Head and neck vascular anomalies. A multidisciplinary approach and diagnostic criteria.

Vascular anomalies represent a heterogeneous group of pathologies of the circulatory system that can affect any type of hematic and /or lymphatic vessel of different diameter or anatomic site. The extreme variability of tissue types and districts involved by these lesions determines a wide heterogeneity of clinical manifestations, resulting in involvement of different medical expertise. In this context, a commonly agreed terminology is crucial for the appropriate evaluation and multidisciplinary management of patients. The ISSVA Classification that has its roots in the previous Classification of Mulliken and Glowacky distinguishes vascular anomalies in two main groups: vascular tumors and vascular malformations. In head and neck, where vascular anomalies are the most common benign lesions of infancy and childhood, correct diagnosis with the use of unequivocal terminology is more crucial for treatment considering the relevance of structures that can be involved. The aim of this work has been to clarify information and knowledges currently available in the field of vascular anomalies. Referring to ISSVA Classification, clinico- histopathological aspects of each entity have been elucidated.

Thoracic outlet syndrome in paediatrics: clinical presentation, surgical treatment, and outcome in a series of eight children.

BACKGROUND/PURPOSE: This report reviews the clinical presentation, surgical treatment, and outcome of 8 children treated for the thoracic outlet syndrome (TOS) during the last 3 years. METHODS: From 1998 through 2001 31 patients were admitted to our Vascular Surgery Unit with TOS. Eight of them (25.8%) were in the paediatric age group, 8 to 16 years (mean, 13 years). No sex prevalence was found. The presenting symptoms were neurologic in 2 patients (25%) and secondary to venous flow impairment in 6 (75%). At phlebography, venous thrombosis was seen in 2 cases, and functional intermittent obstruction was seen in 4. Seven patients underwent decompressive surgical partial resection of the first rib with transaxillary or supraclavicular access. One patient was treated conservatively. RESULTS: There were no major postoperative complications. Mean hospital stay was 2.7 days. In no patient were there signs of recurrence after a mean follow-up of 18 months (range, 3 to 36 months). CONCLUSIONS: In the authors' experience TOS in paediatric patients occurs with the same symptoms and thrombotic complications as in adults. The same surgical strategy adopted in adult patients is advisable for affected children.

Early surgical management of Klippel-Trenaunay syndrome in childhood can prevent long-term haemodynamic effects of distal venous hypertension.

PURPOSE: The aim of this study was to evaluate the authors' preliminary experience in early surgical treatment of distal venous hypertension (DVH) in children affected by Klippel-Trenaunay syndrome (KTS). METHODS: Clinical assessment, surgical management, and outcome of 29 children (18 girls, 11 boys) affected by KTS observed from October 1998 to October 2000 were reviewed retrospectively. RESULTS: Patients ranged in age from 8 months to 17 years (median age at surgery, 10.3 years). The clinical findings are presented. Surgical treatments included stripping of persistent marginal vein (n = 16), multiple legation of bulky varicosities (n = 10), complementary sclerotherapy (n = 14) and laser photocoagulation (n = 13), and excision of associated lymphatic malformations (n = 5). No mortality or major postoperative morbidity occurred. Follow-up period ranged from 6 months to 2 years. CONCLUSION: These preliminary results suggest that early surgical management of DVH in KTS is safe and could be effective in preventing or minimising the long-term haemodynamic effects of DVH in absence of associated deep venous system anomalies.

[Transcatheter embolization in 39 cases of hyperactive arteriovenous malformation]. / Embolizzazione transcatetere in 39 casi di malformazione artero-venosa iperattiva.

Hyperdynamic arteriovenous malformations are a relevant therapeutic problem because of the complexity and variability of their presentation. The incidence of this angiodysplasia is quite low, so that only few institutions have treated more than a few patients, which certainly does not help treatment optimization. The role that transcatheter embolization has gained during the last years has fostered growing interest in this method, even though surgery remains the treatment of choice. Transcatheter embolization is a highly effective treatment, which can ensure long-lasting, although rarely definitive, hemodynamic results. The authors report their experience in 39 patients affected with hyperdynamic arteriovenous malformations. The total number of percutaneous embolization sessions was 81. In 11 patients a preoperative treatment was performed 48 hours before surgery. In all cases polyvinyl alcohol particles were used, whose diameter ranged 250-500 micron. The results, with a mean follow-up of 53 months, are reported. In the 11 patients who underwent combined surgery plus embolization treatment, conservative surgical resection was radical in 73% of cases. As for the other patients, the result was substantial in 46% of cases, partial in 27% and modest or insignificant in 27% of cases. The total incidence of major complications was 6.2%. Our experience confirms that transcatheter embolotherapy, although yielding effective long-term results, has a mostly palliative role.

Semiclosed thromboendoarterectomy on femoro-popliteal tract revisited after a fourteen years experience on 595 cases.

In the seventies atherosclerotic femoropopliteal lesions were extensively treated by means of retrograde semiclosed thromboendarterectomy (FP-TEA) an analytic follow-up of cases, until 1980, induced the modification of the indications to FP-TEA. Currently the FP-TEA technique is only employed for patients at the 2nd Fontaine's stage with disabling claudication (generally less than 100 mt) with a good distal run-off (at least 2 tibial vessels patent). The report deals with a series of 595 cases operated in the period January 1971-December 1984. In 45% of cases FP-TEA was associated with a proximal revascularization. In an attempt to focus on the factors that may influence the outcome, the patients operated in 1976, 1980, 1984, were assessed and the results related to clinical stage, angiographic pattern and postoperative treatment.

Treatment of peripheral congenital arterio-venous fistulas.

The authors describe their experience in the treatment of peripheral congenital A-V fistulas in 64 cases. Different surgical procedures (skeletation, "en bloc resection") have been performed in 19 patients, embolization in 15 patients. The need for a more radical and definitive procedure has induced the authors, in a recent series of 6 patients, to associate embolization and surgical therapy in the same operative session. The results are encouraging. The technique is reported.