1 / 52

Hemangiomas and Vascular Malformations

Hemangiomas and Vascular Malformations. Yağmur AYDIN, M.D. University of Istanbul , Cerrahpasa Medical Faculty Department of Plastic ,  Recons t.  and Aesthetic Surgery. Vascular Anomalies. In U.S, 40000 babies with vascular anomailes are born in a year

diata
Download Presentation

Hemangiomas and Vascular Malformations

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HemangiomasandVascularMalformations Yağmur AYDIN, M.D. University of Istanbul, CerrahpasaMedicalFacultyDepartment of Plastic, Reconst. and Aesthetic Surgery

  2. Vascular Anomalies • In U.S, 40000 babieswithvascularanomailesareborn in a year • 1of 10 childrenhas vascularanomaly • A commonmistakehas been done withthenaming • Strawbery, cavernous, capillaryhemangioma • MullikenandGlowacki in 1982 – classificationaccordingtothebiologicalcharacteristics(endothelialproperties)

  3. Vascular Anomalies • Tumors • Hemangioma • pyogenicgranuloma • Kaposiphormhemangio-endothelioma • Malformations • Capillary • Lymphatic • Venous • Arteriovenous • combined

  4. Hemangioma • Themostcommontumor of infancyandchildhood (4-10%) • 3-5 timesmoreseen in girls • Moreseen in prematureinfants (<1200 grams% 23) • Not frequent in darker-skinnedbabies • Usuallyoccurs in first 2 weeksafterbirth • Initially, a pale-colored,  telangiectaticormacularredstainorpurple-coloredstain • Singlelesion in 80%, 20% morethanonelesion • Inpatientswithmorethanonelesionaccompaniesothersystemhemangiomas( liveretc.)

  5. ClinicalAppearance • Lesions located in the superficial dermis • Hard, shiny dark-red  coloured bulky lesion • Lesion  located in deep dermis, subcutaneous fat or muscle • Showing a slight bulking, hot, bluish coloured lesion

  6. The incidence of hemangiomas • Craniofacial area (60%) • The body (25%) • Extremities (15%)

  7. 3 phases of hemangiomas • Proliferationperiod (0-1 years) • Rapidlydividingendothelialcells • İnvolutionperiod (1-5 years) • Reducedendothelialproliferation, increasedapoptosis, fibrofattyreplacement,  reducedtumorvolume, skinsoftening • Involutioncompletionterm (> 5 years) • Thinveinsandcapillariesthatdraincurrentfibrofatty islets

  8. Proliferation period: • Rapid growth (upto10-12. months) • Involution period (1-7 years) • Growth slows down,compatiblewith the child's growth rate  • Fading of the skin starting from the center of the lesion,softening • The color disappearsuntill 5-7 years • Normal skin takesplace in nearly50% of children 

  9. Differential Diagnosis • Lymphatic malformation –deep located hemangioma (neck, axilla) • Capillary malformation - macular hemangioma • Vascular tumors of infancy - Fibrosarcoma etc. • Radiological studies • Biopsy

  10. Clinical evaluation • Clearand open dialoguewith the family • Confirmthe diagnosis • Documentation with photos • The need for medicalorsurgicaltreatment • Other diagnostic studies to investigate the extensionofhemangiomas and otheranomalies • Provide support groups andpublications forfamily

  11. Complications • Ulceration, bleeding • Infection • Visualimpairment • Airwayobstruction • Obstructionin theearcanal • Congestiveheartfailure • diffuseneonatalhemangiomathosis • largevisceralhemangiomas

  12. Problems • Hemangiomaslocated in head&neck(PHACES syndrome.) • Hemangiomascoveringthevisualarea • Periorallocation • Respiratory distress (subglottichemangioma • Ulcer

  13. hemangiomacoveringthevisualfield in 2 monthsoldinfant Rapidreductionafter oral andintralesionalcorticosteroidinjection Residuemass at age 1,atrophy, telangiectasia

  14. Treatment • Followupandobservation • Trainingandconvincingthefamily • Systemiccorticosteroid • Second-generationdrugs (vincristine, interferon alpha) • Lasertherapy - pulsed-dyelaser • ulceratedhemanjyom • Remainingtelangiectasiaafterinvolution

  15. Hemangiomas  requiring treatment • Coveringthe visualarea, the air way, the ear canal • Leading to congestive heart failure • Showing ulceration and bleeding

  16. Treatment • Dangerous and life-threatening complicationsoccur in 10% of patient • The first option in medical treatmentapplication of corticosteroids (90% response) • Corticosteroid • Topical / injection into the lesion • Triamcinolone 3-5 mg / kg • 3-5 timesapplication (6-8 weeks apart) • systemic application • Oral prednisone or prednisolone 2-3 mg / kg /day • Once every 2-4 weeks (10-12 months)

  17. Othermedicaltreatmentagents(vicristine, interpheronalpha) • Casesnon –responsiveto corticosteroid therapy • If long-term use of corticosteroids is contraindicated • Ifcomplicationsdevelopafterthe use of corticosteroids • Incasesthatthe family does not want to use  (rare)

  18. Systemic steroid treatment

  19. Ulcer local diffuse

  20. Ulcer Treatment • Dressings • Corticosteroid • Laser( flashlamp dye laser) • Total excision (if primary closure is possible)

  21. Hemangioma Ulceration

  22. residual athrophic • tissue and wrinkled skin after involution • of hemangioma

