Vascular Malformations: Advances and Controversies in Contemporary Management

Cover......Page 1
Half Title......Page 2
Title Page......Page 4
Copyright Page......Page 5
Contents......Page 6
Preface......Page 12
Foreword......Page 14
Contributors......Page 16
Part 1: Congenital Vascular Malformations (CVMs) in General......Page 20
Section 1: Definition and Classification......Page 22
1. ISSVA classification: Controversy with the benefit and liability......Page 24
2. Hamburg classification: Controversy with the benefit and liability......Page 26
3. Syndromic classification of congenital vascular malformations: How useful is it?......Page 30
4. Consensus on contemporary classification......Page 34
Section 2: Diagnosis......Page 38
5. How extensive study should be included in initial assessment for congenital vascular malformations......Page 40
6. Should hemangiomas be included in initial differential diagnosis for congenital vascular malformations?......Page 44
7. To what extent should genetic studies be incorporated for assessment of venous and arteriovenous malformations, and when?......Page 50
8. Indications for genetic testing in evaluation of lymphatic and hemolymphatic malformations......Page 54
Section 3: Management......Page 56
9. Importance of interdisciplinary team approach for evaluation and management of vascular malformations......Page 58
10. How will genetics influence management of vascular malformations?......Page 62
Part 2: Arteriovenous Malformations (AVMs)......Page 70
Section 4: Definition and Classification......Page 72
11. Confusion with arteriovenous fistula versus arteriovenous malformation of ISSVA classification......Page 74
12. Nidus or no nidus: Is it a crucial issue for diagnostic assessment of arteriovenous malformations?......Page 78
13. New classification of arteriovenous malformations based on angiographic findings: What are the advantages?......Page 82
Section 5: Diagnosis......Page 86
14. Arteriographic assessment: Is it still the gold standard for diagnosis of arteriovenous malformations?......Page 88
15. Ultrasonographic assessment: New role for arteriovenous malformations. How far can it be implied?......Page 92
16. Magnetic resonance angiography and/or computed tomography angiography: New gold standard for arteriovenous malformations?......Page 96
17. Transarterial lung perfusion scintigraphy (TLPS): New role for follow-up assessment?......Page 100
Section 6: Management: 1......Page 102
18. Do all the arterio-venous malformations mandate the therapy? Is there any contraindication for the therapy?......Page 104
19. How much is too much for arteriovenous malformation management?......Page 108
20. Ethanol sclerotherapy: Is it gold standard for arteriovenous malformation management?......Page 114
21. N-butyl cyanoacrylate versus Onyx embolotherapy......Page 118
Section 7: Management: 2......Page 124
22. Surgical therapy combined with embolo-/sclerotherapy: Multidisciplinary approach......Page 126
23. Indications for amputation in patients with arterio-venous malformations......Page 130
24. How much pharmacological therapy can be incorporated into arteriovenous malformation management?......Page 134
25. Secondary changes in arteriovenous malformations: Arteries, veins, tissues, bones, when do they have to be treated?......Page 136
Part 3: Venous Malformations......Page 138
Section 8: Definition and Classification......Page 140
26. Capillary and cavernous hemangioma and venous malformations......Page 142
27. Angiographic classification of venous malformations based on venous drainage status: What are the advantages?......Page 146
Section 9: Diagnosis......Page 150
28. Ultrasonographic assessment: Mandatory test to lead the assessment of the venous malformations?......Page 152
29. Conventional and dynamic contrast enhanced magnetic resonance imaging (dceMRI) and/or magnetic resonance venography: Diagnostic modalities with different objectives? Can they replace phlebography?......Page 156
30. Computed tomography (CT) and CT venography: How are these diagnostic modalities different from magnetic resonance imaging (MRI) for evaluation of venous malformations?......Page 160
31. Whole-body blood pool scintigraphy (WBBPS): Special role for management of venous malformations?......Page 162
Section 10: Management: 1......Page 166
32. Do all venous malformations require treatment?......Page 168
33. How much is too much for venous malformation management?......Page 172
34. What is the first option for venous malformation management?......Page 176
35. Ethanol sclerotherapy: Is it gold standard for venous malformation management as well?......Page 182
36. Foam sclerotherapy: First option for venous malformations?......Page 184
37. Considerations regarding feasibility, safety, and efficacy of N-butyl cyanoacrylate (n-BCA) and Onyx embolization for the treatment of venous malformations......Page 186
Section 11: Management: 2......Page 188
38. Surgical therapy of venous malformation combined with embolo-/sclerotherapy: How much and when?......Page 190
39. How aggressive should management be of vascular bone syndrome caused by venous malformation?......Page 194
40. To what extent should anticoagulation therapy be considered for venous malformations?......Page 198
41. How to approach treatment of marginal vein combined with deep vein hypoplasia/aplasia?......Page 202
42. Indications for amputation in patients with extensive venous malformations......Page 206
43. How much pharmacological therapy can be incorporated in venous malformations management?......Page 210
Part 4: Lymphatic Malformations......Page 214
