Información del artículo
Abstract
Diagnosis of vascular malformations is essentially clinical, based on the evolution and morphology of lesions. A biopsy is rarely needed to evaluate the nature of the vessels. Imaging examinations are necessary to assess the extension of malformations as well as the osteomuscular and visceral compromise. New techniques such as 3D angio-CT scan and angio-MRI improve the diagnosis of some vascular malformations, especially the large combined ones such as Klippel-Trénaunay syndrome, thus limiting the need for invasive procedures. On the other hand, the advances in laser technology, particularly pulsed dye laser for port-wine stains and Nd:YAG laser for superficial venous malformations constitute new alternatives for the management of these patients. Other emergent treatments include microfoam sclerotherapy for venous and combined, slow-flow malformations, and new embolizing materials associated to surgery for arteriovenous malformations. The second part of this review is focused on the complementary diagnosis (imaging exams, pathology and accessory tests) and multidisciplinary and specific treatment based on the different groups.
Key words:
angio-CT scan
angio-MRI
pulsed dye laser
microfoam sclerotherapy
embolization
surgery
Resumen
El diagnóstico de las malformaciones vasculares es fundamentalmente clínico, y está basado en la evolución y morfología de las lesiones, siendo necesaria en muy raras ocasiones la realización de una biopsia para valorar histológicamente la naturaleza de los vasos. Para delimitar la extensión de las malformaciones, así como el compromiso músculo-esquelético y visceral, son necesarias las pruebas de imagen. La incorporación de nuevas técnicas como la angio-tomografía computarizada (TC) o la angio-resonancia magnética (RM) en 3D agilizan el diagnóstico de algunas malformaciones vasculares, especialmente las combinadas extensas tipo síndrome de Klippel-Trenaunay, limitando la necesidad de procedimientos invasivos. Por otra parte, los avances en tecnología láser, concretamente el láser de colorante pulsado para la mancha en vino de Oporto y el láser de Nd:YAG para las malformaciones venosas superficiales, la escleroterapia con microespuma en las malformaciones venosas y combinadas de bajo flujo, y los nuevos materiales embolizantes asociados con la cirugía en malformaciones arteriovenosas, son terapias emergentes para el seguimiento de los pacientes. La segunda parte de esta revisión está enfocada al diagnóstico complementario (pruebas de imagen, histología y pruebas accesorias) y al tratamiento multidisciplinar y específico según los diferentes grupos.
Palabras clave:
angio-TC
angio-RM
láser de colorante pulsado
esclerosante en microespuma
embolización
cirugía
El Texto completo está disponible en PDF
References
[1.]
J.B. Mulliken, J. Glowacki.
Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics.
Plast Reconstr Surg, 69 (1982), pp. 412
[2.]
J.L. Hand, I.J. Frieden.
Vascular Birthmarks of infancy: resolving nosologic confusion.
Am J Med Genet, 108 (2002), pp. 257-264
[3.]
M.C. Finn, J. Glowacki, J.B. Mulliken.
Congenital vascular lesions: clinical application of a new classification.
J Pediatr Surg, 18 (1983), pp. 894
[5.]
P.E. Burrows, J.B. Mulliken, K.E. Fellows, R.D. Strand.
Childhood hemangiomas and vascular malformations: angiographic differentiation.
Am J Roentgenol, 141 (1983), pp. 483-488
[6.]
J. Bliznak, T.W. Staple.
Radiology of angiodysplasias of the limb.
Radiology, 110 (1974), pp. 35-44
[8.]
K.D. Hein, J.B. Mulliken, H.P. Kozakewich, J. Upton, P.E. Burrows.
Venous malformations of skeletal muscle.
Plast Reconstr Surg, 110 (2002), pp. 1625-1635
[9.]
J.D. DesPrez, C.L. Kiehn, C. Vlastou, C. Bonstelle.
Congenital arteriovenous malformation of the head and neck.
Am J Surg, 136 (1978), pp. 424-429
[10.]
H. Yoshida, H. Yusa, E. Ueno.
Use of Doppler color for imaging for differential diagnosis of vascular malformations: a preliminary report.
J Oral Maxillofac Surg, 53 (1995), pp. 369-374
[11.]
W.T. Yang, A. Ahuja, C. Metreweli.
Sonographic features of head and neck hemangiomas and vascular malformations: review of 23 patients.
J Ultrasound Med, 16 (1997), pp. 39-44
[12.]