  23. Clinical appearance afterinvolution of a largeperioralandperiorbitalhemangioma

  24. Vascular Malformations • As a result of an error during embryological andfetal development • Classification • Clinical • Radiological • Histological

  25. Vascular Malformations • Capillary • Lymphatic • Venous • Combined • Arteriovenous • Lymphatico-venous • Lympathico-capillary-venous

  26. Vascular Malformations • Slow-Flow • Capillary • Lymphatic • venous • Fast-flow • Arteriovenous

  27. Capillary Malformations • "Port wine stain“ • present at birth • Pink or red-colored  intradermal discoloration • Small, or large enough to cover the extremity or the face • Seen in 3 infants per 1000 live births

  28. Real-capillary malformations • Progressive • Growthicker over time, darken and noduledevelopsinside • "Salmon patch", "Nevus simplex", "vascularstain ” “birthstain” • Oftenseen in the middle part of the face, neck • Generallyfade andreduce at theage of 1

  29. Otherunderlyingdiseaseorsyndrome • Capillarymalformation  on midlinelumbarorcervicalregion,(spinaldysraphism, tetheredspinalcord) • Sturge-Webersyndrome (capillarymalformation of thedistributionarea of thetrigeminalnerve,lepthomeningealvascularabnormalities,seizures) • Klippel-Trenaunaysyndrome(slow- flowcapillary-lympho-venousmalformation , elongation on axialplaneandovergrowth of a limb

  30. Sturge-Webersyndrome • capillary malformation of the trigeminal nervedistribution area • lepthomeningeal vascular anomaly • Seisures

  31. Klippel-Trenaunay syndrome • capillary malformation • soft tissue and bone overgrowth • varices

  32. Treatment • Flashlamp-pumpedpulseddyelaser • 577, 585, or 595 nmwavelength • Targetsoxyhemoglobin • Provokesintravascularthrombosis • 50- 90% of patientspresentdiscoloration • Treatmentgivesthebestresults in earlychildhood • Otherlasers (non-responsivepatients) • Alexandrite (755 nm) • Neodymium: yttrium-aluminum-garnet (1064nm) • Intensepulsedlight (IPL)

  33. Port wine stainThe result obtained after two applications of pulsed dye laser

  34. Lympathic Malformations • Seen as local sponge-like lesionsordifuse lesions covering an anatomical  organ orarea • Radiological and histological • Microcystic • Macrocyctic • Mixed • Usually occurs at birth or first 2 ages • most common seen in cervicofacialarea • Axilla, chest, mediastinum, retroperitoneal area,perineum, glutealarea • Overlying skin is intact, looksbluish  • Small ,thin vesicles arepathognomonicfordermal involvement

  35. Treatment • Bleeding • Recurrentinfection (cellulitis) • Body contouring • Correction of funtionaldeficits • Sclerotherapy (macrocycticlesions) • Intralesionalinjection of bleomycin • OK-432 • Argon, neodynium: YAG, orcarbondioxidelaser

  36. Surgical treatment indications • Lesions blocking the respiratoryway • Lesions that create feeding problems • Lesions making distortion

  37. Venous Malformation • Soft, fadingwith pressure, bluish coloured  masses under the skin • Swellingwith physical activity and whenslouched down  • Palpable thrombi • Morningpain (stasis and microthrombi) • Frequent localization of head and neck • Moreexpansive than itlooks(muscle,bone, oral mucosa, salivary gland)

  38. Diagnosis • Magnetic resonance imaging (MRI) • To diagnose • To evaluate the extent of malformation • Bleeding-coagulation profile should be assessed • coagulopathy

  39. Treatment • Percutaneoussclerotherapy • absoluteethanol • hypertonicsaline • sodiumsulfatetetradesil • Elasticcompressionstockings (extremity) • Aspirin (daily) • painfulthrombus • Forprophylaxis of phlebitis • SurgicalTreatment • headandnecklesionscausingcosmetic problem •  severe painandbleeding • Lesionswithwell-definedborders

  40. Venous  malformation spreading into the vulva and inner thigh  muscles Partial excision and injection of sclerosing agents

  41. Venous malformation: 2 months after1 time the Nd: YAG laser  application  •  complete regression

  42. Arterio-venous malformations • Connection exists between the arterial system and venous system • They usually present at birth • Often incorrectly diagnosed (KM orhemangioma) • There is a rapidflow between the two systems • Fast flow is evident in childhood

  43. Arterio-venous malformations • Over time the stain on the skin  • Erythema •  The local  rise of temperature • Thrill  • Murmur • The mass may expand • Rapid growth may be seen during puberty  or trauma

  44. Arterio-venous malformations • Arteriovenous shunts • Ischemia and related symptoms and signs • painless ulceration • Persistent pain, occasional bleeding • Widespread AVM may  increasecardiac output and cause congestive heart

  45. Diagnosis • Ultrasonography • ColouredDoppler • MRI • Angiography • Feederanddrainingvessels • Varyingdegrees of arterialdilatation • curvedvessels •  A-V shunts • Enlargeddrainingveins

  46. Treatment • Embolization • Sclerotherapy • Surgical resection and reconstruction • Preoperative angiography • Determines feeder and draining vessels • Embolization (adhesive or with special springs)

  47. Arterio-venous malformations • Intracranial (most common) • Extracranial • Head and neck • Extremity • Body • İnternal organs

More Related