Centers of Excellence in Interventional Cardiology and Radiology

Pediatric Angiology

Hemangioma embolization

The procedure performed by team of specialists from abroad!

Our center has saved the lives of over 4,500 patients in the last 4 years

The most modern equipped angiography room , an exceptional medical team

We have the most famous abroad specialists! Team from Romania, Israel, Greece and Germany!

This complex procedure of aorta needs the best specialists ! Call us now!

Find out the costs for this procedure!

Or
you can contact us!

Call Center
031 9300

Generalities

Hemangiomas are the most common tumors of infancy, and most infantile hemangiomas are medically insignificant. A hemangioma is a birthmark that most commonly appears as a rubbery, bright red nodule of extra blood vessels in the skin.

Sometimes called a strawberry mark, a hemangioma grows during the first year of life, and then recedes over time. A child who had a hemangioma during infancy usually has little visible trace of the growth by age 10.

A hemangioma can occur anywhere on the body, but most commonly appears on the face, scalp, chest or back. Eighty percent of cutaneous hemangiomas are single, while 20% are multiple. Multiple cutaneous lesions often are associated with hemangiomas in other organ systems, particularly the liver.

Treatment of a hemangioma usually isn’t needed, unless the nodule interferes with vision or breathing.

Causes:

At ARES Centers
you have your own medical care officer!

Fill out this form and in the shortest time you will be contacted!

Or
you can contact us!

Call Center
031 9300

A hemangioma consists of an abnormally dense group of extra blood vessels. It’s not clear what causes the blood vessels to group together, although there may be a hereditary component involved.

Hemangiomas occur more often in:

females

premature babies

white infants

thirty percent of infantile hemangiomas are present at birth, and 70% of them initially appear in the first several weeks of life.

Occasionally infantile hemangiomas may impinge on vital structures, ulcerate, bleed, cause high-output cardiac failure or significant structural abnormalities or disfigurement. Rarely, a cutaneous infantile hemangioma may be associated with one or more underlying congenital anomalies.

The prognosis for most uncomplicated infantile hemangiomas is very good. Despite resolution of the vascular component, residual skin changes are observed in roughly 50% of cases. Of hemangiomas that have involuted by age 6 years, 38% still have residual evidence with scar formation, telangiectasia, or redundant or anetodermic skin. Hemangiomas that take longer to involute have a higher incidence of permanent cutaneous residua. Eighty percent of lesions that complete involution after age 6 years may exhibit significant cosmetic deformities. An increased incidence of permanent residua exists when the lip, nasal tip, eyelid, and ear are involved.

Symptoms

As we pointed above, hemangioma may be present at birth, but more often appears during the first several months of life. It starts out as a flat red mark anywhere on the body, most often on the face, scalp, chest or back. Usually a child has only one mark, but some children may have more than one, particularly if they’re part of a multiple birth.

During your child’s first year, the red mark grows rapidly and becomes a spongy mass that protrudes from the skin. The hemangioma then enters a rest phase and, eventually, it begins to slowly disappear.

Half of all hemangiomas resolve by age 5, and nearly all hemangiomas are resolved by age 10. Although the color of the birthmark also fades, faint — but permanent — discoloration of the skin or residual extra skin may remain.

The earliest sign of an infantile hemangioma is blanching of the involved skin. This may be followed by fine telangiectasias and then a red or crimson macule. Rarely, a shallow ulceration may be the first sign of an incipient infantile hemangioma.

Multiple hemangiomas in a single patient have been called ‘‘disseminated hemangiomatosis.’’ In these infants, the cutaneous lesions are usually tiny (<5 mm in diameter), firm, and dome-like. Any infant with five or more cutaneous tumors should be suspected to harbor visceral hemangiomas (most commonly in the liver, followed by the brain, gastro- intestinal tract, and lung) and screened by way of ultrasonography or MRI as indicated.

Complications

Occasionally, a hemangioma can break down and develop a sore. This can lead to pain, bleeding, scarring or infection.

