidad e interés en el tratamiento de este tipo de lesiones

Carotid body tumors represent a relatively uncommon finding in vascular surgery. We present the case of a 62 years old man with a right carotid paraganglioma diagnosed by cervical ultrasound scanner, magnetic resonance imaging and carotid arteriography. We decided to treat the patient in two times. In a first approach the tumor was percutaneously embolized, later on in a second time the paraganglioma was surgically resected. The patient is doing well without echographic evidence of tumor 3 years after the operation. This modality of treatment, embolization followed by surgical excision is a useful and valuable alternative

[Internal carotid artery pseudoaneurysm and stenosis: treatment with stents and coils]. / Tratamiento con endoprótesis y espirales de un pseudoaneurisma asociado a una estenosis en la arteria carótida interna

PURPOSE: To describe the endovascular management of a patient with post-dissection internal carotid pseudoaneurysm and stenosis. CASE REPORT: A 45-year-old man presented with left hemyparesia; angiography showed right internal carotid artery occlusion, left carotid stenosis and pseudoaneurysm. A metallic uncovered stent was implanted by means of a femoral approach. Coils were delivered through the uncovered stent and the pseudoaneurysm was excluded. CONCLUSION: The internal carotid percutaneous implantation of a carotid uncovered stent, and embolization through stent in a patient with stenosis and pseudoaneurysm, appears to be a safe procedure without risk of coils migration.

Tratamiento con endoprótesis y espirales de un pseudoaneurisma asociado a una estenosis en la arteria carótida interna / Internal carotid artery pseudoaneurysm and stenosis. Treatment with stents and coils

Propósito. Comunicar nuestra experiencia en el tratamiento de un paciente con un pseudoaneurisma asociado a una estenosis post-disección en la arteria carótida interna cervical. Caso clínico. Paciente de 45 años valorado en el servicio de urgencias por hemiparesia izquierda. Entre sus antecedentes destacaba ser fumador importante, hipertensión arterial, hipercolesterolemia, peritonitis a los 18 años e infarto de miocardio hace un año. Tras la realización de TC y RM, en una angiografía cerebral se diagnosticó una oclusión de la arteria carótida interna derecha, presentando en la izquierda una estenosis asociada a un pseudoaneurisma. Mediante abordaje femoral común derecho, se realizó un implante de una endoprótesis metálica en la zona estenótica; a través dela malla de la misma, se excluyó el pseudoaneurisma con espirales metálicos. Conclusión. Este caso muestra la posibilidad de recuperar la luz de una zona estenótica de la arteria carótida interna con una endoprótesis metálica no cubierta y simultáneamente embolización a su través de una zona pseudoaneurismática sin riesgo de migración

Purpose. To describe the endovascular management of a patient with postdisection internal carotid pseudoaneurysm and stenosis. Case report. A 45-year-old man presented with left hemyparesia; angiography showed right internal carotid artery occlusion, left carotid stenosis and pseudoaneurysm. A metallic uncovered stent was implanted by means of a femoral approach. Coils were delivered throught the uncovered stent and the pseudoaneurysm was excluded. Conclusion. The internal carotid percutaneous implantation of a carotid uncovered stent, and embolization throught stent in a patient with stenosis and pseudoaneurysm, appears to be a safe procedure without risk of coils migration

One-year continuous inhaled nitric oxide for primary pulmonary hypertension.

We describe a case of long-term administration of nitric oxide (NO) in a 32-year-old man who was admitted with exertional dyspnea and anasarca. A diagnosis of primary pulmonary hypertension was made. An acute vasodilator trial with inhaled NO showed a 5% reduction of the mean pulmonary artery pressure. Long-term NO inhalation therapy was initiated. Twenty days later, the dyspnea improved, the anasarca resolved, and the PaO(2) level increased. After 12 months of NO therapy, the patient remained stable and no signs of toxicity or tachyphylaxis were observed. To our knowledge, this is the first report of 1 year of continuously inhaled NO in an adult patient with primary pulmonary hypertension. These findings suggest that prolonged NO therapy might be an effective alternative, at a lower cost, to the continuous IV infusion of epoprostenol.

[Percutaneous treatment of peripheral vascular malformations]. / Tratamiento percutáneo de las malformaciones vasculares periféricas.