S. Sheth, A.R. Nussbaum, G.M. Hutchins, R.C. Sanders.
Cystic hygromas in children: sonographic-pathologic correlation.
Radiology, 162 (1987), pp. 821-824
[13.]
W.D. Foley, M. Karcaaltincaba.
Computed tomography angiography: principles and clinical applications.
J Comput Assist Tomogr, 27 (2003), pp. S23-S30
[14.]
E. Levine, L.H. Wetzel, J.R. Neff.
MR imaging and CT of extrahepatic cavernous hemangiomas.
Am J Roentgenol, 147 (1986), pp. 1299-1304
[15.]
A.J. Davidson, D.S. Hartman.
Lymphangioma of the retroperitoneum: CT and sonographic characteristic.
Radiology, 175 (1990), pp. 507-510
[16.]
X. Fan, W. Qiu, Z. Zhang, Q. Mao.
Comparative study of clinical manifestation, plain-film radiography, and computed tomographic scan in arteriovenous malformations of the jaws.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 94 (2002), pp. 503-509
[17.]
L. Remonda, G. Schroth, C. Ozdoba, K. Lovblad, K. Ladrach, P. Huber.
Facial intraosseous arteriovenous malformations: CT and MR features.
J Comput Assist Tomogr, 19 (1995), pp. 277-281
[18.]
C.U. Herborn, M. Goyen, T.C. Lauenstein, J.F. Debatin, S.G. Ruehm, K. Kroger.
Comprehensive time-resolved MRI of peripheral vascular malformations.
Am J Roentgenol, 181 (2003), pp. 729-735
[19.]
F. Caseiro-Alves, P. Gil-Agostinho, G. Ramalheiro, P. Gil-Agostinho.
Contrast-enhanced MR angiography of thoracic vascular malformations in a pediatric population.
Am J Roentgenol, 181 (2003), pp. 861-866
[20.]
O. Konez, P.E. Burrows.
Magnetic resonance of vascular anomalies.
Magn Reson Imaging Clin N Am, 10 (2002), pp. 363-388
[21.]
S. Kern, C. Niemeyer, K. Darge, C. Merz, J. Laubenberger, M. Uhl.
Differentiation of vascular birthmarks by MR imaging. An investigation of hemangiomas, venous and lymphatic malformations.
Acta Radiol, 41 (2000), pp. 453-457
[22.]
J. Dubois, G. Soulez, V.L. Oliva, M.J. Berthiaume, C. Lapierre, E. Therasse.
Soft-tissue venous malformations in adult patients: imaging and therapeutic issues.
Radiographics, 21 (2001), pp. 1519-1531
[23.]
T. Sunagawa, Y. Ikuta, O. Ishida, M. Ishiburo, Y. Yasunaga, M. Ochi.
Arteriovenous malformation of the ring finger. Pre- and postoperative evaluation using three-dimensional computed tomography angiography.
J Comput Assist Tomogr, 27 (2003), pp. 820-823
[24.]
G. Bastarrika, P. Redondo, Sierra, D. Cano, A. Martínez-Cuesta, J.C. López-Gutierrez, et al.
New techniques for the evaluation and therapeutic planning of patients with Klippel-Trenaunay syndrome.
J Am Acad Dermatol, 56 (2007), pp. 242-249
[25.]
Pretel M, Bastarrika G, Redondo P. Nuevas técnicas diagnósticas en pacientes con síndrome de Klippel-Trenaunay. Piel. 2007. In press.
[26.]
P.F. Vilela.
Sturge-Weber syndrome revisited. Evaluation of encephalic morphological changes with computerized tomography and magnetic resonance.
Acta Med Port, 16 (2003), pp. 141-148
[27.]
K. Hagiwara, N.M. Khaskhely, H. Uezato, S. Nonaka.
Mast cell “densities” in vascular proliferations: a preliminary study of pyogenic granuloma, port wine stain, cavernous hemangioma, cherry angioma, Kaposi's sarcoma, and malignant hemangioendothelioma.
J Dermatol, 26 (1999), pp. 577-586
[28.]
M.A. Nuovo, M.M. Grimes, D.M. Knowless.
Glomus tumors: clinicopathologic and immunohistochemical analysis of forty cases.
Surg Pathol, 3 (1990), pp. 31-40
[29.]
R.C. Lawton, R.T. Tidrick, E.S. Brintnall.
