Venous malformations : differential diagnostics, blood coagulation, and treatment safety

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

Venous malformations (VMs) are congenital vascular anomalies. They cause variable symptoms and are associated with blood coagulation disorders. Sclerotherapy has recently become the primary treatment for most VMs. This thesis aimed to investigate histology and imaging of VMs operated on for unsatisfactory sclerotherapy response, blood coagulation and fibrinolysis activity in pediatric VM patients, and safety aspects of sclerotherapy for trunk and extremity and head and neck VMs. We studied VM patients undergone sclerotherapy at Helsinki University Hospital between 2007 and 2013 and paediatric VM patients collected from the Helsinki Children's hospital outpatient registry. We analyzed histology and imaging findings of extremity VMs operated on for poor response to sclerotherapy (n=102), sclerotherapy complications of all sclerotherapy-treated patients (n=202), and coagulation abnormalities of the paediatric VM patients (n=62). Of the sclerotherapy-treated extremity VMs, 19% were operated on for insufficient sclerotherapy response. The histology of most intramuscular VMs was not consistent with common VM, corresponding instead to angiomatosis of soft tissue (AST). The imaging findings for common VM and AST were overlapping. Pediatric VM patients had significant abnormalities in leukocyte, antithrombin, FVII, FVIII, and FXIII levels, in addition to previously reported elevated D-dimer levels. Disseminated intravascular coagulation did not occur and platelets were generally normal. The sclerotherapy complication rate per procedure was 13% for trunk and extremity VMs and 10% for head and neck VMs. Superficial location and use of ethanol increased the risk for local complications. Blood coagulopathy was a predisposing factor for severe complications. Histology has an important role in the differential diagnostics of intramuscular VMs, as different histological entities require different treatment approaches. VMs are associated with specific abnormalities in coagulation biomarkers, implying a close interrelation between coagulation and angiogenesis. Sclerotherapy for both peripheral and head and neck VMs is generally safe, but entails a risk for severe complications
Original languageEnglish
Supervisors/Advisors
  • Pitkäranta, Anne, Supervisor
  • Pekkola, Johanna, Supervisor
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-3623-7
Electronic ISBNs978-951-51-3624-4
Publication statusPublished - 2017
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • 3123 Gynaecology and paediatrics
  • 3126 Surgery, anesthesiology, intensive care, radiology

Cite this

@phdthesis{8440fc629e7643488ee4478dc1c358ec,
title = "Venous malformations : differential diagnostics, blood coagulation, and treatment safety",
abstract = "Venous malformations (VMs) are congenital vascular anomalies. They cause variable symptoms and are associated with blood coagulation disorders. Sclerotherapy has recently become the primary treatment for most VMs. This thesis aimed to investigate histology and imaging of VMs operated on for unsatisfactory sclerotherapy response, blood coagulation and fibrinolysis activity in pediatric VM patients, and safety aspects of sclerotherapy for trunk and extremity and head and neck VMs. We studied VM patients undergone sclerotherapy at Helsinki University Hospital between 2007 and 2013 and paediatric VM patients collected from the Helsinki Children's hospital outpatient registry. We analyzed histology and imaging findings of extremity VMs operated on for poor response to sclerotherapy (n=102), sclerotherapy complications of all sclerotherapy-treated patients (n=202), and coagulation abnormalities of the paediatric VM patients (n=62). Of the sclerotherapy-treated extremity VMs, 19{\%} were operated on for insufficient sclerotherapy response. The histology of most intramuscular VMs was not consistent with common VM, corresponding instead to angiomatosis of soft tissue (AST). The imaging findings for common VM and AST were overlapping. Pediatric VM patients had significant abnormalities in leukocyte, antithrombin, FVII, FVIII, and FXIII levels, in addition to previously reported elevated D-dimer levels. Disseminated intravascular coagulation did not occur and platelets were generally normal. The sclerotherapy complication rate per procedure was 13{\%} for trunk and extremity VMs and 10{\%} for head and neck VMs. Superficial location and use of ethanol increased the risk for local complications. Blood coagulopathy was a predisposing factor for severe complications. Histology has an important role in the differential diagnostics of intramuscular VMs, as different histological entities require different treatment approaches. VMs are associated with specific abnormalities in coagulation biomarkers, implying a close interrelation between coagulation and angiogenesis. Sclerotherapy for both peripheral and head and neck VMs is generally safe, but entails a risk for severe complications",
keywords = "Angiomatosis, +diagnosis, Blood Coagulation, Diagnosis, Differential, Sclerosing Solutions, +administration & dosage, +adverse effects, Sclerotherapy, +methods, Thromboembolism, Treatment Outcome, Vascular Malformations, +surgery, +therapy, Veins, +abnormalities, 3123 Gynaecology and paediatrics, 3126 Surgery, anesthesiology, intensive care, radiology",
author = "Johanna Aronniemi",
note = "M1 - 66 s. + liitteet",
year = "2017",
language = "English",
isbn = "978-951-51-3623-7",
publisher = "[J. Aronniemi]",
address = "Finland",

}

Venous malformations : differential diagnostics, blood coagulation, and treatment safety. / Aronniemi, Johanna.

