A proposal for a revision of the phlebographic classification of congenital venous malformations.

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Cardiovascular diagnosis and therapy Pub Date : 2024-04-30 Epub Date: 2024-04-01 DOI:10.21037/cdt-23-378
Sarah M Bernhard, Franz R Kammer, Marie C Roumet, Fabian Haupt, Aleksandra Tuleja, Marc Schindewolf, Iris Baumgartner
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引用次数: 0

Abstract

Background: Venous malformation (VM) is the most frequent type of congenital vascular malformation. In terms of functional outcome local sclerotherapy remains the most important therapeutic tool. For planning and correct estimation and prevention of complications, an exact anatomical classification of the VM is crucial. Not only the drainage, as assessed in the established classification, but also the phlebographic aspect of the internal VM structure itself plays a decisive role. In order to integrate this aspect, we aim to validate a proposal for a revised phlebographic VM classification distinguishing non-lacunar (a) and lacunar (b) types.

Methods: We retrospectively analyzed all patients with VM in whom a direct puncture phlebography was performed in our clinic between 2009 and 2018 to assess morphology and flow characteristics. Phlebographic assessment included: (I) differentiation of non-lacunar vs. lacunar type; (II) drainage assignment according to the existing classification; (III) adjusted classification combining both. Inter-reader agreement was measured in percentage as well as by the Cohen's kappa coefficient (κ).

Results: Overall 26 patients were classified as non-lacunar (a) and 41 patients as lacunar (b) VM. For this categorization, inter-reader agreement was 96% (κ=0.91). Classical Puig classification into types I, II, III and IV showed 87% inter-reader agreement (κ=0.78). For the adjusted classification adding the non-lacunar or lacunar characteristic to type I-IV an agreement of 82% (κ=0.77) was achieved.

Conclusions: Phlebographic differentiation into non-lacunar and lacunar VM is feasible and reliable to distinguish phenotypic subgroups of patients with VM. We therefore propose to integrate this parameter of the internal VM structure into the existing classification.

关于修订先天性静脉畸形静脉图分类的建议。
背景:静脉畸形(VM)是最常见的先天性血管畸形类型。就功能效果而言,局部硬化剂注射仍然是最重要的治疗手段。为了制定计划、正确估计和预防并发症,对静脉畸形进行准确的解剖学分类至关重要。不仅是既定分类中评估的引流情况,血管瘤内部结构本身的静脉造影也起着决定性作用。为了整合这方面的内容,我们旨在验证一项关于修订静脉血管造影分类的建议,以区分非腔隙型(a)和腔隙型(b):我们回顾性分析了 2009 年至 2018 年期间在本诊所进行直接穿刺静脉造影的所有 VM 患者,以评估其形态和血流特征。静脉造影评估包括(I)非腔隙型与腔隙型的区分;(II)根据现有分类进行引流分配;(III)结合两者进行调整分类。阅读者之间的一致性以百分比和科恩卡帕系数(κ)来衡量:共有 26 名患者被归类为非腔隙(a)型 VM,41 名患者被归类为腔隙(b)型 VM。在这一分类中,读片者之间的一致性为 96%(κ=0.91)。经典的 Puig 分型为 I、II、III 和 IV 型,读片者之间的一致性为 87%(κ=0.78)。对于在 I-IV 型基础上增加非腔隙或腔隙特征的调整型分类,一致性达到 82%(κ=0.77):结论:将血管造影分为非腔隙型和腔隙型血管瘤是可行且可靠的,可用于区分血管瘤患者的表型亚组。因此,我们建议将这一VM内部结构参数纳入现有的分类中。
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来源期刊
Cardiovascular diagnosis and therapy
Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
4.20%
发文量
45
期刊介绍: The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.
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