A clinicopathological study of multiple congenital arteriovenous fistulae of the lower extremities.
Angiology, 8 (1957), pp. 161-169
[30.]
R.D.G. Peachey, C.C. Lim, J.W. Whimster.
Lymphangioma of the skin: a review of 65 cases.
Br J Dermatol, 83 (1970), pp. 519-527
[31.]
O. Enjolras, D. Ciabrini, E. Mazoyer, C. Laurian, D. Herbreteau.
Extensive pure venous malformations in the upper or lower limb, a review of 27 cases.
J Am Acad Dermatol, 36 (1997), pp. 219-225
[32.]
E. Mazoyer, O. Enjolras, C. Laurian, E. Houdart, L. Drouet.
Coagulation abnormalities associated with extensive venous malformations of the limbs: differentiation from Kasabach-Merrit syndrome.
Clin Lab Haem, 24 (2002), pp. 243-251
[33.]
M. Benchakroun, M. Ouadghiri, S. Berrada, F. Hermas, S. Wahbi, M. El Yaacoubi, et al.
Pathological fracture of the femur in a patient with a venous malformation.
Rev Chir Orthop Reparatrice Appar Mot, 90 (2004), pp. 280-284
[34.]
L.I. Plotkin, T.S. Weinstein, A.M. Parfitt, P.K. Roberson, S.C. Manolagas, T. Bellido.
Prevention of osteocyte and osteoblast apoptosis by bisphosphonates and calcitonin.
J Clin Invest, 104 (1999), pp. 1363-1374
[35.]
A.B. Hodsman, D.C. Bauer, D. Dempster, L. Dian, D.A. Hanley, S.T. Harris, et al.
Parathyroid hormone and teriparatide for the treatment of osteoporosis: a review of the evidence and suggested guidelines for its use.
Endocr Rev, 26 (2005), pp. 688-703
[36.]
N. Ferrara, R.S. Kerbel.
Angiogenesis as a therapeutic target.
Nature, 438 (2005), pp. 967-974
[37.]
O. Enjolras, J.B. Mulliken.
Vascular tumors and vascular malformations (new issues).
Adv Dermatol, 13 (1998), pp. 375-422
[38.]
A.G. Jacob, D.J. Driscoll, W.J. Shaughnessy, A.W. Stanson, R.P. Clay, P. Gloviczki.
Klippel-Trenaunay syndrome: spectrum and management.
Mayo Clin Proc, 73 (1998), pp. 28-36
[39.]
B.B. Lee.
What is new in venous disease: new approach to old problem of venous disease: congenital vascular malformation.
Advances in Phlebology, pp. 59-64
[40.]
D.E. Szilagyi, R.F. Smith, J.P. Elliott, J.H. Hageman.
Congenital arteriovenous anomalies of the limbs.
Arch Surg, 111 (1976), pp. 423-429
[41.]
R.B. Rutherford.
Congenital vascular defects or malformations (CVMs).
Semin Vasc Surg, 6 (1993), pp. 197-198
[42.]
M. Hartman, M. Spauwen, A. Rieu.
Surgical treatment of hemangiomas and vascular malformations in functional areas.
Pediatr Surg Int, 11 (1996), pp. 308-311
[43.]
A.A. Noel, P. Glovizcki, K.J. Cherry Jr, T.W. Rooke, A.W. Stanson, D.J. Driscoll.
Surgical treatment of venous malformations in Klippel-Trénaunay syndrome.
J Vasc Surg, 32 (2000), pp. 840-847
[44.]
B.B. Lee, J.J. Bergan.
Advanced management of congenital vascular malformations: a multidisciplinary approach.
Cardiovasc Surg, 10 (2002), pp. 523-533
[45.]
M. Poetke, C. Philipp, H.P. Berlien.
Flashlamp-pumped pulsed dye laser for hemangiomas in infancy. Treatment of superficial vs. mixed hemangiomas.
Arch Dermatol, 136 (2000), pp. 628-632
[46.]
D.C. Seukeran, P. Collins, R.A. Sheehan-Dare.
Adverse reactions following pulsed tunable dye laser treatment of port wine stains in 701 patients.
Br J Dermatol, 136 (1997), pp. 725-729
[47.]
R.G. Geronemus, A.T. Quintana, W.W. Lou, A.N.B. Kauvar.
High-fluence modified pulsed dye laser photocoagulation with dynamic cooling of Port-wine stain in infancy.