Another complications include: ulceration, airway obstruction, visual obstruction.

Diffuse neonatal hemangiomatosis is a potentially life-threatening condition characterized by numerous cutaneous hemangiomas accompanied by visceral hemangiomas. When more than 10 cutaneous hemangiomas are present, the risk of visceral lesions rises. The liver and gastrointestinal tract are affected most often, although any organ can be involved. Congestive heart failure is a cause of early mortality because of increased vascular volume.

Kasabach-Merritt phenomenon (KMP) is marked by platelet sequestration and severe thrombocytopenia associated with a rapidly proliferating vascular neoplasm. This often is accompanied by a potentially fatal, generalized bleeding disorder. KMP is heralded by rapid enlargement, edema of the surrounding tissues, and accompanying purpura.

Patients with PHACE syndrome present with hemangiomas and one or more extracutaneous congenital anomalies. Reports have also described intracranial invasion of associated infantile hemangiomas. PHACE syndrome is an acronym denoting posterior fossa abnormalities (most characteristically Dandy-Walker malformation and other forms of brain hypoplasia), hemangiomas (cervicofacial, segmental/> 5 cm in diameter), arterial anomalies (especially carotid, cerebral, and vertebral), cardiac anomalies (especially coarctation of the aorta), eye abnormalities, and, rarely, midline ventral abnormalities (sternal clefting or supraumbilical raphe).

Segmental infantile hemangiomas involving the perineal area may be associated with other underlying congenital anomalies as delineated in the PELVIS or SACRAL syndromes. The acronymic PELVIS syndrome describes the association of a perineal hemangioma with any of the following: external genital malformations, lipomyelomeningocele, vesicorenal abnormalities, imperforate anus, or skin tag. SACRAL syndrome is spinal dysraphism with anogenital, cutaneous, renal, and urologic anomalies, associated with an angioma of lumbosacral localization.

Rarely, infantile hemangiomas have been implicated in cases of consumptive hypothyroidism. This was initially reported with hepatic hemangiomas; however, this has also been reported with bulky cutaneous infantile hemangiomas.

Psychosocial problems associated with disfiguring facial hemangiomas can be significant. During infancy and early childhood, parents often have reactions of loss and grief. Parental feelings of disbelief, panic, or fear often are associated with the rapid growth of these lesions. The variability in the natural course, in regard to timing and completeness of resolution, adds to parental anxiety. Parental stress is heightened by strangers who stare, startle, or raise questions about causality, such as trauma (especially implied or suspected child abuse), infection, or cancer. Psychosocial stigmatization can be problematic for both parents and patients with disfiguring facial hemangiomas. Lesions that result in significant facial or obvious disfigurement should be addressed before the child starts school.

Diagnosis

A hemangioma is diagnosed based on appearance. Diagnostic tests aren’t usually needed. Deeper vascular malformations can be diagnosed on MRI (magnetic resonance imaging).

MRI with and without intravenous gadolinium is the imaging modality of choice to delineate the location and extent of both cutaneous and extracutaneous hemangiomas. MRI also helps in differentiating other high-flow vascular lesions (eg, arteriovenous malformations vs proliferating hemangiomas). Involuting hemangiomas have features that resemble low-flow lesions (eg, venous malformations).

Ultrasonography is useful in differentiating hemangiomas from other deep dermal or subcutaneous structures, such as cysts or lymph nodes. Ultrasonography is generally limited by its inability to fully evaluate the magnitude and extent of the hemangioma.

Plain radiography is fairly limited but may be useful for evaluating hemangiomas that impinge on the airway.

Indications

The majority of hemangiomas never need any form of treatment.

If the growth interferes with your child’s vision or causes other problems, treatment options may include:

Corticosteroid medications. Corticosteroids can be injected into the nodule, given by mouth or applied to the skin. Side effects can include poor growth, high blood sugar, high blood pressure and cataracts.

Laser surgery. Lasers can stop the growth of a hemangioma. Sometimes lasers can be used to remove a hemangioma or treat sores on a hemangioma that won’t heal. Side effects include pain, infection, bleeding, scarring and changes in skin color.

