Case report
Acquired Digital Arteriovenous Malformations: Laser Treatment Of An Uncommon Vascular Abnormality
Malformaciones arteriovenosas digitales adquiridas. Una anomalía vascular infrecuente tratada con láser
Read
8614
Timeswas read the article
2464
Total PDF
6150
Total HTML
Share statistics
array:24 [ "pii" => "S1578219014001243" "issn" => "15782190" "doi" => "10.1016/j.adengl.2014.04.018" "estado" => "S300" "fechaPublicacion" => "2014-06-01" "aid" => "968" "copyright" => "Elsevier España, S.L. and AEDV" "copyrightAnyo" => "2013" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2014;105:e33-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2970 "formatos" => array:3 [ "EPUB" => 45 "HTML" => 2224 "PDF" => 701 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731014000441" "issn" => "00017310" "doi" => "10.1016/j.ad.2013.12.019" "estado" => "S300" "fechaPublicacion" => "2014-06-01" "aid" => "968" "copyright" => "Elsevier España, S.L. y AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2014;105:e33-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3594 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 2476 "PDF" => 1116 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">e-Casos clínicos</span>" "titulo" => "Malformaciones arteriovenosas digitales adquiridas. Una anomalía vascular infrecuente tratada con láser" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e33" "paginaFinal" => "e37" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Acquired Digital Arteriovenous Malformations: Laser Treatment Of An Uncommon Vascular Abnormality" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 813 "Ancho" => 2333 "Tamanyo" => 225061 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A. Paciente número 3 con malformación arteriovenosa digital adquirida dolorosa y sangrante localizada en la región palmar del 2.° dedo de la mano derecha. B. Resolución parcial tras 3 sesiones de tratamiento. Durante el seguimiento se apreció recidiva de los vasos, pero no de la sintomatología, por lo que se descartó una nueva sesión.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Lapresta, E. Hermosa, P. Boixeda, R. Carrillo-Gijón" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Lapresta" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Hermosa" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Boixeda" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Carrillo-Gijón" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219014001243" "doi" => "10.1016/j.adengl.2014.04.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014001243?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731014000441?idApp=UINPBA000044" "url" => "/00017310/0000010500000005/v1_201405270041/S0001731014000441/v1_201405270041/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219014001218" "issn" => "15782190" "doi" => "10.1016/j.adengl.2014.04.015" "estado" => "S300" "fechaPublicacion" => "2014-06-01" "aid" => "915" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2014;105:515-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2290 "formatos" => array:3 [ "EPUB" => 43 "HTML" => 1308 "PDF" => 939 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Ulcer on the Scrotum" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "515" "paginaFinal" => "516" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Úlcera en el escroto" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1287 "Ancho" => 1669 "Tamanyo" => 319596 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.C. Arango-Duque, S. Blanco-Barrios, E. Fernández-López" "autores" => array:3 [ 0 => array:2 [ "nombre" => "L.C." "apellidos" => "Arango-Duque" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Blanco-Barrios" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Fernández-López" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101300375X" "doi" => "10.1016/j.ad.2013.10.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101300375X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014001218?idApp=UINPBA000044" "url" => "/15782190/0000010500000005/v1_201405281018/S1578219014001218/v1_201405281018/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219014001164" "issn" => "15782190" "doi" => "10.1016/j.adengl.2014.04.010" "estado" => "S300" "fechaPublicacion" => "2014-06-01" "aid" => "910" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2014;105:510-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2083 "formatos" => array:3 [ "EPUB" => 43 "HTML" => 1531 "PDF" => 509 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Camouflage Therapy Workshop for Pediatric Dermatology Patients: A Review of 6 Cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "510" "paginaFinal" => "514" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Taller de camuflaje terapéutico en dermatología pediátrica: revisión de 6 casos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1227 "Ancho" => 1301 "Tamanyo" => 223388 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A and B. Acne scars before and after the camouflage session. C and D. Segmental vitiligo before and after the camouflage session.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Padilla-España, J. del Boz, M.B. Ramírez-López, M.E. Fernández-Sánchez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Padilla-España" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "del Boz" ] 2 => array:2 [ "nombre" => "M.B." "apellidos" => "Ramírez-López" ] 3 => array:2 [ "nombre" => "M.E." "apellidos" => "Fernández-Sánchez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731013003700" "doi" => "10.1016/j.ad.2013.10.