Arch Dermatol, 136 (2000), pp. 942-943
[48.]
K. Scherer, S. Lorenz, M. Wimmershoff, M. Landthaler, U. Hohenleutner.
Both the flashlamp-pumped dye laser and the long-pulsed tunable dye laser can improve results in port-wine stain therapy.
Br J Dermatol, 145 (2001), pp. 79-84
[49.]
D.W. Edstrom, A.M. Ros.
The treatment of port-wine stains with the pulsed dye laser at 600 nm.
Br J Dermatol, 136 (1997), pp. 360-363
[50.]
N. Tomson, S.PR. Lim, A. Abdullah, S.W. Lanigan.
The treatment of port-wine stains with the pulsed-dye laser at 2-week and 6-week intervals: a comparative study.
Br J Dermatol, 154 (2006), pp. 676-679
[51.]
R. Ashinoff, R.G. Geronemus.
Flashlamp-pumped dye laser for port wine stains in infancy: earlier versus later treatment.
J Am Acad Dermatol, 24 (1991), pp. 467-472
[52.]
E. Tevar, M. Calvo, M. Moratinos, P. Boixeda.
Láser y otras fuentes de luz en el tratamiento de manchas en vino de Oporto.
Actas Dermosifiliogr, 97 (2006), pp. 419-427
[53.]
L. Molin, S. Hallgren.
Hair ignition by dye laser for portwine stain: risk factors evaluated.
J Cutan Laser Ther, 1 (1999), pp. 121-124
[54.]
B. Greve, S. Hammes, C. Raulin.
The effect of cold air cooling on 585 nm pulsed dye laser treatment of port-wine stains.
Dermatol Surg, 27 (2001), pp. 633-636
[55.]
C.J. Chang, J.S. Nelson.
Cryogen spray cooling and higher fluence pulsed dye laser treatment improve port-wine stain clearance while minimizing epidermal damage.
Dermatol Surg, 25 (1999), pp. 767-772
[56.]
L.E. Eubanks, E.I. McBurney.
Videomicroscopy of port-wine stains: correlation of location and depth of lesion.
J Am Acad Dermatol, 44 (2001), pp. 948-951
[57.]
E.J. Fiskerstrand, L.O. Svaasand, G. Kopstad, M. Dalaker, L.T. Norvang, G. Volden, et al.
Laser treatment of port-wine stains: therapeutic outcome in relation to morphological parameters.
Br J Dermatol, 134 (1996), pp. 1039-1043
[58.]
S. Michel, M. Landthaler, U. Hohenleutner.
Recurrence of Port-wine stains after treatment with the flashlamp-pumped pulsed dye laser.
Br J Dermatol, 143 (2000), pp. 1230-1234
[59.]
L. Renfro, R.G. Geronemus.
Anatomical differences of Portwine stains in response to treatment with the pulse dye laser.
Arch Dermatol, 129 (1993), pp. 182-188
[60.]
S.W. Lanigan.
Port-wine stain unresponsive to pulsed dye laser: explanations and solutions.
Br J Dermatol, 139 (1998), pp. 173-177
[61.]
I. Sánchez-Carpintero, M.C. Mihm, A. Mizeracki, M. Waner, P.E. North.
Epithelial and mesenchymal hamartomatous changes in a mature port-wine stain: morphologic evidence for a multiple germ layer field defect.
J Am Acad Dermatol, 50 (2004), pp. 608-612
[62.]
J. del Pozo, E. Fonseca.
Port-wine stain nodules in the adult: report of 20 cases treated by CO2 laser vaporization.
Dermatol Surg, 27 (2001), pp. 699-702
[63.]
P.L. Bencini.
The multilayer technique: a new and fast approach for flashlamp-pumped pulsed (FLPP) dye laser treatment of port-wine stains (preliminary reports).
Dermatology Surg, 25 (1999), pp. 786-789
[64.]
P.H. Koster, C.M. van der Horst, M.J. van Gemert, A.C. van der Wal.
Histologic evaluation of skin damage after overlapping and nonoverlapping flashlamp pumped pulsed dye laser pulses: A study on normal human skin as a model for Port wine stains.
Lasers Surg Med, 28 (2001), pp. 176-181
[65.]
D. Groot, J. Rao, P. Johnston, T. Nakatsui.
Algorithm for using a long-pulsed Nd:YAG laser in the treatment of deep cutaneous vascular lesions.
