DOI:

10.37988/1811-153X_2022_2_68

Treatment tactics of vascular malformations of the head and neck depending on the quantitative assessment of the preoperative examination

Downloads

Authors

  • T.Z. Chkadua 1, PhD in Medical Sciences, head of the Maxillofacial Surgery Clinic
    ORCID: 0000-0001-8270-8843
  • L.M. Baisova 1, maxillofacial surgeon in the Department of reconstructive maxillofacial and plastic surgery
    ORCID: 0000-0001-8281-3715
  • A.G. Nadtochiy 1, PhD in Medical Sciences, full professor of the X-Ray diagnostics Department
  • M.N. Bolshakov 1, PhD in Medical Sciences, maxillofacial surgeon in the Department of reconstructive maxillofacial and plastic surgery
    ORCID: 0000-0002-1126-2159
  • D.L. Weise 1, PhD in Medical Sciences, ultrasonographer
  • 1 Central Research Institute of Dental and Maxillofacial Surgery, 119021, Moscow, Russia

Abstract

To date, the diagnosis and treatment of patients with vascular malformations remain topical. The authors were the first to introduce a method of objective (quantitative) assessment of the degree of vascularization of the affected tissues, as well as velocity characteristics on the basis of which the tactics and assessment of treatment efficacy were determined. The purpose of the work was to increase the efficiency of treatment of patients with vascular malformations of the head and neck.
Materials and methods.
In 2019-2021, 98 patients (27 men and 71 women) from 18 to 74 years of age with vascular malformations in the head and neck region were examined and treated. Based on the results of MSCT angiography and ultrasonography, patients were divided into 4 groups: I - 19 patients with high-vascularized (X-ray density >70 HU) fast-flow vascular malformations (peak systolic blood flow rate >20 cm/s); II - 27 patients with low-vascularized (≤70 HU) fast-flow malformations; III - 20 patients with high-vascularized slow-flow malformations (≤20 cm/s); IV - 32 patients with low-vascularized slow-flow malformations. All patients were operated according to the recommendations for each group: I - embolization and thermal excision; II - thermal excision; III - piercing, sclerosing, compression; and IV - thermal excision/sclerosing.
Results.
The following data were obtained based on instrumental studies (MSCT-AG, ultrasound) before and after surgical treatment: reduction of peak blood flow velocity in the nidus (Vps) by 39.9% in group I, 62.5% in group II, 30.7% in group III and 76.2% in group IV study. Devascularization level after treatment: 59.7% in group I, 47.8% in group II, 32.4% in group III, and 46.8% in group IV. Complications in the form of massive intraoperative bleeding requiring transfusion of blood components were seen in 6 cases in group I and 2 cases in group III. Bleeding in the postoperative period, which required additional surgical intervention - 5 cases in group I and 3 cases in group III. Partial necrosis in the postoperative area - 1 case each in groups I, II and IV, 5 cases in group III. Paresis of the mimic muscles was observed in 2 cases in groups I and II. Paralysis of the mimic muscles - 1 case in group I.
Conclusion.
The recommended methods proved to be good in practice and showed a high degree of vascular malformation devascularization, which in our opinion is a priority in the treatment of this category of patient.

Key words:

vascular malformations, arteriovenous malformations, venous malformations, maxillofacial region

For Citation

[1]
Chkadua T.Z., Baisova L.M., Nadtochiy A.G., Bolshakov M.N., Weise D.L. Treatment tactics of vascular malformations of the head and neck depending on the quantitative assessment of the preoperative examination. Clinical Dentistry (Russia).  2022; 25 (2): 68—73. DOI: 10.37988/1811-153X_2022_2_68