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013003700?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014001164?idApp=UINPBA000044" "url" => "/15782190/0000010500000005/v1_201405281018/S1578219014001164/v1_201405281018/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Acquired Digital Arteriovenous Malformations: Laser Treatment Of An Uncommon Vascular Abnormality" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e33" "paginaFinal" => "e37" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Lapresta, E. Hermosa, P. Boixeda, R. Carrillo-Gijón" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Lapresta" "email" => array:1 [ 0 => "amlapresta@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Hermosa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "P." "apellidos" => "Boixeda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "Carrillo-Gijón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital San Rafael, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Ramón y Cajal, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Ramón y Cajal, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Malformaciones arteriovenosas digitales adquiridas. Una anomalía vascular infrecuente tratada con láser" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1212 "Ancho" => 2169 "Tamanyo" => 268405 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A, Patient number 6 had a painful acquired digital arteriovenous malformation located close to the lateral periungual fold. B, significant improvement was achieved without scarring or nail deformity after 1 laser session.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Acquired digital arteriovenous malformation (AVM) is a rare vascular anomaly that usually affects acral areas of the body, in particular the fingers. The lesions are complex and composed of multiple interconnected medium- or large-caliber arteries and veins lacking any intervening capillary bed. Although these lesions are not tumors, neither are they entirely benign since they can grow and invade adjacent tissue causing necrosis and bone resorption, inhibiting blood flow, and even leading to amputation of the affected region.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although in most cases they appear spontaneously, these AVM have also been reported in association with trauma, inflammation, and surgery.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Treatment of these lesions often requires complete excision followed by reconstruction with flaps or grafts. However, in recent years some authors have reported cases treated successfully with laser therapy.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> We present a series of 6 patients, 5 of whom were treated with laser therapy and 1 with surgery.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case Report</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Patients and Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We present the cases of 6 patients who were referred to the dermatology department of Hospital Ramón y Cajal between 2010 and 2012. The patient characteristics are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">All the patients complained of severe bleeding after minor trauma, and 2 of them also reported intense pain that limited their daily activities.</p><p id="par0030" class="elsevierStylePara elsevierViewall">On palpation, the lesions were firm and the temperature was raised locally. Only one patient presented a pulsatile lesion. Diascopy revealed incomplete emptying of the lesions, followed by rapid reengorgement. Physical examination revealed reticular arboriform erythematous-violaceous macular plaques with a longest diameter of between 1 and 3<span class="elsevierStyleHsp" style=""></span>cm and a slightly keratotic surface. Dermoscopy revealed various vascular patterns: blue-red nodules, red ovoid patches, vascular dots, and tortuous vessels of diverse calibers radiating from a central nest.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Two of the patients provided samples from biopsies performed at other centers. Histologic study of these samples revealed a neoformation in the superficial dermis composed of thin-walled and thick-walled vascular structures lined with an endothelium without atypia and separated by loose connective tissue with a moderate number of cells.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The radiographs supplied by the patients were normal in all 6 cases, providing no evidence of bone involvement.</p><p id="par0045" class="elsevierStylePara elsevierViewall">All the patients underwent a 20<span class="elsevierStyleHsp" style=""></span>Mhz Doppler ultrasound study, which revealed well-defined hyperechoic lesions located in the superficial dermis. There was no evidence in any of the cases of involvement of adjacent tissue. Direct communications between large-caliber arteries and veins was observed. All the lesions had arterial and venous waveforms except for the pulsatile lesion in one patient, which was predominantly high-flow.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The lesions of 5 of these patients were stage <span class="elsevierStyleSmallCaps">i</span> and in the sixth the pulsatile lesion was stage <span class="elsevierStyleSmallCaps">ii</span> according to Schöbinger's classification of AVM (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">On the basis of the clinical and exploratory findings we could reasonably rule out any involvement of bone or soft tissue and decided that further tests, for instance magnetic resonance imaging, were unnecessary.