Embolization treatment – a nonsurgical method of closing down the blood flow into the malformation, wich is done by interventional radiologists, who treat patients with image guided procedures.

Embolization is defined as the therapeutic introduction of various substances into the circulation to occlude vessels, either to arrest or prevent hemorrhaging; to devitalize a structure, tumor, or organ by occluding its blood supply; or to reduce blood flow to an arteriovenous malformation.

Procedure

Find out more details about this procedure directly from the most famous doctors!

Or
you can contact us!

Call Center
031 9300

The hemangiomas can be closed by advancing a tiny plastic tubing, no larger than a pencil point, into the feeding artery to the malformation. This can be done without incisions or stitches. Medical glue or alcohol or small beads are then floated into the malformation until it is full and no longer has blood flowing through it.

Agents for embolotherapy can be broadly divided into 2 groups: absorbable materials and nonabsorbable materials. The nonabsorbable materials can be further subdivided into particulate, liquid, sclerosing, and nonparticulate agents

In the treatment of vasoformative tumors, the resorbable materials are not particularly useful in the long term, except when they precede a surgical treatment and only short-term occlusion is required. They resorb over time, and the occluded vessel recanalizes, restoring flow to the occluded segment.

The procedure is performed in a special room ( cath lab) and it begins with diagnostic conventional angiography to fully characterize the hemagioma, followed by catheter-directed placement of embolic material into the feeding artery of this anomalie, until blood flow ceases.

Usually, it is done under general anesthesia. Thus, after local asepsy, a small inguinal incision is made. Through this incision, the physician will introduce a small narrow tube into the femoral artery, then through this tube a catheter will be introduced which will reach the supply artery, under fluoroscopic control (X ray control), and then, as we pointed above, these abnormal vessels are closed using various substances.

Is it painful?

No, usually, the intervention is performed under general anesthesia.

How long does it take?

The duration of the procedure is about 1 hour.

Risks

The complications are rare; the complications are reduced by the proper preparation and the continuous surveillance of the patient. Potential complications:

• allergic reactions to administered substances, including renal disfunction

• reactions to anesthetic compounds

• arteriovenous fistulas at the vascular puncture site

• minor bleeding at the vascular puncture site

• fever

• headache, migraine

• infection

• gaseous embolism

• temporofacial pain

• soft tissue necrosis has also been described as a complication, particularly when more than one vessel is occluded or when liquid embolic agents are used

• the most feared complications, however, are those in connection with the passage of embolic material into the intracranial arteries, which may result in stroke or blindness.

Before procedure

The preoperative assessment will establish if embolotherapy is the treatment of choice.

Prior to the intervention, the interventional radiologist must be prevented about any history of allergic reactions. Blood tests are taken including hemoglobin level, coagulation, renal function, and other specific tests.

The patient is admitted the day before the intervention, and he/she should not eat before the procedure.

After procedure

You will be connected to monitors that will constantly display your electrocardiogram (ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level. You will be given pain medication for incisional pain or you may have had an epidural during surgery which will help with postoperative pain.

Since the procedure is minimally invasive, the postprocedural recovery is usually very fast. The majority of patients can leave the hospital the following day. Indications about recovery and postprocedural treatment will be clearly specified to all patients.

Important!

Find out the cost for this procedure!

Or
you can contact us!

Call Center
031 9300

Hemangiomas are benign tumors that require no treatment in most patients. In rare patients, embolization may be necessary (particularly in patients in whom therapy is needed urgently) because of spontaneous hemorrhage or functional abnormality caused by the extreme size of the lesion or the particular anatomic location or because of significant congestive heart failure. In addition, embolotherapy is considered useful prior to surgical resection in select patients and in patients in whom a hemangioendothelioma causes Kasabach-Merritt phenomenon (platelet trapping).

Some tumors may require several sessions of embolotherapy because of revascularization of the tumor.

X

Sună Mesaj