Section 12: Definition and Classification......Page 216
44. Confusion on terminology: Primary lymphedema and lymphangioma (lymphatic malformation)......Page 218
45. Contemporary diagnosis of primary lymphedema and lymphatic malformation......Page 222
46. Clinical staging of lymphedema: How practical is it for clinical management of primary lymphedema?......Page 226
47. Laboratory (lymphoscintigraphic) staging guideline?......Page 230
Section 13: Diagnosis......Page 234
48. Ultrasonographic assessment of lymphatic malformations—Lymphangioma and primary lymphedema: A new role for diagnosis?......Page 236
49. Radionuclide lymphoscintigraphy—Gold standard for assessment of lymphatic malformation: Lymphangioma and primary lymphedema or both?......Page 240
50. Magnetic resonance imaging and magnetic resonance lymphangiography of primary lymphedema: A new gold standard?......Page 244
51. Indocyanine green fluorescent lymphography: Clinical implementation......Page 248
52. Oil contrast lymphangiography: New role for the surgical candidate?......Page 252
53. Fluorescent microlymphangiography: Controversy, confusion, and neglected problems......Page 258
54. Can indocyanine green replace role of lymphoscintigraphy?......Page 262
55. How to differentiate between lymphedema and lipedema: How to rule out lipedema......Page 264
Section 14: Management: 1—Primary Lymphedema......Page 268
56. Manual lymphatic drainage: Myth?......Page 270
57. Compression therapy: Optimal pressure? Bandage versus stocking......Page 274
58. Sequential intermittent pneumatic compression: Rationale? How much can it be incorporated into compression therapy?......Page 280
59. Reconstructive surgery: Lymphovenous anastomosis versus lymph node transplantation—Can they stay as independent therapy options?......Page 284
60. Excisional surgery: When and how much it can be incorporated......Page 290
61. Multidisciplinary approach with liposuction in primary lymphedema: Is there a difference compared to patients with secondary lymphedema?......Page 292
62. How much pharmacological therapy can be incorporated in primary lymphedema management?......Page 298
63. What is difference in management of primary lymphedema between adults and children, and how much?......Page 302
64. How to manage lipedema involved with primary lymphedema?......Page 306
65. How to assess response/efficacy of manual lymphatic drainage and compression therapy......Page 308
66. How to assess efficacy of lipedema management involved in lymphedema......Page 312
67. Pathophysiology behind adipose tissue deposition in lymphedema and how liposuction can completely reduce excess volume......Page 316
68. Liposuction: Can it be applied to management of lipedema?......Page 324
Section 15: Management: 2—Lymphangioma......Page 328
69. How to manage lymphatic leakage involved in lymphangioma?......Page 330
70. How to manage recurrent infections involved with lymphangioma?......Page 334
71. How should aggressive chyloreflux (e.g., chyluria, chyloascites, chylothorax,  chyle leakage) be handled?......Page 338
72. Pharmacological considerations for lymphatic malformation management......Page 344
73. How much different should the management of lymphangioma among the pediatric/neonatal age group be?......Page 346
74. Peculiarities in surgical treatment in childhood: Can we ignore?......Page 350
Part 5: Combined vascular malformations: Hemolymphatic malformations/Klippel–Trenaunay syndrome......Page 354
Section 16: Diagnosis......Page 356
75. To what extent should diagnostic study be extended for assessment of arteriovenous malformation involvement in Klippel–Trenaunay syndrome?......Page 358
76. How much should diagnostic investigations incorporate visceral involvement for Klippel–Trenaunay syndrome?......Page 362
Section 17: Management: 1......Page 366
77. How to decide priority for treatment among congenital vascular malformation components......Page 368
78. Management of vascular bone syndrome: How aggressive and when?......Page 372
79. How aggressively should varicose veins be managed in Klippel–Trenaunay syndrome?......Page 380
80. How aggressive should management be of indolent stasis ulcer in Klippel–Trenaunay syndrome?......Page 384
Section 18: Management: 2......Page 386
81. How should aggressive gastrointestinal bleeding in Klippel–Trenaunay syndrome be handled?......Page 388
82. Therapeutic considerations for infection, sepsis, and lymphatic leak management in patients with Klippel–Trenaunay syndrome......Page 390
83. How to manage coagulopathy in Klippel–Trenaunay syndrome?......Page 392
84. Klippel–Trenaunay syndrome: Pain and psychosocial considerations......Page 396
85. Klippel–Trenaunay syndrome and complex venous malformations: Should multimodality approach be standard of care?......Page 400
Part 6: Capillary Malformations (CMs)......Page 406
Section 19: Diagnosis......Page 408
86. Is this capillary malformation? Differential diagnosis and other dermal vascular lesions......Page 410
87. How much diagnostic assessment for port-wine stains should be extended for other vascular malformations to exist together?......Page 416
Section 20: Management......Page 420
88. Port-wine stains/capillary malformation among patients with Klippel–Trenaunay syndrome: How to select candidate for laser therapy and when......Page 422
89. To what extent should surgical excision be implemented to port-wine stains, and when?......Page 426
90. To what extent could laser therapy and surgical excision be combined for port-wine stain management?......Page 428
Epilogue......Page 430
Index......Page 432