OBJECTIVE: Vascular malformations are uncommon pathologic entities in which surgery is usually not possible or is inefficient. Our experience with the percutaneous treatment of peripheral vascular malformations, by means of transarterial embolization or direct puncture is here reported. MATERIAL AND METHODS: During the 1993-1997 period a total of 35 patient, 20 females (57%) and 15 males (43%) aged 11 to 75 years, were treated at our Unit. Sixteen vascular malformations were hemodynamically active (45.7%) and 19 hemodynamically inactive (54.3%). A total of 126 embolizations (mean 3.6) were performed. Malformations were studied by means of doppler-echography, magnetic resonance, arteriography and direct puncture angiography. Considering location, size and hemodynamic characteristics a specific approach and therapy was performed in each case. In two cases (5.7%) a surgical exeresis after embolization was performed. RESULTS: A technical success, defined as the possibility of embolizing the malformation, was achieved in 100% of cases. No technical complications during the procedure occurred. The mean follow-up time was 23 months (6-69). All patients but one improved both objectively and subjectively and all but one have recovered their daily activities in the following days. The exception was one patient who developed a severe complication--cutaneous necrosis--a few days after the procedure which required repairing surgery. All patient had edema, pain and increased functional impairment after the embolization which subsided with medical treatment. CONCLUSIONS: Percutaneous embolization of vascular malformations is an effective method associated with a low complication rate. Our results are encouraging although more extensive investigation are required to draw definite conclusions.

[Wallstent endoprostheses implanted by fluoroscopic guidance in the palliative treatment of malignant esophageal obstructions and esophago-tracheal fistulas]. / Endoprótesis de Wallstent implantadas bajo control fluoroscópico en el tratamiento paliativo de las obstrucciones esofágicas malignas y fístulas esófago-traqueales.

PURPOSE: The objective of this study was to present our experience with metallic stents (Wallstent) for palliation of dysphagia due to malignant esophageal obstruction and esophagotracheal fistula. PATIENTS AND METHODS: From August 1994 to July 1996 20 uncovered and 6 covered stents were inserted in 16 consecutive patients with dysphagia grade 3 (n = 4) or grade 4 (n = 12) caused by incurable malignant obstructions. The obstruction was in the proximal (n = 4), in the middle (n = 3) and the distal (n = 9) third of the esophagus. Five patients presented with esophagotracheal fistula. The stent insertion was performed under fluoroscopic control. RESULTS: Exact positioning of the stent with reduction of the dysphagia was obtained in all patients. There were no complications related with the procedure. Esophagotracheal fistula was solved in those patients treated with covered stents. Six patients had recurrent dysphagia due to tumor ingrowth or overgrowth. In these patients an additional overlapping stent was placed. In latest evaluation 2 patients presented dysphagia grade I, 5 grade III, and 4 grade IV. CONCLUSION: Implantation of stents proved to be an effective and safe method of palliating dysphagia and occluding esofagotracheal fistula. Placement of stents was feasible without major procedure-related complications.

[Percutaneous implant of Hickman catheters and reservoirs. Long-term experience]. / Implante percutáneo de catéteres de Hickman y reservorios. Experiencia a largo plazo.

OBJECTIVE: To report our experience with long term external catheters and implantable ports in the last 8 years. MATERIAL AND METHODS: From December 1987 to August 1995 a total of 617 central venous catheters were implanted in 541 patients in our Interventionist Vascular Radiology Unit, 265 men (49%) and 276 women (51%), with a mean age of 46 years. A total of 335 (54%) were partially implantable external catheters and 241 (39%) implantable ports in chest and 41 (7%) in the forearm. RESULTS: A technical success--defined as the possibility of implanting the catheter--was achieved in 98% of cases. Immediate complications included 5 pneumothorax (0.8%), 11 accidental carotid artery puncture (2%) with no clinical relevance, 18 catheter misplacement (3%), and 8 vein spasm (1%). Fifty-two catheters (8%) were removed on account of infectious complications. Currently, 71 catheters are still in use (12%), 433 (70%) have been removed or the catheter was patent until patients's death. CONCLUSIONS: Partially implantable central venous catheters and totally implantable ports are a safe alternative in patients requiring a central venous access for prolonged treatments. The low number of immediate complications renders the Interventionist Vascular Radiology Unit the proper place where to perform these procedures.