Surgical Treatment of Venous Malformations of the Knee: Treatment Outcomes for 35 Patients.

BACKGROUND: The place of open surgery in venous malformations (VMs) of knee joint is still discussed. The aim of this study was to evaluate the benefits of surgery in terms of pain, function, and quality of life. DESIGN: This was a retrospective observational study. METHODS: Thirty-five consecutive young patients undergoing surgery for VMs of the knee between 2011 and 2014 were included. Data collection was performed using a prospective database by reviewing patient records. Pain, mobility of the joint, residual VMs as seen by magnetic resonance imaging, and quality of life were the main outcome endpoints for this study. RESULTS: Thirty-five patients (22 females and 13 males, with a median age of 15 y, range of 5 to 20 y) were included. Twenty-seven VMs were localized in and around the knee joint, of which 8 were extensive. Indication for surgery was intermittent or permanent pain.Details of the surgical excisions of the VM are as follows: suprapatellar area in 57%, suprapatellar and infrapatellar area in 29%, infrapatellar area in 2%, limited in the femoropatellar area in 12%. Partial resection of a vastus muscle or patellar retinaculum was necessary for 19 patients.The median duration of the surgery was 4 hours (range: 2 to 7 h). The median hospital stay was 5 days; full-time physiotherapy was systematic for 2 to 3 weeks.After 6 months, 74% had no longer pain, the mobility of the joint was normal for 60%. Of the 33 patients who had a magnetic resonance imaging at 6 months, 86% (28 patients) had no residual intra-articular VMs, and 14% had focal residual VMs.At the last follow-up, 77% (27 patients) had no longer pain, 23% experienced intermittent pain with unusual activities, and 91% (32 patients) had normal mobility of the joint. Quality of life was increased significantly due to the pronounced impact on pain. CONCLUSION: Extensive surgical excision of knee VMs is a safe procedure with good outcomes in terms of pain, function, and quality of life. LEVEL OF EVIDENCE: Level II-retrospective observational monocentric study.

Spontaneous and isolated dissection of the superior mesenteric artery: proposal of a management algorithm.

BACKGROUND: Spontaneous and isolated dissection of the superior mesenteric artery (SIDSMA) is a rare pathology, and the treatment of symptomatic forms is not consensual. The objective of this study was to analyze the management of a series of patients presenting a symptomatic SIDSMA within a structure taking care of intestinal vascular emergencies. METHODS: From January 2010 to January 2014, the patients presenting a symptomatic SIDSMA were included retrospectively. The clinical and radiologic data as well as the treatment and the follow-up were analyzed. RESULTS: Nine patients were included. Among them, 2 patients presenting with acute mesenteric ischemia were revascularized surgically in emergency, and 1 patient presenting a rupture of a superior mesenteric artery aneurysm had an arteriography followed by medical care. The 6 other patients received medical treatment. Among these, 2 patients developed mesenteric angina requiring surgical revascularization during the follow-up. CONCLUSIONS: The revascularization of spontaneous and isolated dissections of the superior mesenteric artery is indicated in the cases complicated with acute mesenteric ischemia, aneurysmal rupture, or in the event of appearance of mesenteric angina or aneurysmal evolution. It should also be discussed in the event of failure of the medical treatment.

Surgical resection of venous malformations of the forearm.

We retrospectively reviewed 35 patients with venous malformations located in the forearm and treated by surgery in a single institution during the period 2010-19. The common complaints were pain and swelling (34 patients) and impaired function with contractures of fingers (15 patients). Twenty-four had complete resection and 11 had an incomplete resection. Associated procedures were reconstruction or lengthening of tendons in 17 patients. At the last follow-up (mean 61 months), 32 of the 35 had no residual pain and 27 had no functional sequelae. On MRI follow-up exams, 27 had no residual venous malformations. Venous malformations in the anterior compartment of the forearm can impair the function of the hand. They are developed almost exclusively in the connective tissue around tendons and muscles, deforming the musculotendinous structures and involving nerves. Surgery seems an appropriate option for the condition in this area.Level of evidence: IV.

Surgical treatment of arteriovenous malformations of the buttock.

For symptomatic buttock arteriovenous malformations (AVMs), embolization techniques and surgical resection have been suggested as treatment options. Our aim was to evaluate the feasibility and long-term results after a single surgical resection. Twelve patients had undergone surgical resection without preoperative embolization. Of the 12 patients, 11 had had incomplete procedures, 9 of whom had undergone arterial embolization 1 to 3 years previously. All the patients were symptomatic. Computed tomography scans showed AVMs located in the cellular spaces with preservation of the gluteal muscle. The median follow-up time was 80 months. On the last follow-up computed tomography scan, 67% had had no residual AVM. The use of preoperative embolization, especially with nonresorbable embolic material (Onyx; Medtronic, Dublin, Ireland), makes AVM resection and imaging follow-up more difficult because of artifacts and should be avoided.

Surgical treatment of vulvar venous malformations without preoperative sclerotherapy: Outcomes of 18 patients.