Dermatol Surg, 29 (2003), pp. 35-42
[66.]
M.M. Chowdhury, S. Harris, S.W. LAnigan.
Potassium titanyl phosphate laser treatment of resistant port-wine stains.
Br J Dermatol, 144 (2001), pp. 814-817
[67.]
C. Raulin, C.A. Schroeter, R.A. Weiss, M. Keiner, S. Werner.
Treatment of port-wine stain with a noncoherent pulsed light source.
Arch Dermatol, 135 (1999), pp. 679-683
[68.]
S. Cliff, K. Misch.
Treatment of mature port wine stains with the PhotoDerm VL.
J Cutan Laser Ther, 1 (1999), pp. 101-104
[69.]
J.A. Werner, B.M. Lippert, P. Hoffmann, H. Rudert.
Nd:Yag laser therapy of voluminous hemangiomas and vascular malformations.
Adv Otorhinolaryngol, 49 (1995), pp. 75-80
[70.]
A. Glaessl, A.G. Schreyer, M.B. Wimmershoff, M. Landthaler, S. Feuerbach, U. Hohenleutner.
Laser surgical planning with magnetic resonance imaging-based 3-dimensional reconstructions of intralesional Nd:Yag laser therapy of a venous malformation of the Neck.
Arch Dermatol, 137 (2001), pp. 1331-1335
[71.]
L.D. Derby, D.W. Low.
Laser treatment of facial venous vascular malformations.
Ann Plast Surg, 38 (1997), pp. 371-378
[72.]
M. Waner, J.Y. Suen.
Treatment options for the management of vascular malformations.
Hemangiomas and vascular malformations of the head and neck. Chapter 10,
[73.]
Y. Fujii, B.W. Keene, K.G. Mathews, C.E. Atkins, T.C. Defrancesco, E.M. Hardie, et al.
Coil occlusion of residual shunts fter surgical closure of patent ductus arteriosus.
Vet Surg, 35 (2006), pp. 781-785
[74.]
H.S. Cekirge, I. Saatci, S. Geyik, K. Yayuz, H. Ozturk, G. Pamuk.
Intrasaccular combination of metallic coils and onyx liquid embolic agent for the endovascular treatment of cerebral aneurysms.
J Neurosurg, 105 (2006), pp. 706-712
[75.]
M.J. Sánchez, C.L. Ananian, T. Berkmen.
Embolization of an aortic arch pseudoaneurysm with coils and N-butylcyanoacrylate.
J Vasc Interv Radiol, 17 (2006), pp. 1677-1679
[76.]
A.S. Gomes.
Embolization therapy of congenital arteriovenous malformations: use of alternate approaches.
Radiology, 190 (1994), pp. 191-195
[77.]
R.E. Latchaw, L.H.A. Gold.
Polyvinyl foam embolization of vascular and neoplastic lesions of the head, neck, and spine.
Radiology, 131 (1979), pp. 669-674
[78.]
R.A. Weiss, M.P. Goldman.
Advances in sclerotherapy.
Dermatologic Clin, 13 (1995), pp. 431-445
[79.]
J. Van der Stricht.
The sclerosing therapy in congenital vascular defects.
Int Angiol, 9 (1990), pp. 224-227
[80.]
T. Cadere.
Treatment of varices with ethoxysclerol.
Phebologie, 33 (1980), pp. 377-378
[81.]
J.L. Villavicencio.
Primum non nocere: Is it always true? The use of absolute ethanol in the management of congenital vascular malformations.
J Vasc Surg, 33 (2001), pp. 904-906
[82.]
M.P. Goldman, R.G. Bennet.
Treatment of telangiectasia: a review.
J Am Acad Dermatol, 17 (1987), pp. 167-182
[83.]
A.A. de Lorimier.
Sclerotherapy for venous malformations.
J Pediatr Surg, 30 (1995), pp. 188-194
[84.]
J.J. Bikerman.
Foams.
Springer-Verlag, (1973),
[85.]
E.J. Orbach.
Sclerotherapy of varicose veins: utilization of intravenous air block.
Am J Surg, 66 (1994), pp. 362-366
[86.]
J. Cabrera, J. Cabrera Jr, M.A. García-Olmedo.
Elargissement des limites de la sclerotherapie: Nouveaux produits sclerosants.
Phlebologie, 2 (1997), pp. 181-188
[87.]