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">The patients with stage <span class="elsevierStyleSmallCaps">i</span> lesions received laser treatment, which involved the application of pulsed dye laser at 595<span class="elsevierStyleHsp" style=""></span>nm followed by long pulse Nd:YAG at 1064<span class="elsevierStyleHsp" style=""></span>nm (Cynergy with Multiplex, Cynosure). A continuous flow of cold air was applied during treatment (Cryo5, Zimmer MedizinSystems GmbH) using the maximum level provided by the device.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The patient whose lesion was classified as stage <span class="elsevierStyleSmallCaps">ii</span> was referred to another hospital for surgery. The stage <span class="elsevierStyleSmallCaps">ii</span> lesion was complex and laser treatment would have entailed a high risk of bleeding and complications and the prospect of an acceptable response to laser treatment was poor. The stage <span class="elsevierStyleSmallCaps">ii</span>lesion was excised without significant complications and Doppler ultrasound follow-up a few months later showed no signs of recurrence.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Four of the patients treated with laser responded satisfactorily after 1 session (pain, bleeding, and functional limitation were reduced). In one case the lesion worsened after the first session and 2 more sessions were required to obtain optimal results.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The patients who received laser treatment were followed up for between 15 and 36 months after treatment. Three of them showed no signs of relapse; however, residual vessels were detected in the other 2 and confirmed by Doppler ultrasound in 1 patient. As the new lesions were asymptomatic it was decided that further laser treatment was not necessary, although these cases are being closely monitored.</p><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> summarizes the doses used, the improvement and satisfaction achieved, and the duration of follow-up for each patient.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#fig0005">Figures 1–3</a> show some of the lesions before and after treatment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">Acquired digital AVM are rare vascular anomalies.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–10</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The term <span class="elsevierStyleItalic">acquired digital AVM</span> was first used in 1997 by McCulley,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> who reported the presence of a pulsatile purpuric mass on the finger of a pregnant woman. Histologic examination showed a vascular lesion with large-caliber arteries and veins and small endothelial spaces.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The pathogenesis of these AVM is poorly understood. Even though no history of trauma is reported in most of the cases described in the literature, we partly share the view of Yang and O’Hara<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> that the appearance of these lesions in acral zones suggests that the trigger may be small unnoticed traumas and that other factors must predispose certain patients to the development of these abnormal arteriovenous connections.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Although histologic examination may be useful, it is not indispensable and obtaining a sample for study may entail risks.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Doppler ultrasound, however, should be used in all patients with a suspected AVM.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> This noninvasive technique can be used to delimit the lesion anatomically and to demonstrate the presence of arterial and venous flow. Ultrasound, clinical, and dermoscopic findings in conjunction with careful examination will provide sufficient evidence to make an accurate diagnosis. Although none of the authors in the literature we reviewed staged the lesions according to Schöbinger's classification for AVM, in our opinion staging is important in this setting because it influences both prognosis and choice of treatment.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The differential diagnosis of these lesions should be primarily with glomus tumor (a very painful benign vascular tumor arising from glomus bodies and found primarily in acral sites) and pyogenic granuloma (a fast-growing vascular lesion that bleeds easily). In the cases presented here, both these possible diagnoses were reasonably ruled out by the duration of the lesions and the findings of explorations, in particular the presence of arterial and venous waveforms in the Doppler ultrasound.</p><p id="par0120" class="elsevierStylePara elsevierViewall">We found surgery to be the treatment chosen by most authors.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,8–10</span></a> In 2007, Bekhor et al<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> described the first 2 patients with acquired digital AVM treated with Nd:YAG laser and reported a reduction in the lesions of over 90%, which was sustained over the following months.