BACKGROUND: Our aim was to evaluate the benefit of surgical resection of the venous malformations (VMs) of the external female genitalia. METHODS: Over the period of 2009-2019, 18 consecutive females underwent surgical resection for vulvar VM. Evaluations included preoperative Doppler ultrasound, MRI, and pre-and postoperative photographic imaging. The main outcomes were: residual pain, cosmetic distortion, residual VM, and quality of life. RESULTS: Over a 10 year periods, 18 females, mean age 35 years (range 9-71) were included in this study. All patients were symptomatic: 16 had intermittent pain or discomfort, 1 had bleeding and 2 requested cosmetic treatment. Of these cases, there were 5 isolated vulvar VM, 12 associated VM: 3 of the clitoral hood, 3 troncular pelvic vein insufficiency and 12 of the lower limb. Eight patients had undergone previous procedures: 2 sclerotherapy treatments (1-3 sessions), 4 partial surgical resections. There were 18 single resections in the vulva (7 focal, 11 complete), 2 partial resections in clitoral hood and 2 had resection of a VM in the perirtoneovaginal canal at the same time. The mean follow-up was 42. 9 months (range 6-120). Two patients were lost to followup at 6 months. For all patients, elimination of pain and soft tissue redundancy was achieved. Two patients had persistent discomfort and 2 requested cosmetic treatment. CONCLUSION: Surgical resection of vulvar VM can be the best approach with few postoperative complications, good functional and cosmetic results. Appropriate preoperative evaluation is required to identify isolated VM or VM associated with ovarian vein or internal iliac vein insufficiency requiring to be treated before surgery.

Cryopreserved arterial allograft reconstruction for infected peripheral bypass.

Infection of peripheral bypass is a very severe complication associated to a high rate of morbimortality. The aim of this study was to prospectively evaluate cryopreserved arterial allografts (CAAs) performances in the treatment of this complication. Between April 1996 and June 2008, we prospectively collected data from patients presenting with major infections of peripheral bypasses who benefited from a CAA reconstruction in association with the excision of the infected bypass. CAA were taken from multi-organ donors and frozen at -80 °C. CAA mean conservation time was 115 days (±132). Over this 12-year study, 36 patients (31 men, five women, mean age = 68) benefited from CAA reconstruction for major infections of peripheral bypasses. Eighteen patients (50%) had a septic syndrome, five patients (14%) had an acute ischemia at the reconstruction time, and 12 patients (33%) had an anastomotic rupture. Emergency CAA reconstruction was performed on seven patients (19%). There were no perioperative deaths and no early amputations. Patient follow-up was complete, with a mean 42 -month duration (range, 3-116). There were no persisting or recurring infections. During the follow-up, 10 patients benefited from revision, excision, or replacement of the CAA and fifteen patients died from causes nonrelated to the initial infection. The cumulative rate of limb salvage was 87% at 3 years. Primary and secondary cumulative patency rates were 57% and 78% at 3 years, respectively. CAA reconstruction in association with infected bypass excision is an effective treatment for peripheral bypass major infections. Our results prompt us to go on with CAA reconstructions for this type of indication.

Intramuscular venous malformations of the calf: Surgical treatment outcomes of 57 patients.

OBJECTIVES: To report the outcomes of surgical treatment of calf intramuscular venous malformations (IMVMs) on pain, functional limitation, and quality of life. METHODS: We retrospectively reviewed 57 consecutive patients who had surgery for IMVM of the posterior compartment of the leg between 2010 and 2015. Treatments were all done at a single institution. RESULTS: Patients presented with pain (52), muscle contracture (14), or pulmonary embolism (4). Muscle involvement included the soleus muscle (n = 28, 49%), the gastrocnemius muscle (n = 25, 43%), and deep muscles (n = 4, 7%). Complete excision was possible in 52 patients (91%) and partial excision in 5 (9%). Thirty-five of 46 patients who had an MRI follow-up at six months had no residual venous malformation. At the final follow-up (mean 39 months), 32 of 40 patients seen had no residual pain and 37 had no residual functional impairment. CONCLUSION: In cases where IMVM is located in one muscle in the leg, we demonstrated that surgery yielded improvement in pain, function, and quality of life.

Endovascular treatment of aneurysmal deterioration in peripheral arterial allografts.

PURPOSE: To report endovascular treatment of 2 patients with aneurysmal deterioration of peripheral arterial allografts. CASE REPORT: Two men (65 and 64 years old) who had undergone an arterial allograft reconstruction for infection of prosthetic infrapopliteal bypass grafts 5 and 7 years ago, respectively, were diagnosed with asymptomatic aneurysmal deterioration of the allografts. Stent-graft repair was successful in both cases, completely excluding the aneurysms. At >or=1 year, continued aneurysm exclusion was confirmed by duplex scan, with no evidence of endoleak, migration, or stenosis. CONCLUSION: Endovascular treatment may be a useful therapeutic option when treating patients with late peripheral allograft deterioration.