Treatment of severe diffuse cavernous hemangioma of the lower limb by combination of superficial femoral artery ligation and supergenual thigh amputation

doi:10.1007/s11684-009-0031-8

Front Med Chin

2009, Vol. 3

Issue (2) : 240-244 https://doi.org/10.1007/s11684-009-0031-8

CASE REPORT

Treatment of severe diffuse cavernous hemangioma of the lower limb by combination of superficial femoral artery ligation and supergenual thigh amputation

Yin XIA, Dan SHANG, Qin LI, Xiaoqin RUN, Chenxi OUYANG, Yiqing LI, Bi JIN(

)

Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China

Download: PDF(266 KB) HTML
Export: BibTeX | EndNote | Reference Manager | ProCite | RefWorks

Abstract

Severe diffuse cavernous hemangioma of the lower limb is rarely seen among young people and sometimes can be a fatal challenge for operation. We reported a case of diffuse cavernous hemangioma involving both skin and muscles of the left lower limb and perineal region in an adolescent patient. The patient who had previously undergone a local hemangioma resection of the foot ultimately ended in superficial femoral artery ligation and supergenual thigh amputation of the left upper leg because of uncontrollable massive bleeding of anastomotic stoma.

Keywords cavernous hemangioma femoral artery ligation, amputation

Corresponding Author(s): JIN Bi,Email:jinbiwuhan2000@yahoo.com.cn

Issue Date: 05 June 2009

Cite this article:

Yiqing LI,Bi JIN,Yin XIA, et al. Treatment of severe diffuse cavernous hemangioma of the lower limb by combination of superficial femoral artery ligation and supergenual thigh amputation[J]. Front Med Chin, 2009, 3(2): 240-244.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-009-0031-8
https://academic.hep.com.cn/fmd/EN/Y2009/V3/I2/240

Fig.1 Hemangioma. (a) Hemangioma involving the lower limb, presenting with increasing swelling, pain, and bluish discoloration of overlying skin and superficial dilated veins; (b) same hemangioma lesion involving the perineal region.

Fig.2 MR and MRA results of the hemangioma. (a) Cavernous hemangioma extensively invading the muscular tissue of the lower limb; (b) same hemangioma lesion extensively invading the muscular tissue of the perineal region; (c) no abnormal gross vessels were found in the arterial phase; (d) considerable gross vessels and varicose small saphenous vein in the postarterial phase and venous phase.

Fig.3 Pathological examination of the hemangioma. (a) The pathological sections showed samples obtained from amputated leg were characterized by typical blood vessels and vascular sinusoids of hemangioma; (b) typical vascular sinusoids of hemangioma found in the samples of amputated leg. (×100, hematoxylin-eosin stain).

Fig.4 Recovering of the amputation wound. (a) Delayed union due to suture reaction; (b) stoma closed completely resulting from 1 month changing dressing.

1	Baptista E G, Achour H, Boccalandro F, Smalling R W. Cavernous hemangioma of the foot and antecubital fossa: an alternative therapeutic option. Catheter Cardiovasc Interv , 2003, 58(4): 527–531 doi: 10.1002/ccd.10450
2	Chadha M, Singh A P. Unusual knee swelling: a diagnostic dilemma. Arch Orthop Trauma Surg , 2007, 127(7): 593-596 doi: 10.1007/s00402-006-0248-9
3	Olsen K I, Stacy G S, Montag A. Soft-tissue cavernous hemangioma. Radiographics . 2004, 24(3): 849-854 doi: 10.1148/rg.243035165
4	Melman L, Johnson F E. Intramuscular cavernous hemangioma. Am J Surg , 2008, 195(6): 816-817 doi: 10.1016/j.amjsurg.2007.08.064
5	Sundine M J, Wirth G A. Hemangiomas: an overview. Clin Pediatr , 2007, 46(3): 206-221 doi: 10.1177/0009922806290455
6	Redondo P. Vascular Malformations (I). Concept, Classification. Pathogenesis and Clinical Features. Actas Dermosifiliogr , 2007, 98(3): 141-158
7	Devalia K L, Mehta R, Yagnik M G. Benign juvenile hemangioma: a case report. Acta Orthop , 2006, 77(1): 171-173 doi: 10.1080/17453670610045885
8	Kim E Y, Ahn J M, Yoon H K, Suh Y L, Do Y S, Kim S H, Choo S W, Shoo I W, Kim S M, Kang H S. Intramuscular vascular malformations of an extremity: findings on MR imaging and pathologic correlation. Skeletal Radiol , 1999, 28(9): 515-521 doi: 10.1007/s002560050555
9	Mazoyer E, Enjolras O, Laurian C, Houdart E, Drouet L. Coagulation abnormalities associated with extensive venous malformations of the limbs: differentiation from Kasabach-Merritt syndrome. Clin Lab Haematol , 2002, 24(4): 243-251 doi: 10.1046/j.1365-2257.2002.00447.x
10	Hayashi N, Masumoto T, Okubo T, Abe O, Kaji N, Tokioka K, Aoki S, Ohtomo K. Hemangiomas in the face and extremities: MR-guided sclerotherapy--optimization with monitoring of signal intensity changes in vivo. Radiology , 2003, 226(2): 567-572 doi: 10.1148/radiol.2262012157
11	Lookstein R A, Guller J. Embolization of complex vascular lesions. Mt Sinai J Med , 2004, 71(1): 17-28
13	Song J K, Niimi Y, Berenstein A. Endovascular treatment of hemangiomas. Neuroimaging Clin N Am , 2007, 17(2): 165-173 doi: 10.1016/j.nic.2007.02.003
15	Arora S, Weber M A, Fox C J, Neville R, Lidor A, Sidawy A N. Common femoral artery ligation and local debridement: a safe treatment for infected femoral artery pseudoaneurysms. J Vasc Surg , 2000, 33(5): 990-993 doi: 10.1067/mva.2001.114212
16	Salimi J, Shojaeefar A, Khashayar P. Management of infected femoral pseudoaneurysms in intravenous drug abusers: a review of 57 cases. Arch Med Res , 2008, 39(1): 120-124 doi: 10.1016/j.arcmed.2007.07.004
17	Gan J P, Leiberman D P, Pollock J G. Outcome after Ligation of Infected False Femoral Aneurysms in Intravenous Drug Abusers. Eur J Vasc Endovasc Surg , 2000, 19(2): 158-161 doi: 10.1053/ejvs.1999.0976
18	Naqi S A, Khan H M, Akhtar S, Shah T A. Femoral Pseudoaneurysm in Drug Addicts-Excision without Revascularization is a Viable Option. Eur J Vasc Endovasc Surg , 2006, 31(6): 585-587 doi: 10.1016/j.ejvs.2005.12.011
19	Fayad L M, Hazirolan T, Bluemke D, Mitchell S. Vascular malformations in the extremities: emphasis on MR imaging features that guide treatment options. Skeletal Radiol , 2006, 35(3): 127-137 doi: 10.1007/s00256-005-0057-1
20	Herborn C U, Goyen M, Lauenstein T C, Debatin J F, Ruehm S G, Kr?ger K. Comprehensive time-resolved MRI of peripheral vascular malformations. AJR Am J Roentgenol , 2003, 181(3): 729-735
21	Steven M, Kumaran N, Carachi R, Desai A, Bennet G. Haemangiomas and vascular malformations of the limb in children. Pediatr Surg Int , 2007, 23(6): 565-569

Viewed

Full text

Abstract

Cited

Shared

Discussed