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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2000 Giugno;41(3):447-55

lingua: Inglese

Therapeutic tactics and late results in predominant truncal congenital malformation

Dimakakos P. B., Arapoglou V., Katsenis K., Kotsis T., Mourikis D.

From the Depart­ment of Vas­cular Sur­gery *Depart­ment of ­Radiology Uni­ver­sity of ­Athens, Are­taeion Hos­pital, Athens, Greece


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Back­ground. Con­gen­ital vas­cular mal­for­ma­tions are ­rare vas­cular ­lesions of ­unknown eti­ology, non-degen­er­a­tive or of inflam­ma­tory ­nature, ­which ­begin ­during embryo­log­ical devel­op­ment; ­they are char­ac­ter­ized by anom­a­lies of the vas­cular ­system, appar­ently due to hemo­dy­namic and meta­bolic dis­tur­bances.
­Methods. Our diag­nostic and ther­a­peutic man­age­ment in addi­tion to the ­late ­results in 60, ­mainly ­truncal ­cases, out of 265 con­gen­ital vas­cular mal­for­ma­tions, are ana­lyzed in the ­present ­study. In a 20-­year ­period 25,000 vas­cular exam­ina­tions ­were car­ried out, ­among ­which 265 (1.06%) con­gen­ital vas­cular mal­for­ma­tions (­CVMs) ­were dis­cov­ered, ­that is 77% (205/265) ­extra-­truncal ­venous angio­mata and 22.7% (60/265) ­truncal dif­fuse or local­ized ­types. The dis­tri­bu­tion of the ­above ­types was: 22 (36.6%) arter­i­ov­e­nous, 30 (50%) ­venous and 8 (13.4%) lym­phatic.
­Results. Sur­gery was car­ried out in 48.3% (29/60) of the ­truncal ­types of ­which 37.9% of the ­cases, on ­average, ­recurred 8 ­years ­later. Of the 22 arter­i­ov­e­nous mal­for­ma­tions 20 ­patients ­were oper­ated on (90%), of ­whom 35% (7/20) had a recur­rence; of the 30 ­venous ­defects 30% (9/30) ­were oper­ated on and 44.5% (4/9) of ­these had a recur­rence. The recur­rence ­rate ­rose to 50% (5/10) in ­cases of oper­a­tive ­therapy of arter­i­ov­e­nous ­defects and to 20% (2/10) ­with com­bined sur­gical and non sur­gical ­methods. The recur­rence inci­dence of ­venous ­defects ­with sur­gical treat­ment and scle­ro­therapy was 54.1% (6/11).
Con­clu­sions. ­Timely diag­nosis, micro­sur­gical tech­niques and ­highly spe­cial­ized sur­gical and inter­ven­tional expe­ri­ence are ­expected to ­improve ­these ­results sig­nif­i­cantly.

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