Combined glue embolization and surgical excision for management of genitourinary and perineal vascular anomalies in pediatric and adolescent patients assigned female at birth.
This retrospective case series reports symptomatic improvement without observed recurrence in five pediatric and young-adult patients with genitourinary-perineal vascular anomalies treated with n-BCA glue embolization followed within one day by surgical excision, with one pulmonary glue thromboembolism and one wound separation.
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This retrospective case series reports symptomatic improvement without observed recurrence in five pediatric and young-adult patients with genitourinary-perineal vascular anomalies treated with n-BCA glue embolization followed within one day by surgical excision, with one pulmonary glue thromboembolism and one wound separation.
Research significance
The reported cases support the preliminary observation that targeted preoperative n-BCA embolization followed by prompt excision may enable treatment of selected genitourinary-perineal vascular malformations with low operative blood loss and symptom improvement; whether it reduces bleeding, recurrence, or morbidity versus surgery, embolization, or sclerotherapy alone remains an untested inference requiring larger comparative studies and longer follow-up.
Source abstract
STUDY OBJECTIVE: Vascular anomalies (VA) are tumors and malformations of blood vessels that may involve the genitourinary-perineal (GUP) region, causing pain, debility or aesthetic concerns. N-butyl-2 cyanoacrylate (n-BCA) glue embolization followed by surgical excision is an innovative management option for vascular malformations. This case series reviews clinical outcomes of this approach for GUP-VA. METHODS: Female patients with GUP-VA who underwent glue embolization followed by surgical excision were identified from a tertiary children's hospital from 1998-2024. Demographics, operative procedure(s), complications, prior and subsequent treatment history were collected. RESULTS: Five female patients underwent glue embolization and excision (mean age 12.6 years, range 3-22). Four patients had congenital vulvar arteriovenous or venous malformations; one had a perineal venous malformation noted after saddle injury. Indications were swelling (100%), pain (40%) and bleeding (20%). Two patients had prior therapies: sclerotherapy (n=2) and prior surgical excision with recurrence (n=1). Targeted embolization was performed with 1:3 or 1:4 n-BCA glue in ethiodized oil and excision performed within one day. Procedures were successful in all patients: all had symptomatic improvement and none experienced recurrence. One had nontarget glue thromboembolism to a segmental pulmonary artery treated by suction thrombectomy without clinical sequela. One patient had wound separation healed by secondary intention. Mean and median surgical blood loss volumes were 46 and 50 mL (0-100 mL). Mean and median follow-up duration were 12.6 and three months (range 1-37 months). CONCLUSIONS: Glue embolization and excision is safe and effective for pediatric and adolescent patients with GUP-VA.