</p><p id="par0125" class="elsevierStylePara elsevierViewall">In the 6 cases reported here, we chose laser treatment for stage <span class="elsevierStyleSmallCaps">i</span> lesions because they were in the embolization phase and surgery was not indicated. Moreover embolization in acral areas is not without complications because it can increase the risk of necrosis, and surgery in these areas requires very complex reconstructions that can affect the functionality of the digit.</p><p id="par0130" class="elsevierStylePara elsevierViewall">We decided to treat the lesions using a Multiplex laser system because a more superficial laser, such as a pulsed dye laser, and insufficient doses would not treat the deepest part of the lesion and might, in fact, trigger progression of the malformation. Nd:YAG laser alone can be effective, as Bekhor et al. have shown, but high fluences are required for optimal results and these increase the risk of complications.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">With Multiplex laser it was possible to act on localized structures at different skin depths. The system emits pulsed dye laser with a penetration of 1<span class="elsevierStyleHsp" style=""></span>mm that targets the more superficial structures followed by Nd:YAG with a penetration depth of 5 to 6<span class="elsevierStyleHsp" style=""></span>mm. The pulsed dye laser converts oxyhemoglobin to methemoglobin, which increases absorption of the Nd:YAG laser, making possible the use of lower fluences, thereby reducing potential side effects such as necrosis and atrophic scars and, in the case of our patients, nail dystrophy. Although this is a novel laser system, it has already been shown to be effective in the management of resistant port wine stains,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> venous malformations,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and residual infantile hemangiomas.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The chief complications associated with laser treatment are, on the one hand, pain and bleeding during the application of treatment, and on the other, the possibility of leaving residual vessels that may trigger renewed growth of the lesion. If residual vessels are detected, the patient should be closely monitored, and a lesion that progresses should be treated by surgery or embolization.</p><p id="par0140" class="elsevierStylePara elsevierViewall">For lesions classified as stage <span class="elsevierStyleSmallCaps">i</span> using Schöbinger's criteria, laser treatment was shown to be a safe and effective alternative in this series. Tolerance was good and recurrence was low. However, accurate diagnosis and staging and correct selection of lesions is essential to avoid possible risks and complications.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Ethical Disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Protection of human and animal subjects</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Confidentiality of data</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their hospitals concerning the publication of patient data and that all patients included in this study were appropriately informed and gave their written informed consent.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Right to privacy and informed consent</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data are disclosed in this article.</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflicts of Interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres342723" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec324339" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres342722" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec324338" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Case Report" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients and Methods" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0030" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec324339" "palabras" => array:3 [ 0 => "Arteriovenous malformations" 1 => "Laser" 2 => "Echo-doppler" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec324338" "palabras" => array:3 [ 0 => "Malformaciones arteriovenosas" 1 => "Láser" 2 => "Eco-doppler" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Acquired digital arteriovenous malformations (ADAVM) are uncommon acral vascular lesions most often affecting the finger. Treatment usually requires complete excision of the lesion with complex advancement flap or skin graft reconstruction. However, in recent years, some authors have reported satisfactory outcomes with laser treatment. We describe a series of 6 patients with ADAVM, 5 of whom received laser treatment and obtained a good response. The other patient was treated surgically. After an in-depth review of this type of lesion, we conclude that laser treatment is a safe and effective alternative for these malformations, provided the patients are appropriately diagnosed and have Schöbinger stage <span class="elsevierStyleSmallCaps">i</span> lesions.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Las malformaciones arteriovenosas digitales adquiridas (MAVDA) son lesiones vasculares infrecuentes, habitualmente localizadas en zonas acrales, principalmente en los dedos de las manos. Su tratamiento a menudo requiere la extirpación completa de la lesión, requiriendo reconstrucciones complejas como colgajos o injertos. Sin embargo, en los últimos años se han comunicado algunos casos tratados satisfactoriamente con láser. Nosotros aportamos una serie de 6 pacientes con MAVDA, 5 de ellos tratados con láser con buena respuesta, y otro paciente tratado quirúrgicamente. En este trabajo hacemos una revisión exhaustiva de este tipo de lesiones y concluimos que la terapia láser es una alternativa terapéutica segura y efectiva para estas malformaciones, siempre y cuando los pacientes sean diagnosticados correctamente y se encuentren en estadio <span class="elsevierStyleSmallCaps">i</span> de Schöbinger.