RESUMEN
Portal interventions in pediatric patients present unique difficulties when compared to adult procedures. In addition, children who need a portal intervention require a different workup and clinical management. Based on these elements, the clinical decisions for the study and treatment of these pathologies are different. This review is intended to present a summary of the interventional radiologist's role in treating pediatric portal venous diseases. Focus is placed on the technical elements, patient management and procedural indications while discussing different interventions involving the portal vein, providing some recommendations supported by recent research and the authors' experience.
Asunto(s)
Vena Porta , Radiografía Intervencional , Humanos , Vena Porta/diagnóstico por imagen , Vena Porta/fisiopatología , Niño , Resultado del Tratamiento , Flebografía , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/terapia , Enfermedades Vasculares/fisiopatología , Adolescente , Preescolar , Lactante , Portografía , Factores de Edad , Masculino , Femenino , Recién NacidoRESUMEN
PURPOSE: To evaluate feasibility, safety, and results of endovenous mechanochemical ablation (MOCA) for treatment of persistent embryonic and dysplastic veins in pediatric patients with Klippel-Trénaunay syndrome (KTS). MATERIALS AND METHODS: Thirteen MOCA procedures were performed in 11 patients (age range, 4-16 years) with KTS and symptomatic persistent embryonic or dysplastic veins during a 24-month period. All patients were evaluated with color Doppler (CD) ultrasound (US), contrast-enhanced MR imaging, and venography to assess the anatomy of the target vessels and patency of the deep venous system. All procedures were performed under general anesthesia with a ClariVein catheter and liquid sodium tetradecyl sulfate as the sclerosing agent. US and fluoroscopic guidance were used in all cases. Technical success rate, primary occlusion rate, adverse effects, and recanalization rates were evaluated. Clinical and radiological (CD US) controls were performed 1 day, 7 days, 1 month, and 6 months after the procedure and once a year thereafter, with a mean follow-up of 16 months (range, 6-25 months). RESULTS: Technical success and primary occlusion were achieved in all patients with no adverse events. During the follow-up period, CD US demonstrated partial recanalization and symptom recurrence in 2 patients (18%), 14 and 18 months after the initial procedure. These 2 patients had a second ablation procedure with no recanalization or symptom recurrence during the subsequent follow-up period. CONCLUSIONS: MOCA is feasible and appears to be a safe and effective technique for treatment of varicose veins in pediatric patients with KTS.
Asunto(s)
Técnicas de Ablación , Procedimientos Endovasculares , Síndrome de Klippel-Trenaunay-Weber/complicaciones , Soluciones Esclerosantes/administración & dosificación , Escleroterapia , Tetradecil Sulfato de Sodio/administración & dosificación , Várices/terapia , Técnicas de Ablación/efectos adversos , Adolescente , Niño , Preescolar , Procedimientos Endovasculares/efectos adversos , Estudios de Factibilidad , Femenino , Humanos , Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Masculino , Recurrencia , Estudios Retrospectivos , Soluciones Esclerosantes/efectos adversos , Escleroterapia/efectos adversos , Tetradecil Sulfato de Sodio/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Várices/diagnóstico por imagen , Várices/etiologíaRESUMEN
OBJECTIVE: To describe the effects of oral sirolimus administered before and after surgical resection of slow-flow vascular malformations of the scrotum in pediatric patients. METHODS: Retrospective review of 3 patients presenting with complex lymphatic-venous malformations of the scrotum who received adjuvant oral sirolimus 3 months before and 3 months after surgical resection. Demographic data, clinical course, imaging findings, and management strategies were reviewed for each patient. RESULTS: In each of the 3 patients, there was a significant volume reduction of the lesion within the 3 months after initial dose of sirolimus. Scarce lymphatic leakage during and after surgery was reported, associated with an adequate wound healing. Two years after the last postsurgical dose of sirolimus, all patients remain asymptomatic without any lymphatic leakage or lesion recurrence. CONCLUSION: Combined lymphatic-venous vascular malformations of the male genitalia are rare but associated with high morbidity and challenging treatment options. Pre- and postsurgical adjuvant treatment with oral sirolimus seems to be a promising therapeutic option that provides reduction of the lesion size before surgery and improvement of postsurgical recovery and wound healing.