References

  1. Nerobeev A.I., Dobrodeyev A.S., Bolshakov M.N. Approach to treatment of critical vascular malformations of maxillofacial region. Head and Neck. 2016; 3: 41 (In Russ.). eLIBRARY ID: 35050591
  2. Gavelya E.Y., Roginsky V.V., Nadtochy A.G., Kotlukova N.P., Mustafina F.N., Bychkova I.Y. Complex treatment of children with vascular head and neck malformations. Stomatology. 2021; 5: 30—37 (In Russ.). eLIBRARY ID: 47152090
  3. Kohout M.P., Hansen M., Pribaz J.J., Mulliken J.B. Arteriovenous malformations of the head and neck: natural history and management. Plast Reconstr Surg. 1998; 102 (3): 643—54. PMID: 9727427
  4. Houdart E., Gobin Y.P., Casasco A., Aymard A., Herbreteau D., Merland J.J. A proposed angiographic classification of intracranial arteriovenous fistulae and malformations. Neuroradiology. 1993; 35 (5): 381—5. PMID: 8327118
  5. Cho S.K., Do Y.S., Shin S.W., Kim D.I., Kim Y.W., Park K.B., Kim E.J., Ahn H.J., Choo S.W., Choo I.W. Arteriovenous malformations of the body and extremities: analysis of therapeutic outcomes and approaches according to a modified angiographic classification. J Endovasc Ther. 2006; 13 (4): 527—38. PMID: 16928170
  6. Yakes W.F. [Endovascular management of high-flow arteriovenous malformations]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2008; 43 (6): 327—32 (In Chinese). PMID: 19031780
  7. Gemmete J.J. Periorbital arteriovenous malformations: a word of caution. J Neurointerv Surg. 2018; 10 (3): 211—212. PMID: 29021313
  8. Lindquist J.D., Vogelzang R.L. Pelvic Artery Embolization for Treatment of Postpartum Hemorrhage. Semin Intervent Radiol. 2018; 35 (1): 41—47. PMID: 29628615
  9. Yakes W., Yakes A., Rohlffs F., Ivancev K. Current controversies and the state of the art in endovascular treatment of vascular malformations. J Interv Med. 2018; 1 (2): 65—69. PMID: 34805831
  10. Buchta K., Sands J., Rosenkrantz H., Roche W.D. Early mechanism of action of arterially infused alcohol U.S.P. in renal devitalization. Radiology. 1982; 145 (1): 45—8. PMID: 7122894
  11. Liu A.S., Mulliken J.B., Zurakowski D., Fishman S.J., Greene A.K. Extracranial arteriovenous malformations: natural progression and recurrence after treatment. Plast Reconstr Surg. 2010; 125 (4): 1185—1194. PMID: 20335868
  12. Vegivinti C.T.R., Pederson J.M., Saravu K., Gupta N., Evanson K.W., Kamrowski S., Schmidt M., Barrett A., Trent H., Dibas M., Reierson N.L., Mikoff N., Pisipati S., Joseph B.A., Selvan P.T., Dmytriw A.A., Pulakurthi Y.S., Keesari P.R., Sriram V., Chittajallu S., Brinjikji W., Katamreddy R.R., Chibbar R., Davis A.R., Malpe M., Mishra H.K., Kallmes K.M., Hassan A.E. Efficacy of convalescent plasma therapy for COVID-19: A systematic review and meta-analysis. J Clin Apher. 2021; 36 (3): 470—482. PMID: 33544910
  13. Kim B., Kim K., Jeon P., Kim S., Kim H., Byun H., Kim D., Kim Y. Long-term results of ethanol sclerotherapy with or without adjunctive surgery for head and neck arteriovenous malformations. Neuroradiology. 2015; 57 (4): 377—86. PMID: 25563632
  14. Pekkola J., Lappalainen K., Vuola P., Klockars T., Salminen P., Pitkäranta A. Head and neck arteriovenous malformations: results of ethanol sclerotherapy. AJNR Am J Neuroradiol. 2013; 34 (1): 198—204. PMID: 22766677
  15. Vogelzang R.L., Atassi R., Vouche M., Resnick S., Salem R. Ethanol embolotherapy of vascular malformations: clinical outcomes at a single center. J Vasc Interv Radiol. 2014; 25 (2): 206—13; quiz 214. PMID: 24461130
  16. Zheng L.Z., Fan X.D., Zheng J.W., Su L.X. Ethanol embolization of auricular arteriovenous malformations: preliminary results of 17 cases. AJNR Am J Neuroradiol. 2009; 30 (9): 1679—84. PMID: 19617451
  17. Jin Y., Lin X., Chen H., Hu X., Fan X., Li W., Ma G., Yang C., Wang W. Auricular arteriovenous malformations: potential success of superselective ethanol embolotherapy. J Vasc Interv Radiol. 2009; 20 (6): 736—43. PMID: 19375350
  18. Yakes W.F. Endovascular management of high-flow arteriovenous malformations. Semin Intervent Radiol. 2004; 21 (1): 49—58. PMID: 21331109
  19. Hua C., Jin Y., Yang X., Zou Y., Wang T., Gu H., Qiao C., Zhang Z., Lin X. Midterm and long-term results of ethanol embolization of auricular arteriovenous malformations as first-line therapy. J Vasc Surg Venous Lymphat Disord. 2018; 6 (5): 626—635. PMID: 29752186
  20. Meila D., Grieb D., Greling B., Melber K., Jacobs C., Hechtner M., Schmitz T., Schlunz-Hendann M., Lanfermann H., Brassel F. Endovascular treatment of head and neck arteriovenous malformations: long-term angiographic and quality of life results. J Neurointerv Surg. 2017; 9 (9): 860—866. PMID: 27566490
  21. Chiu A.H., Aw G., Wenderoth J.D. Double-lumen arterial balloon catheter technique for Onyx embolization of dural arteriovenous fistulas: initial experience. J Neurointerv Surg. 2014; 6 (5): 400—3. PMID: 23749795
  22. Pop R., Manisor M., Wolff V., Kehrli P., Marescaux C., Beaujeux R. Flow control using Scepter™ balloons for Onyx embolization of a vein of Galen aneurysmal malformation. Childs Nerv Syst. 2015; 31 (1): 135—40. PMID: 25358810
  23. Spiotta A.M., Miranpuri A.S., Vargas J., Magarick J., Turner R.D., Turk A.S., Chaudry M.I. Balloon augmented Onyx embolization utilizing a dual lumen balloon catheter: utility in the treatment of a variety of head and neck lesions. J Neurointerv Surg. 2014; 6 (7): 547—55. PMID: 24026949

Downloads

Received

May 18, 2022

Accepted

June 8, 2022

Published on

June 1, 2022