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as: Lapresta A, Hermosa E, Boixeda P, Carrillo-Gijón R. Malformaciones arteriovenosas digitales adquiridas. Una anomalía vascular infrecuente tratada con láser. Actas Dermosifiliogr. 2014;105:e33–e37.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 813 "Ancho" => 2334 "Tamanyo" => 229769 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Patient 3 had a bleeding and painful acquired digital arteriovenous malformation on the palmar surface of the 2nd finger of the right hand. B, Partial resolution after 3 treatment sessions. Recurrence of the vessels was observed on follow-up, but as the lesion remained asymptomatic, no more treatment was applied.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 958 "Ancho" => 2336 "Tamanyo" => 256802 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A, Patient number 4 had an intensely painful acquired digital arteriovenous malformation located in the hypothenar region, which was treated with a single session of laser therapy. B, Significant improvement in morphological appearance and no symptoms 2 years after treatment.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1212 "Ancho" => 2169 "Tamanyo" => 268405 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A, Patient number 6 had a painful acquired digital arteriovenous malformation located close to the lateral periungual fold. B, significant improvement was achieved without scarring or nail deformity after 1 laser session.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Age, y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Phototype \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Site \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Largest diameter, cm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Schöbinger classification \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Duration of disease, y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Prior trauma \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Woman \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Finger \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Man \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2-3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Finger \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Man \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Finger \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Man \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand (hypothenar eminence) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Woman \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Finger \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Woman \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Finger \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab508542.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Clinical Characteristics of the Patients.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pink-bluish macule. Arteriovenous shunting revealed by Doppler scanning. Typically asymptomatic and appears between birth and adolescence. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The description is the same as stage <span class="elsevierStyleSmallCaps">I,</span>but the lesion is pulsatile and there is clinical evidence of tense/tortuous vessels at puberty \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Same as stage <span class="elsevierStyleSmallCaps">II</span>, but with the addition of dystrophic skin changes, ulceration, bleeding, persistent pain, and possibly even necrosis and lytic bone lesions. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Same as stage <span class="elsevierStyleSmallCaps">III,</span> but with the addition of heart failure \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab508543.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Schöbinger Classification.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">No. of Sessions<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Improvement (% Clearing)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Satisfaction (Scale 1-10)<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Follow-up, mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Relapse/response to additional session \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1, Multiplex (10-10-7 →15-85) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1, Multiplex (7-10-8 →15-100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3, Multiplex (7-10-8 →15-60, 7-10-10 →15-80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Partial/no further treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1, Multiplex (7-10-10 →15-70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Partial/no further treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1, Multiplex (7-10-8→15-80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab508544.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Multiplex laser (PDL spot [mm]-pulse [msec]-fluence [J/cm<span class="elsevierStyleSup">2</span>]→delay 1 sec→Nd-YAG Pulse [msec]-fluence [J/cm<span class="elsevierStyleSup">2</span>])</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Percentage of clearing was expressed as follows: 1<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0%-25%; 2<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>26%-50%; 3<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>51%-75%; 4<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>76%-100%</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">0<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>not at all satisfied and 10<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>very satisfied.