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      Single-session Preoperative Embolization and Surgical Resection of Vascular Anomalies: A Case Series

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          Summary:

          Vascular anomalies encompass 2 broad classifications including vascular tumors and vascular malformations. The management of vascular anomalies is best approached by a multidisciplinary team. Surgical treatment can offer definitive treatment, but carries several risks such as intraoperative hemorrhage, recurrence, and collateral vascular formations from incomplete resections. Here, we present a case report of 3 patients with different vascular anomalies who were all treated by a multidisciplinary team including interventional radiology and plastic surgery. All underwent preoperative embolization before surgical excision, accomplished under a single anesthetic. Here, we discuss the surgical planning and overall approach to patients presenting with localized vascular anomalies and support the use of preoperative embolization with surgical excision under a single anesthetic as a treatment approach.

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          Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics.

          Forty-nine specimens from a variety of vascular lesions were analyzed for cellular characteristics. Two major categories of lesions emerged from this investigation: hemangiomas and vascular malformations. This classification and its implications are justified by several considerations. Hemangiomas in the proliferating phase (n = 14) were distinguished by (1) endothelial hyperplasia with incorporation of [3H]thymidine, (2) multilaminated basement membrane formation beneath the endothelium, and (3) clinical history of rapid growth during early infancy. Hemangiomas in the involuting phase (n = 12) exhibited (1) histologic fibrosis and fat deposition, (2) low to absent [3H]thymidine labeling of endothelial cells, and (3) rapid growth and subsequent regression. The endothelium in hemangiomas had many characteristics of differentiation: Weibel-Palade bodies, alkaline phosphatase, and factor VIII production. Vascular malformations (n = 23) demonstrated no tritiated thymidine incorporation and normal ultrastructural characteristics. These lesions were usually noted at birth, grew proportionately with the child, and consisted of abnormal, often combined, capillary, arterial, venous, and lymphatic vascular elements. This cell-oriented analysis provides a simple yet comprehensive classification of vascular lesions of infancy and childhood and serves as a guide for diagnosis, management, and further research.
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            Venous malformations: clinical diagnosis and treatment.

            Venous malformation (VM) is the most common type of congenital vascular malformation (CVM). They are present at birth and are often symptomatic, causing morbidity and pain. VMs can be challenging to diagnose and are often confused with hemangioma in terminology as well as with imaging. An accurate clinical history and cross-sectional imaging are critical for diagnosis and for devising management. This manuscript will review imaging approaches to diagnosing VMs and current treatment strategies.
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              RASA1 mutations and associated phenotypes in 68 families with capillary malformation-arteriovenous malformation.

              Capillary malformation-arteriovenous malformation (CM-AVM) is an autosomal-dominant disorder, caused by heterozygous RASA1 mutations, and manifesting multifocal CMs and high risk for fast-flow lesions. A limited number of patients have been reported, raising the question of the phenotypic borders. We identified new patients with a clinical diagnosis of CM-AVM, and patients with overlapping phenotypes. RASA1 was screened in 261 index patients with: CM-AVM (n = 100), common CM(s) (port-wine stain; n = 100), Sturge-Weber syndrome (n = 37), or isolated AVM(s) (n = 24). Fifty-eight distinct RASA1 mutations (43 novel) were identified in 68 index patients with CM-AVM and none in patients with other phenotypes. A novel clinical feature was identified: cutaneous zones of numerous small white pale halos with a central red spot. An additional question addressed in this study was the "second-hit" hypothesis as a pathophysiological mechanism for CM-AVM. One tissue from a patient with a germline RASA1 mutation was available. The analysis of the tissue showed loss of the wild-type RASA1 allele. In conclusion, mutations in RASA1 underscore the specific CM-AVM phenotype and the clinical diagnosis is based on identifying the characteristic CMs. The high incidence of fast-flow lesions warrants careful clinical and radiologic examination, and regular follow-up. © 2013 WILEY PERIODICALS, INC.
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                Author and article information

                Journal
                Plast Reconstr Surg Glob Open
                Plast Reconstr Surg Glob Open
                GOX
                Plastic and Reconstructive Surgery Global Open
                Lippincott Williams & Wilkins (Hagerstown, MD )
                2169-7574
                November 2024
                18 November 2024
                : 12
                : 11
                : e6302
                Affiliations
                From the [* ]Rutgers Robert Wood Johnson Medical School, Piscataway, N.J.
                []Division of Plastic Surgery, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill.
                []Texas A&M School of Medicine, Engineering Medicine (EnMed), Houston, Tex.
                [§ ]Division of Interventional Radiology, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill.
                Author notes
                Akira Yamada, MD, PhD, Division of Plastic Surgery, Ann & Robert H. Lurie Children’s Hospital, 225 E. Chicago Ave, Box 93, Chicago, IL 60611, E-mail: ayamada@ 123456luriechildrens.org
                Article
                GOX-D-24-00115 00038
                10.1097/GOX.0000000000006302
                11573328
                39559266
                530625fe-ccb7-462a-ab52-97a70c9e7789
                Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                : 1 February 2024
                : 18 September 2024
                Categories
                Craniofacial/Pediatric
                Special Topic
                Custom metadata
                TRUE
                UNITED STATES

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