Helsinki : [J. Aronniemi], 2017. 66 p.

Research output: ThesisDoctoral ThesisCollection of Articles

TY - THES

T1 - Venous malformations : differential diagnostics, blood coagulation, and treatment safety

AU - Aronniemi, Johanna

N1 - M1 - 66 s. + liitteet

PY - 2017

Y1 - 2017

N2 - Venous malformations (VMs) are congenital vascular anomalies. They cause variable symptoms and are associated with blood coagulation disorders. Sclerotherapy has recently become the primary treatment for most VMs. This thesis aimed to investigate histology and imaging of VMs operated on for unsatisfactory sclerotherapy response, blood coagulation and fibrinolysis activity in pediatric VM patients, and safety aspects of sclerotherapy for trunk and extremity and head and neck VMs. We studied VM patients undergone sclerotherapy at Helsinki University Hospital between 2007 and 2013 and paediatric VM patients collected from the Helsinki Children's hospital outpatient registry. We analyzed histology and imaging findings of extremity VMs operated on for poor response to sclerotherapy (n=102), sclerotherapy complications of all sclerotherapy-treated patients (n=202), and coagulation abnormalities of the paediatric VM patients (n=62). Of the sclerotherapy-treated extremity VMs, 19% were operated on for insufficient sclerotherapy response. The histology of most intramuscular VMs was not consistent with common VM, corresponding instead to angiomatosis of soft tissue (AST). The imaging findings for common VM and AST were overlapping. Pediatric VM patients had significant abnormalities in leukocyte, antithrombin, FVII, FVIII, and FXIII levels, in addition to previously reported elevated D-dimer levels. Disseminated intravascular coagulation did not occur and platelets were generally normal. The sclerotherapy complication rate per procedure was 13% for trunk and extremity VMs and 10% for head and neck VMs. Superficial location and use of ethanol increased the risk for local complications. Blood coagulopathy was a predisposing factor for severe complications. Histology has an important role in the differential diagnostics of intramuscular VMs, as different histological entities require different treatment approaches. VMs are associated with specific abnormalities in coagulation biomarkers, implying a close interrelation between coagulation and angiogenesis. Sclerotherapy for both peripheral and head and neck VMs is generally safe, but entails a risk for severe complications

AB - Venous malformations (VMs) are congenital vascular anomalies. They cause variable symptoms and are associated with blood coagulation disorders. Sclerotherapy has recently become the primary treatment for most VMs. This thesis aimed to investigate histology and imaging of VMs operated on for unsatisfactory sclerotherapy response, blood coagulation and fibrinolysis activity in pediatric VM patients, and safety aspects of sclerotherapy for trunk and extremity and head and neck VMs. We studied VM patients undergone sclerotherapy at Helsinki University Hospital between 2007 and 2013 and paediatric VM patients collected from the Helsinki Children's hospital outpatient registry. We analyzed histology and imaging findings of extremity VMs operated on for poor response to sclerotherapy (n=102), sclerotherapy complications of all sclerotherapy-treated patients (n=202), and coagulation abnormalities of the paediatric VM patients (n=62). Of the sclerotherapy-treated extremity VMs, 19% were operated on for insufficient sclerotherapy response. The histology of most intramuscular VMs was not consistent with common VM, corresponding instead to angiomatosis of soft tissue (AST). The imaging findings for common VM and AST were overlapping. Pediatric VM patients had significant abnormalities in leukocyte, antithrombin, FVII, FVIII, and FXIII levels, in addition to previously reported elevated D-dimer levels. Disseminated intravascular coagulation did not occur and platelets were generally normal. The sclerotherapy complication rate per procedure was 13% for trunk and extremity VMs and 10% for head and neck VMs. Superficial location and use of ethanol increased the risk for local complications. Blood coagulopathy was a predisposing factor for severe complications. Histology has an important role in the differential diagnostics of intramuscular VMs, as different histological entities require different treatment approaches. VMs are associated with specific abnormalities in coagulation biomarkers, implying a close interrelation between coagulation and angiogenesis. Sclerotherapy for both peripheral and head and neck VMs is generally safe, but entails a risk for severe complications

KW - Angiomatosis

KW - +diagnosis

KW - Blood Coagulation

KW - Diagnosis, Differential

KW - Sclerosing Solutions

KW - +administration & dosage

KW - +adverse effects

KW - Sclerotherapy

KW - +methods

KW - Thromboembolism

KW - Treatment Outcome

KW - Vascular Malformations

KW - +surgery

KW - +therapy

KW - Veins

KW - +abnormalities

KW - 3123 Gynaecology and paediatrics

KW - 3126 Surgery, anesthesiology, intensive care, radiology

M3 - Doctoral Thesis

SN - 978-951-51-3623-7

PB - [J. Aronniemi]

CY - Helsinki

ER -