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Combined Surgical and Endovascular Approaches

  • Byung-Boong Lee
  • James Laredo
  • Richard Neville
Chapter

Abstract

The “combined approach” to the treatment of CVMs represents a combination of traditional surgical therapy and endovascular therapy based on embolotherapy and sclerotherapy.

The ultimate goal of this combined treatment approach utilizing the two different modalities is to maximize the inherent treatment advantages both approaches have to offer while minimizing the associated risk and morbidity.

This new approach opened a new chapter for the traditional surgical approach which was severely hampered in the past and limited to the excision of “localized” lesions due to high morbidity. Throughout the last century, such poor surgical outcomes were inevitable due to the indiscriminate, “overzealous” surgical approach to all of the CVMs, using the same principles involved in oncologic surgery in order to minimize recurrence.

A new strategy that combines both the endovascular approach and a modernized surgical approach has demonstrated significantly improved efficacy when employed in sequence (e.g., preoperative embolotherapy and subsequent surgical excision), with fewer complications and reduced morbidity when compared to the outcomes achieved when utilizing the two individual treatment approaches alone.

References

  1. 1.
    Lee BB. Advanced management of congenital vascular malformation (CVM). Int Angiol. 2002;21(3):209–13.PubMedGoogle Scholar
  2. 2.
    Lee BB. Critical issues on the management of congenital vascular malformation. Ann Vasc Surg. 2004;18(3):380–92.CrossRefPubMedGoogle Scholar
  3. 3.
    Lee BB, Baumgartner I, Berlien HP, Bianchini G, Burrows P, Do YS, Ivancev K, Kool LS, Laredo J, Loose DA, Lopez-Gutierrez JC, Mattassi R, Parsi K, Rimon U, Rosenblatt M, Shortell C, Simkin R, Stillo F, Villavicencio L, Yakes W. Consensus Document of the International Union of Angiology (IUA)-2013. Current concept on the management of arterio-venous management. Int Angiol. 2013;32(1):9–36.PubMedGoogle Scholar
  4. 4.
    Lee BB, Baumgartner I, Berlien P, Bianchini G, Burrows P, Gloviczki P, Huang Y, Laredo J, Loose DA, Markovic J, Mattassi R, Parsi K, Rabe E, Rosenblatt M, Shortell C, Stillo F, Vaghi M, Villavicencio L, Zamboni P. Diagnosis and treatment of venous malformations consensus document of the International Union of Phlebology (IUP): updated 2013. Int Angiol. 2015;34(2):97–149.PubMedGoogle Scholar
  5. 5.
    Belov ST, Loose DA. Surgical treatment of congenital vascular defects. Int Angiol. 1990;9(3):175–82.PubMedGoogle Scholar
  6. 6.
    Mattassi R. Experiences in surgical treatment of congenital vascular malformation: changes in diagnosis and surgical tactics in the view of new experiences. In: Belov S, Loose DA, Weber J, editors. Vascular malformations. Reinbek: Einhorn-Presse Verlag GmbH; 1989. p. 202–5.Google Scholar
  7. 7.
    Malan E. Surgical problems in the treatment of congenital arteriovenous fistulae. J Cardiovasc Surg (Torino). 1965;6:251.Google Scholar
  8. 8.
    Lee BB, Laredo J, Kim YW, Neville R. Congenital vascular malformations: general treatment principles. Phlebology. 2007;22(6):258–63.CrossRefPubMedGoogle Scholar
  9. 9.
    Lee BB, Laredo J. Venous malformation: treatment needs a bird’s eye view. Phlebology. 2013;28:62–3.CrossRefPubMedGoogle Scholar
  10. 10.
    Lee BB. Endovascular management of the Congenital Vascular Malformation (CVM) is not a panacea. Editorial. Damar Cer Derg. 2013;22(1):1–3.CrossRefGoogle Scholar
  11. 11.
    Lee BB. Not all venous malformations needed therapy because they are not arteriovenous malformations. Comments Dermatol Surg. 2010;36(3):340–346. Dermatol Surg. 2010;36(3):347.Google Scholar
  12. 12.
    Lee BB. Changing concept on vascular malformation: no longer enigma. Ann Vasc Dis. 2008;1(1):11–9.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Belov S. Classification, terminology, and nosology of congenital vascular defects. In: Belov S, Loose DA, Weber J, editors. Vascular malformations. Reinbek: Einhorn-Presse; 1989. p. 25–30.Google Scholar
  14. 14.
