Clinical Analysis And Experimental Study Of Interventional Sclerotherapy For Venous Malformations In Children

Backdround Venous Malformation(VM)is the most common type of benign vascular malformation in humans,which is usually found at birth or adolescence.In the course of growth,patients gradually increase with age,or a series of symptoms,such as pain,bleeding,ulcer,functional damage and appearance defects,are caused by local traumatic stimulation.Those who are located in important organs in the body may even have breathing difficulties,asphyxia and so on.Therefore,it is necessary to diagnose accurately in clinic and give reasonable suggestions in time. MR imaging is currently recognized as the preferred imaging method for the diagnosis of venous malformations.The lesions usually show low or equal signal on T1-weighted sequence,high signal on T2-weighted fat suppression sequence,partial lobulation sign,and sometimes low signal venous stones can be seen in large venous malformations. As the first-line treatment of venous malformations-percutaneous interventional sclerotherapy,the curative effect is definite and the side effects are small,but there are still many factors affecting the sclerosis effect,such as the shape and distribution of venous malformations,Puig classification,types of sclerosing agents,and the residence time of sclerosing agents. Tyrosine kinase receptor 2(Tie2)/angiopoietin 2(ANG2)pathway is an important signal pathway regulating angiogenesis.Tie2 plays a key regulatory role in this pathway.Gene mutation can induce different levels of Tie2 phosphorylation,which can cause vascular malformation.Object1.Multivariate analysis of prognosis of interventional sclerotherapy for venous malformations in children;2.Preliminary study of Tie2 mutation site related to venous malformations.Methods1.Collect 92 cases of sporadic venous malformations before and after the first interventional treatment,DSA images and clinical data,design data collecton form referring to relevant literature at home and abroad,image data were judged by two experienced doctors in our hospital;clinical follow-up data were obtained by telephone calls or Wechat from data collectors.The final data were analyzed by SPSS13.0,and logistic regression analysis showed that P < 0.05 had significant difference,that is,there was statistical significance.2.The peripheral venous blood of 56 children with sporadic venous malformations was collected and compared with the normal blood of healthy people.DNA was extracted and exon 13 of Tie 2 was sequenced by direct sequencing.Results1.Distribution of venous malformations is different and prognosis of sclerotherapy is different.The prognosis of diffuse multi-site venous malformations is worse than that of focal lesions and diffuse single-site lesions.The lesions are widely distributed and large in area,requiring multiple sclerotherapy.In Puig classification,the prognosis of type Ⅲ and Ⅳ venous malformations treated by sclerotherapy alone is worse than that of type I and II.2.The mutation rate of exon 13 of Tie2 gene was 3.3%(1/30)in 30 normal blood samples and 57.1%(32/56)in VM patients.The mutation rate accords with the relevant research at home and abroad,but no special mutation rule has been found.Conlusion1.Distribution of venous malformations and Puig classification have important clinical value in evaluating the therapeutic effect of interventional sclerotherapy.The distribution of venous malformations is diffuse and multi-site distribution.In Puig classification,type Ⅲ and Ⅳ sclerosis have poor curative effect.It is suggested that other treatment methods should be combined.2.The mutation rate of exon Tie2 13 in venous malformations is about 57.1%.Molecular therapy may be a new way to treat refractory VM which is not sensitive to standard therapy.