J. Cabrera, J. Cabrera Jr, M.A. García-Olmedo.
Treatment of varicose long saphenous veins with sclerosant in microfoam form: long-term outcomes.
Phebology, 15 (2000), pp. 19-23
[88.]
J.-C.G.R. Wollmann.
The history of sclerosing foams.
Dermatol Surg, 30 (2004), pp. 694-703
[89.]
P. Redondo, J. Cabrera.
Microfoam sclerotherapy.
Semen Cutan Med Surg, 24 (2005), pp. 175-183
[90.]
European consensus meeting on foam sclerotherapy. April 4-6, 2003, Tegernsee, Germany. Dermatol Surg. 2004;30: 709-17.
[91.]
R.E. Paul, T.M. Durant, M.J. Oppenheimer, H.M. Stauffer.
Intravenous carbon dioxide for intracardiac gas contrast in the roentgen diagnosis of pericardial effusion and thickening.
Am J Roentgenol Radium Ther Nucl Med, 78 (1957), pp. 224-225
[92.]
R.S. Meltzer, P.W. Serruys, P.G. Hugenholtz, J. Roelandt.
Intravenous carbon dioxide as an echocardiographic contrast agent.
J Clin Ultrasound, 9 (1981), pp. 127-131
[93.]
A. Martínez-Cuesta, B. Elduayen, I. Vivas, C. Delgado, I. González-Crespo, J.I. Bilbao.
CO2 wedged hepatic venography technical considerations and comparison with direct and indirect portography with iodinated contrast.
Abdom Imaging, 25 (2000), pp. 576-582
[94.]
M. Bendib, M. Toumi, A. Boudjellab.
CO2 angiography and enlarged CO2 angiography in cardiology.
Ann Radiol (Paris), 20 (1977), pp. 673-686
[95.]
J. Cabrera, J. Cabrera Jr, M.A. García-Olmedo, P. Redondo.
Treatment of venous malformations with sclerosant in microfoam form.
Arch Dermatol, 139 (2003), pp. 1409-1416
[96.]
T.S. Hsu, R.A. Weiss.
Foam sclerotherapy: a new era.
Arch Dermatol, 139 (2003), pp. 1494-1496
[97.]
S. Ogita, T. Tsuto, K. Nakamura, E. Deguchi, K. Tokiwa, N. Iwai.
OK-432 therapy for lymphangiomas in children: why and how does it work?.
J Pediatr Surg, 31 (1996), pp. 477-480
[98.]
S. Ogita, T. Tsuto, K. Tokiwa, T. Takahashi.
Intracystic injection of OK-432: a new sclerosing therapy for cystic hygroma in children.
Br J Surg, 74 (1987), pp. 690-691
[99.]
S. Ogita, T. Tsuto, E. Deguchi, K. Tokiwa, M. Nagashima, N. Iwai.
OK-432 therapy for unresectable lymphangiomas in children.
J Pediatr Surg, 26 (1991), pp. 263-270
[100.]
S. Ogita, T. Tsuto, K. Nakamura, E. Deguchi, N. Iwai.
OK-432 therapy in 64 patients with lymphangioma.
J Pediatr Surg, 29 (1994), pp. 784-785
[101.]
C. Luzzatto, P. Midrio, Z. Tchaprassian, M. Guglielmi.
Sclerosing treatment of lymphangiomas with OK-432.
Arch Dis Child, 82 (2000), pp. 316-318
[102.]
G. Claesson, R. Kuyelenstierna.
OK-432 therapy for lymphatic malformation in 32 patients (28 children).
Int J Pediatr Otorhinolaryngol, 65 (2002), pp. 1-6
[103.]
K. Uchida, M. Inoue, T. Araki, C. Miki, M. Kusunoki.
Huge scrotal, flank and retroperitoneal lymphangioma successfully treated by OK-432 sclerotherapy.
Urology, 60 (2002),
[104.]
Y. Suzuki, A. Obana, Y. Gohto, T. Miki, H. Otuka, Y. Inoue.
Management of orbital lymphamgioma using intralesional injection of OK-432.
Br J Ophtalmol, 84 (2000), pp. 614-617
[105.]
B. Banieghlbal, M.R. Davies.
Guidelines for the successful treatment of lymphangioma with OK-432.
Eur J Pediatr Surg, 13 (2003), pp. 103-107
Copyright © 2007. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
