| Objectives:To explore the method of treatment and curative effect for the limbs soft tissue of venous malformations and arterial malformation.Methods:Select 44 cases of soft tissue in patients with deformity of the limb blood vessels in the Sichuan Provincial People’s Hospital during the period from 2013-04 to 2015-02 as the object of study, including 40 cases of venous malformations, arteriovenous malformation in 4 cases. All patients with conventional MRI and color Doppler ultrasound examination, clearly diagnosed to determine size, range of the focus. According to the blood flow velocity of venous, the venous malformation were divided into low backflow group (A group) with 25 cases and high backflow group (B group) with 15 cases. For both of A, B groups of venous malformation, lauromacrogol foam sclerosing agent were fabricated using the Tessari process of, then under the guidance of ultrasound intralesional injection were performed through the skin on many points. The total amount for each injection is calculated according to the liquid, which does not exceed 20ml. After treatment of two weeks, multiple injections were performed on uncured patients until the tumor size shrinks and vascular malformation disappears. Three months after the end of treatment, they were examined by MRI or ultrasound, the size of the focus and the strength of blood flow signal therein were recorded before and after treatment for evaluation of the curative effect. Treatment effect of A, B two groups were compared through chi-square test comparisons. If treatment after 2 times proved completely ineffective (focus not narrowing, a lot of blood flow signals still found after ultrasonic examination of the focus), treatment will be given up for such cases.of the 40 cases of venous malformation patients,5 patients (B group) was proved invalid simply through lauromacrogol foam sclerosing agent treatment.3 patients were fitted with balloon dilating catheter in the DSA through femoral vein, for temporary occlusion the venous drainage for the focus, and then were injected through the skin of lauromacrogol foam sclerosing agent. Two weeks later, injections were performed again under the guidance of color Doppler ultrasound for residual lesions; 2 patients were injected with anhydrous alcohol and lipiodol suspension to the focus under DSA perspective, and follow-up interviews were made for assessment of therapeutic effect and complications. In another 4 cases of arteriovenous malformation, microcatheter were super-selected at the opening of the feeding artery of the malformed blood vessel nest under DSA using transcatheter arterial embolization, and feeding artery embolization was enabled through the use of PVA particles, and follow-up interviews were made for assessment of therapeutic effect. Results:In this study, the therapeutic effects for 40 cases of venous malformation patients are as follows:In group A, 9 cases were cured,13 cases improved,3 cases ineffective, cure and improvement was considered to be effective, effective rate was 88%. In group B,0 cases were cured,8 cases improved,7 cases ineffective, cure and improvement was considered to be effective, efficient 53.3%. The curative effect of group A was better than group B, the treatment effect difference was statistically significant of the two groups (P=0.038<0.05). For 5 invalid cases with high flow venous malformation of group B, further research was made on its treatment method. For 3 patients, after occlusion of the draining veins for the lesions through the placement of balloon catheter in the DSA, lauromacrogol foam sclerosing agent was then injected through the skin. With this method, after two weeks of treatment, reexaminations by ultrasound suggest:focal partially fibrosis, reduced blood flow signal, significant contraction of lesion internal drainage vessel diameter, reduction of blood flow velocity. Injection of lauromacrogol foam sclerosing agent were performed twice under the guidance of color Doppler ultrasound. After 3 months, the lesions of 3 cases were reduced more than 50%. The lesion texture became soft, and blood flow signals of the lesions disappeared. For another 2 cases with percutaneous intralesional injection of anhydrous alcohol, reexaminations suggest that the vascular malformations disappeared after 1 months, and the lesion reduced by about 70% after the 6 months.4 cases of arteriovenous malformation patients were all proved cure-effective. Reexaminations for 3 months after treatment showed that most of color Doppler ultrasound blood flow signal disappeared, and for 2 patients the lesions reduced by more than 70%, and for 2 patients, the lesions reduced by more than 50%. Swelling pains for patient pain were significantly improved. In the course of treatment, a total of 2 patients experienced dizziness, chest tightness and heart palpitations when being injected with lauromacrogol foam sclerosing agent, and after suspension of injections, these uncomfortable symptoms disappeared after having a rest on their backs.2 cases with injections of percutaneous ethanol were observed with severe limb pain. Pains disappeared after 2 weeks. Almost all of the patients had different degrees of swelling and pain in the affected area after receiving the treatment, and all symptoms disappeared within 2 weeks of treatment. The majority of patients, after the treatment, were seen with hardened lesions, stiffened joints and unshrinking legions. However, generally 3 months after the end of the treatment, the lesions became soft, contracted, and the joints can move normally. One patient, after injection of lauromacrogol, experienced skin pigmentation. Because the focus is shallow, one patient was seen with skin necrosis in the injection site one week after injection of lauromacrogol; three months later, the skin at the lesion began to scab and fall off, and the skin scar healed up. The sclerosing agent allergy, muscle necrosis, deep vein thrombosis were not observed for all patients, and no fatal pulmonary artery embolism, stroke and other complications were also not observed. Conclusion:For the focus of vascular malformation, it is of utmost importance to define the nature of blood flow for diagnosis, because it directly affects the treatment method and prognosis.1. For the low flow vascular malformation, lauromacrogol foam sclerosing treatment under the guidance of ultrasound can be used as the preferred method.2 For high flow vascular malformation, lauromacrogol foam sclerosing alone will hardly achieve any effect, one option is to inject through the skin lauromacrogol foam sclerosing agent after temporary occlusion of venous drainage of the focus through femoral vein placement of balloon catheter under the DSA, or another effective therapeutic approach is intralesional injection of anhydrous alcohol under the DSA.3. with transcatheter arterial embolization under DSA is an effective method for the treatment of arteriovenous malformations. |
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