    Enjolras O, Wassef M, Chapot R. Introduction: ISSVA classification. In: Color atlas of vascular tumors and vascular malformations. New York: Cambridge University Press; 2007. p. 1–11.Google Scholar
  15. 15.
    Lee BB. New classification of congenital vascular malformations (CVMs). Rev Vasc Med. 2015;3(3):1–5.CrossRefGoogle Scholar
  16. 16.
    Lee BB, Antignani PL, Baraldini V, Baumgartner I, Berlien P, Blei F, Carrafiello GP, Grantzow R, Ianniello A, Laredo J, Loose D, Lopez Gutierrez JC, Markovic J, Mattassi R, Parsi K, Rabe E, Roztocil K, Shortell C, Vaghi M. ISVI-IUA consensus document – diagnostic guidelines on vascular anomalies: vascular malformations and hemangiomas. Int Angiol. 2015;34(4):333–74.PubMedGoogle Scholar
  17. 17.
    Belov ST. Anatomopathological classification of congenital vascular defects. Semin Vasc Surg. 1993;6:219–24.PubMedGoogle Scholar
  18. 18.
    Belov ST. Classification of congenital vascular defects. Int Angiol. 1990;9:141–6.PubMedGoogle Scholar
  19. 19.
    Lee BB, Laredo J, Lee TS, Huh S, Neville R. Terminology and classification of congenital vascular malformations. Phlebology. 2007;22(6):249–52.CrossRefPubMedGoogle Scholar
  20. 20.
    Gloviczki P, Duncan AA, Kalra M, Oderich GS, Ricotta JJ, Bower TC, et al. Vascular malformations: an update. Perspect Vasc Surg Endovasc Ther. 2009;21(2):133–48.CrossRefPubMedGoogle Scholar
  21. 21.
    Lee BB. Critical role of multidisciplinary team approach in the new field of vascular surgery – endovascular surgery. J Kor Soc Vasc Surg. 2003;19(2):121–3.Google Scholar
  22. 22.
    Lee BB, Bergan JJ. Advanced management of congenital vascular malformations: a multidisciplinary approach. J Cardiovasc Surg. 2002;10(6):523–33.CrossRefGoogle Scholar
  23. 23.
    Lee BB. Current concept of venous malformation (VM). Phlebolymphology. 2003;43:197–203.Google Scholar
  24. 24.
    Lee BB, Do YS, Yakes W, Kim DI, Mattassi R, Hyun WS, Byun HS. Management of arterial-venous shunting malformations (AVM) by surgery and embolosclerotherapy. A multidisciplinary approach. J Vasc Surg. 2004;3:596–600.Google Scholar
  25. 25.
    Lee BB. New approaches to the treatment of Congenital Vascular Malformations (CVMs) – Single Center Experiences – (editorial review). Eur J Vasc Endovasc Surg. 2005;30(2):184–97.CrossRefPubMedGoogle Scholar
  26. 26.
    Lee BB, Kim DI, Huh S, Kim HH, Choo IW, Byun HS, Do YS. New experiences with absolute ethanol sclerotherapy in the management of a complex form of congenital venous malformation. J Vasc Surg. 2001;33(4):764–72.CrossRefPubMedGoogle Scholar
  27. 27.
    Lee BB, Do YS, Byun HS, Choo IW, Kim DI, Huh SH. Advanced management of venous malformation (VM) with ethanol sclerotherapy: mid-term results. J Vasc Surg. 2003;37(3):533–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Do YS, Yakes WF, Shin SW, Kim DI, Shin BS, Lee BB. Ethanol embolization of arteriovenous malformations: interim results. Radiology. 2005;235(2):674–82.CrossRefPubMedGoogle Scholar
  29. 29.
    Yamaki T, Nozaki M, Sasaki K. Color duplex-guided sclerotherapy for the treatment of venous malformations. Dermatol Surg. 2000;26(4):323–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Pascarella L, Bergan JJ, Yamada C, Mekenas L. Venous angiomata: treatment with sclerosant foam. Ann Vasc Surg. 2005;19(4):457–64.CrossRefPubMedGoogle Scholar
  31. 31.
    O’Donovan JC, Donaldson JS, Morello FP, Pensler JM, Vogelzang RL, Bauer B. Symptomatic hemangiomas and venous malformations in infants, children, and young adults: treatment with percutaneous injection of sodium tetradecyl sulfate. AJR Am J Roentgenol. 1997;169(3):723–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Cabrera J, Cabrera Jr J, Garcia-Olmedo MA, Redondo P. Treatment of venous malformations with sclerosant in microfoam form. Arch Dermatol. 2003;139(11):1494–6.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Byung-Boong Lee
    • 1
    • 2
  • James Laredo
    • 3
  • Richard Neville
    • 3
  1. 1.Center for the Lymphedema and Vascular MalformationsGeorge Washington UniversityWashington, DCUSA
  2. 2.Uniformed ServicesUniversity of the Health SciencesBethesdaUSA
  3. 3.Division of Vascular Surgery, Department of SurgeryGeorge Washington University Medical CenterWashington, DCUSA

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