Keynotelecture: What a vascular specialist needs to know ... · 12/11/2019 · • CTA or MRA–...

Keynote lecture:

What a vascular specialist needs to know about the management of

vascular malformations (11 min)

Prof. I. Baumgarner, Vascular Division, University Hospital Bern

Speaker name:

..................Baumgartner........................................................................

I have the following potential conflicts of interest to report:

Institutional educational grants: Abbott, Cook, Boston Scientific

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

Other(s)

I do not have any potential conflict of interest

Disclosure

Munich Vascular Conference (MAC) 2019 2

Vascular Anomalies (ISSVA)

Mulliken and Glowacki 1982

suffix ‘‘oma’’ (‘‘angioma’’) proliferation of tumor

‘‘angioma,’’ ‘‘hemangioma,’’ ‘‘lymphangioma’’ oftenerroneous used for vascular malformations

Munich Vascular Conference (MAC) 2019

* ISSVA (International Society for the Study for Vascular Anomalies)

Vascular malformations

• Hemodynamics• Predominant anomalous channels

Classification


Capillary Malformation (CM)incl. angiokeratomas

Dermal & subdermal tissuedestructing lasertherapy


Venous Malformation (VM)


LIC D-dimer >1,000 ng/mL a/o fibrinogen <200 mg/dLincidence between 42% and 88%

lesion size (P < 0.001), presence of phleboliths (P = 0.005)

DIC conversion of LIC to DIC consumption of platelets and coagulation factorsincrease in PT & decrease in FV earliest signsbleeding

Arch Dermatol. 2008 Jul;144(7):861-7; Pediatric (AVWS) Radiology 2015, 45 (11), 1690-1695

Localized intravascular coagulopathy (LIC)

Subset VM exhibit localized LIC pain, thrombosis & excessive bleeding


Arch Dermatol. 2008 Jul;144(7):873-77

Management algorithm

• ASS low efficacy (vs. Kasabach-Merritt phenomenon, platelets not involved in LIC) • OAC decrease coagulation factors, not sufficient to prevent thrombin formation in LIC


Rivaroxaban for treatment of LIC in venousmalformation (case report)

J Thromb Thrombolysis (2014) 38:121–123; Blood Coagulation and Fibrinolysis 2015, 26:00–00

LMWH recommended in LIC: invasive procedures, active bleeding, very low fibrinogen levels (\0.5–1.0 g/L) associated with a bleeding diathesis

.


- UGS for superficial lesions- FGS for extensive and deep lesions (e.g. intramuscular) with

relevant drainage into deep vein system *


30 ml, 96% ethanol

Venous Malformation Type I


Before

After

Lateral Marginal Vein (Type I-IV)truncal VM found in syndromic form (KTS)


Laser & RF-Ablation; Venaseal in younger patients

3D reconstruction of CT contrast study

Arterio-Venous Malformation (AVM)


Yakes Type IIIb AVM

Coiling• 5 fibered coils, 10mm;

4 fibered coils, 8 mm; Nester Embolization Coils®, Cook Medical

Embolosclerotherapy• 15 ml; 96% ethanol

Nester coils were surgicallyremoved 3 mo later

JVS, 2015, in press


Lymphatic Malformation (LM)


Frequently associated with syndromic CVM

Swelling: complex manual decongestive tx, lymphdrainage

Lymphleakage: sclerotherapy using ethanol or Picibanil (OK432)

Recurrent erysipelas: sclerotherapy; long term AB-therapy

Lymphatic Malformation (LM)


34 – year old male

Parkes Weber S.

for > 2 years weepinglymphatic papillomatosein rima ani

2x /year

erysipelas / fever


Hämolymphatic Malformation (HLM) LM, VM

after 8 treatment sessions


Rendu-Osler-Weber (HHT) CM, viszerale AVM


Screening HHT

• Echocardiography – screening for pulmonary AVM

• CTA or MRA– screening for pulmonary AVM

• Doppler ultrasonography of the liver

• GI endoscopy (Hb, Ferritin)

• (Brain MRI – screening for intracrainal AVM)

• (Genetic screening for children)


What a vascular specialist needs to know about the management ofvascular malformations

Munich Vascular Conference (MAC) 2019 22

Keynotelecture: What a vascular specialist needs to know ... · 12/11/2019 · • CTA or MRA–...

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