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Results of Treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired digital arteriovenous malformation: A report of three cases and study with epiluminescence microscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.H. Yang" 1 => "K. Ohara" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2002" "volumen" => "147" "paginaInicial" => "1007" "paginaFinal" => "1011" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12410716" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired digital arteriovenous malformation: Ultrasound imaging and response to long-pulsed neodymium:yttrium-aluminum-garnet treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.S. Bekhor" 1 => "M.R. Ditchfield" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2006.05.043" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2007" "volumen" => "56" "paginaInicial" => "S122" "paginaFinal" => "S124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17434039" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous digital arteriovenous malformation in a 28-year-old pregnant female" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Mcculley" 1 => "L. Fourie" 2 => "S.M. Hull" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1997" "volumen" => "136" "paginaInicial" => "472" "paginaFinal" => "473" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9115945" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired digital arteriovenous malformation: Clinical, dermoscopy, ultrasound and histological study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Cuesta Montero" 1 => "P. Soro" 2 => "J. Bañuls" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1684/ejd.2011.1570" "Revista" => array:6 [ "tituloSerie" => "Eur J Dermatol" "fecha" => "2012" "volumen" => "22" "paginaInicial" => "138" "paginaFinal" => "139" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21983140" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Digital arteriovenous malformation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.Y. Yoon" 1 => "S.H. Cho" 2 => "J.D. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/00015550510011529" "Revista" => array:6 [ "tituloSerie" => "Acta Derm Venereol" "fecha" => "2006" "volumen" => "86" "paginaInicial" => "82" "paginaFinal" => "83" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16586004" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arteriovenous malformations of the head and neck: Natural history and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.P. Kohout" 1 => "M. Hansen" 2 => "J.J. Pribaz" 3 => "J.B. Mulliken" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Plast Reconstr Surg" "fecha" => "1998" "volumen" => "102" "paginaInicial" => "643" "paginaFinal" => "654" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9727427" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malformaciones vasculares (I). Concepto, clasificación, fisiopatogenia y manifestaciones clínicas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Redondo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2007" "volumen" => "98" "paginaInicial" => "141" "paginaFinal" => "158" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17504698" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous keratotic hemangioma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I.A. Niechajev" 1 => "N.H. Sternby" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Plast Reconstr Surg" "fecha" => "1983" "volumen" => "17" "paginaInicial" => "153" "paginaFinal" => "154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6658388" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired digital arteriovenous malformation: A report of six cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Kadono" 1 => "A. Kishi" 2 => "Y. Onishi" 3 => "K. Ohara" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2000" "volumen" => "142" "paginaInicial" => "362" "paginaFinal" => "365" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10730776" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravascular pyogenic granuloma arising in an acquired arteriovenous malformation: Report of a case and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.H. Hung" 1 => "H.W. Kuo" 2 => "Y.K. Chiu" 3 => "P.H. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.2004.30316.