Our Options for the Treatment of Congenital Vascular Pathologies; Wait and See, Surgery, Sclerotherapy: When and Which Method?

Abstract

Objective: In addition to vascular disorders that are present at birth or appear shortly after birth and are externally visible, there are also vascular pathologies that may develop later in life. In the management of these lesions, a conservative “wait-and-see” approach may be preferred in some cases, whereas surgical and/or sclerotherapy methods may be required in others. Methods: In this study, patients who were admitted to our clinic between 2004 and 2011 and diagnosed with vascular lesions were retrospectively evaluated. Results: A total of 66 patients were included in the study, of whom 15 were diagnosed with hemangiomas and 51 with vascular malformations. The mean age was lower in the hemangioma group compared to the vascular malformation group (9.4 vs. 24.9 years), and female predominance was observed in both groups. Lesions were most frequently located in the head and neck region, accounting for 8 cases in the hemangioma group and 29 cases in the vascular malformation group. Surgical excision was the most commonly applied treatment modality for hemangiomas, whereas surgical excision and ethanol sclerotherapy were the main treatment approaches for vascular malformations. Complete regression was achieved in all patients with hemangiomas. In the vascular malformation group, complete regression was observed in 41 patients, partial regression in 9 patients, and no regression in 1 patient. Conclusion: Excluding small-sized vascular malformations located on the tongue, ethanol injection (sclerotherapy) appears to be the most appropriate treatment approach for venous-type vascular malformations. For the treatment of hemangiomas, surgical intervention is considered appropriate except in anatomically challenging regions requiring complex reconstruction. In lesions involving areas such as the eyelid and lip, where reconstruction is difficult, a conservative approach may be more appropriate in the absence of urgent surgical indications. Rather than adopting diagnosis-based algorithmic approaches, an individualized, patient-oriented treatment strategy may be more beneficial.

Keywords

• Hemangioma
• vascular malformation
• surgery
• ethanol
• sclerotherapy

Doğumsal Vasküler Patolojilerin Tedavisinde Elimizdeki Tedavi Seçenekleri; Beklemek, Cerrahi, Skleroterapi: Ne Zaman ve Hangisi?

Abstract

Amaç: Doğumda var olan veya doğduktan kısa bir süre sonra ortaya çıkan, dışarıdan görünen damar kökenli sorunlar dışında hayatın sonraki yıllarında ortaya çıkabilen vasküler patolojiler de vardır. Bunların tedavisinde bazen hiçbir şey yapmadan beklemek yolu seçilebileceği gibi bazen de cerrahi ve/veya sikleroterapi yöntemleri seçilebilmektedir. Yöntem: Bu çalışmada 2004-2011 yılları arasında kliniğimize başvuran ve vasküler lezyon tanısı alan hastalar geriye dönük olarak değerlendirildi. Bulgular: Toplam 66 hasta çalışmaya dâhil edildi; bunların 15’i hemanjiom, 51’i ise vasküler malformasyon tanısı almıştı. Ortalama yaş, hemanjiom grubunda vasküler malformasyon grubuna kıyasla daha düşüktü (9,4’e karşı 24,9 yıl) ve her iki grupta da kadın predominansı mevcuttu. Lezyonlar en sık baş-boyun bölgesinde yerleşim göstermekteydi; bu oran hemanjiomlarda 8 olgu, vasküler malformasyonlarda ise 29 olgu idi. Hemanjiomlarda en sık uygulanan tedavi yöntemi cerrahi eksizyon olurken, vasküler malformasyonlarda cerrahi eksizyon ve etanol skleroterapisi başlıca tedavi yöntemleriydi. Hemanjiomlu hastaların tamamında tam regresyon sağlandı. Vasküler malformasyon grubunda ise 41 hastada tam regresyon, 9 hastada kısmi regresyon saptanırken, 1 hastada regresyon izlenmedi. Sonuç: Dilde oturan küçük boyuttaki vasküler malformasyonlar hariç tutulacak olursa venöz yapıdaki vasküler malformasyonlara en uygun yaklaşımın lezyon içine etanol enjeksiyonu (skleroterapi) olabileceği sonucuna vardık. Hemanjiomların tedavisi için rekonstrüksiyonu zor yapılar dışında cerrahi müdahalenin uygun olduğunu ancak göz kapağı ve dudak gibi rekonstrüksiyonu zor vakalarda acil cerrahi endikasyonu olmadıktan sonra beklemenin daha uygun olacağını düşünüyoruz. Hastaların tanılarına bağlı algoritmik yaklaşımlardan ziyade her hastaya yönelik bireysel yaklaşımın tercih edilmesi daha yararlı olabilir.

Keywords

• Hemanjiom
• Vasküler malformasyon
• cerrahi
• etanol
• skleroterapi

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