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Vascular system

  ORBITAL  VASCULAR  MALFORMATIONS  Two major types of superficial vascular abnormalities are hemangiomas and vascular malformations . Hemangiomas are benign vascular endothelial tumors in children and  are characterized by phases of growth due to proliferation of endothelial cells and phases of involution with spontaneous slow regression.   Vascular malformations are composed of dysplastic vessels with a normal endothelial turnover.  They may be slow flow (Capillary / venous / lymphatic malformations) and high flow (arteriovenous malformations).   HEMANGIOMAS 80% of them regress spontaneously. USG and MRI are useful non invasive imaging modalities to see the extent of the tumor and associated lesions.Angiography is performed only when embolization is indicated.The sole indication for more aggressive therapy is a large extending tumor that has failed medical treatment ( corticosteroid and interferon).  They can cause compression of adjacent structures, (like eye, nose etc) and can cause heart failure and hemorrhage.  Embolization can be done with occlusion of capillary tumor with micro particles after selective catheterization. VASCULAR FORMATIONS: It is diagnosed clinically: MRI is the examination of choice to determine the location and extent of the lesion.  Angiogram is not needed for diagnosis. Three main criterias for the treatment  are cosmetic abnormalities, functional impairment and social intolerance. The treatment needs multi disciplinary approach including dermatologist, plastic surgeon , vascular surgeon and interventional radiologist. Venous malformations can be treated using sclerosing agents like ethibloc, alcohol or even coils or n butyl 2-cyano acrylate.Multiple sessions may be needed. Arteriovenous malformations need angiography as a gold standard for diagnosis and to study the angioarchitecture well. These can be treated with embolization using liquid embolic agents like N-butyl-2 cyanoacrylate or alcohol.  For complete cure, surgery might be needed after embolization  for resection of the lesion. 

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