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2004" "volumen" => "30" "paginaInicial" => "1050" "paginaFinal" => "1053" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15209800" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of resistant port-wine stains with a pulsed dual wavelength 595 and 1064<span class="elsevierStyleHsp" style=""></span>nm laser: A histochemical evaluation of the vessel wall destruction and selectivity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Borges da Costa" 1 => "P. Boixeda" 2 => "C. Moreno" 3 => "J. Santiago" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/pho.2008.2356" "Revista" => array:6 [ "tituloSerie" => "Photomed Laser Surg" "fecha" => "2009" "volumen" => "27" "paginaInicial" => "599" "paginaFinal" => "605" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19558312" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Venous malformations treated with dual wavelength 595 and 1064<span class="elsevierStyleHsp" style=""></span>nm laser system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Alcántara-González" 1 => "P. Boixeda" 2 => "B. Pérez-García" 3 => "M.T. Truchuelo-Díez" 4 => "P. González-Muñoz" 5 => "P. Jaén-Olasolo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2012.04548.x" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2013" "volumen" => "27" "paginaInicial" => "727" "paginaFinal" => "733" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22540234" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemangiomas infantiles tratados con aplicación secuencial de láser de colorante pulsado y Nd:YAG: estudio retrospectivo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Alcántara-González" 1 => "P. Boixeda" 2 => "M.T. Truchuelo-Díez" 3 => "B. Pérez-García" 4 => "L. Alonso-Castro" 5 => "P. Jaén Olasolo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2012.12.010" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2013" "volumen" => "104" "paginaInicial" => "504" "paginaFinal" => "511" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23522740" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010500000005/v1_201405281018/S1578219014001243/v1_201405281018/en/main.assets" "Apartado" => array:4 [ "identificador" => "6156" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010500000005/v1_201405281018/S1578219014001243/v1_201405281018/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014001243?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 15 | 18 | 33 |
| 2024 October | 103 | 51 | 154 |
| 2024 September | 100 | 37 | 137 |
| 2024 August | 133 | 54 | 187 |
| 2024 July | 132 | 40 | 172 |
| 2024 June | 127 | 36 | 163 |
| 2024 May | 125 | 37 | 162 |
| 2024 April | 99 | 32 | 131 |
| 2024 March | 103 | 46 | 149 |
| 2024 February | 86 | 35 | 121 |
| 2024 January | 86 | 34 | 120 |
| 2023 December | 87 | 13 | 100 |
| 2023 November | 95 | 30 | 125 |
| 2023 October | 79 | 31 | 110 |
| 2023 September | 71 | 30 | 101 |
| 2023 August | 54 | 15 | 69 |
| 2023 July | 94 | 32 | 126 |
| 2023 June | 62 | 25 | 87 |
| 2023 May | 76 | 28 | 104 |
| 2023 April | 76 | 24 | 100 |
| 2023 March | 87 | 22 | 109 |
| 2023 February | 72 | 18 | 90 |
| 2023 January | 38 | 35 | 73 |
| 2022 December | 63 | 39 | 102 |
| 2022 November | 32 | 37 | 69 |
| 2022 October | 31 | 27 | 58 |
| 2022 September | 16 | 38 | 54 |
| 2022 August | 27 | 31 | 58 |
| 2022 July | 35 | 42 | 77 |
| 2022 June | 25 | 22 | 47 |
| 2022 May | 98 | 43 | 141 |
| 2022 April | 126 | 21 | 147 |
| 2022 March | 74 | 59 | 133 |
| 2022 February | 81 | 30 | 111 |
| 2022 January | 92 | 50 | 142 |
| 2021 December | 63 | 48 | 111 |
| 2021 November | 66 | 55 | 121 |
| 2021 October | 70 | 66 | 136 |
| 2021 September | 51 | 53 | 104 |
| 2021 August | 96 | 32 | 128 |
| 2021 July | 77 | 30 | 107 |
| 2021 June | 72 | 47 | 119 |
| 2021 May | 57 | 45 | 102 |
| 2021 April | 95 | 36 | 131 |
| 2021 March | 85 | 20 | 105 |
| 2021 February | 64 | 18 | 82 |
| 2021 January | 65 | 9 | 74 |
| 2020 December | 38 | 11 | 49 |
| 2020 November | 42 | 13 | 55 |
| 2020 October | 40 | 9 | 49 |
| 2020 September | 49 | 8 | 57 |
| 2020 August | 27 | 18 | 45 |
| 2020 July | 20 | 18 | 38 |
| 2020 June | 49 | 19 | 68 |
| 2020 May | 28 | 14 | 42 |
| 2020 April | 34 | 16 | 50 |
| 2020 March | 36 | 15 | 51 |
| 2020 February | 7 | 1 | 8 |
| 2020 January | 2 | 0 | 2 |
| 2019 December | 8 | 5 | 13 |
| 2019 November | 2 | 6 | 8 |
| 2019 October | 0 | 8 | 8 |
| 2019 September | 8 | 9 | 17 |
| 2019 August | 4 | 6 | 10 |
| 2019 July | 4 | 10 | 14 |
| 2019 June | 6 | 24 | 30 |
| 2019 May | 6 | 27 | 33 |
| 2019 April | 2 | 26 | 28 |
| 2019 March | 2 | 6 | 8 |
| 2019 February | 4 | 4 | 8 |
| 2019 January | 1 | 2 | 3 |
| 2018 December | 2 | 6 | 8 |
| 2018 November | 2 | 3 | 5 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 4 | 0 | 4 |
| 2018 August | 0 | 9 | 9 |
| 2018 July | 0 | 2 | 2 |
| 2018 June | 0 | 13 | 13 |
| 2018 May | 0 | 12 | 12 |
| 2018 April | 0 | 1 | 1 |
| 2018 March | 3 | 4 | 7 |
| 2018 February | 75 | 5 | 80 |
| 2018 January | 75 | 9 | 84 |
| 2017 December | 80 | 11 | 91 |
| 2017 November | 40 | 7 | 47 |
| 2017 October | 92 | 9 | 101 |
| 2017 September | 58 | 23 | 81 |
| 2017 August | 62 | 21 | 83 |
| 2017 July | 62 | 21 | 83 |
| 2017 June | 61 | 44 | 105 |
| 2017 May | 62 | 18 | 80 |
| 2017 April | 53 | 11 | 64 |
| 2017 March | 41 | 16 | 57 |
| 2017 February | 82 | 14 | 96 |
| 2017 January | 49 | 26 | 75 |
| 2016 December | 62 | 18 | 80 |
| 2016 November | 103 | 27 | 130 |
| 2016 October | 125 | 30 | 155 |
| 2016 September | 202 | 28 | 230 |
| 2016 August | 153 | 27 | 180 |
| 2016 July | 55 | 17 | 72 |
| 2016 June | 11 | 14 | 25 |
| 2016 May | 3 | 4 | 7 |
| 2016 April | 4 | 4 | 8 |
| 2016 March | 3 | 9 | 12 |
| 2016 February | 8 | 14 | 22 |
| 2016 January | 11 | 1 | 12 |
| 2015 December | 8 | 7 | 15 |
| 2015 November | 7 | 12 | 19 |
| 2015 October | 9 | 1 | 10 |
| 2015 September | 5 | 3 | 8 |
| 2015 August | 12 | 1 | 13 |
| 2015 July | 68 | 10 | 78 |
| 2015 June | 52 | 2 | 54 |
| 2015 May | 65 | 5 | 70 |
| 2015 April | 35 | 7 | 42 |
| 2015 March | 39 | 8 | 47 |
| 2015 February | 36 | 7 | 43 |
| 2015 January | 26 | 3 | 29 |
| 2014 December | 36 | 4 | 40 |
| 2014 November | 22 | 3 | 25 |
| 2014 October | 34 | 1 | 35 |
| 2014 September | 23 | 5 | 28 |
| 2014 August | 22 | 3 | 25 |
| 2014 July | 16 | 3 | 19 |
| 2014 June | 6 | 4 | 10 |
| 2014 May | 2 | 1 | 3 |
Show all
