Purpose: To describe the safety and efficacy of a new technique for treating vascular malformations.
Surgery remains a viable and durable treatment option for vascular malformations, however, it is associated with significant intra-operative blood loss, as well as morbidity, and recurrence due to incomplete resections. This is due to the fact that vascular malformations are comprised of blood vessels or vascular spaces, rather than defined solid masses. As a rule , vascular malformations are infiltrative within normal surrounding tissues and organs, cross anatomic planes freely, and are often quite extensive.
The POVAC technique comprises 'casting' of the malformation under ultrasound and angiographic guidane with a liquid embolic. This converts the malformation into a pseudo-solid lesion, and thus minimizes blood loss as well as provides the surgeon with a delineated palpable and radiographically visible lesion to excise.
Materials and Methods: 10 patients being followed in our vascular anomalies clinic underwent POVAC technique over a 2-year period.
Retrospective chart review was performed to assess imaging and clinical follow up.
Results: Follow up ranged from 1 month to 20 months.VA
All patients underwent technically successful POVAC and susequent operative resections. There were no major complications reported in the peri-operative over the follow up period. One minor complication of wound dehiscence after split thickness skin graft was reported at short-term follow up; this patient was then lost to follow up.
All patients report significant improvement in their subjective pain or cosmetic appearce at follow up. Lesion recurrence was not noted in any patients, however, residual lesion was seen in 4 patients (40%) at imaging or clinical follow up.
Conclusion: The POVAC technique appears to be a safe and effective treatment option for vascular malformations, and may convert previously inoperable patients into surgical candidates. Functional and cosmetic improvement is to be expected, however, residual lesion due to incomplete resections is common.
