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Characterization of vascular stains associated with high flow - 15/02/21

Doi : 10.1016/j.jaad.2020.06.985 
Eloise R. Galligan, MD a, b, Eulalia Baselga, MD c, Ilona J. Frieden, MD d, Nicole W. Kittler, MD d, Christine T. Lauren, MD e, f, Kimberly D. Morel, MD e, f, Catherine McCuaig, MD g, Elena Pope, MD h, Megha Tollefson, MD i, Kimberly Tantuco, MD h, Orli Wargon, MD j, Maria C. Garzon, MD e, f,
a Columbia University Vagelos College of Physicians & Surgeons, New York, New York 
b Department of Internal Medicine, Greenwich Hospital, Greenwich, Connecticut 
c Department of Dermatology, Hospital de Sant Joan de Deu Barcelona, Barcelona, Spain 
d Department of Dermatology, University of California, San Francisco, California 
e Department of Dermatology, Vagelos College of Physicians & Surgeons, Columbia University Medical Center, New York, New York 
f Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University Medical Center, New York, New York 
g Department of Dermatology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada 
h Department of Dermatology, Hospital for Sick Children, Toronto, Ontario, Canada 
i Department of Dermatology, Mayo Clinic, Rochester, Minnesota 
j Department of Dermatology, Sydney Children's Hospital, Sydney, New South Wales, Australia 

Correspondence to: Maria C. Garzon, MD, Departments of Dermatology and Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, Herbert Irving Pavilion, 12th Floor, 161 Fort Washington Ave, New York, NY 10032.Departments of Dermatology and PediatricsVagelos College of Physicians and SurgeonsColumbia UniversityHerbert Irving Pavilion, 12th Floor, 161 Fort Washington AveNew YorkNY10032

Abstract

Background

High-flow vascular stains (HFVS) are lesions that have the appearance of capillary malformations/port wine stains but are associated with increased arterial flow.

Objective

To identify features of HFVS that differentiate them from typical “slow-flow” port wine stains.

Methods

Retrospective multicenter cohort study of HFVS evaluated across 7 centers was conducted. HFVS were characterized by clinical features (warmth, thrill, rapid capillary refill), radiologic findings (fast flow), or mutations associated with capillary malformation-arteriovenous malformation syndrome. Investigators reviewed photographs.

Results

The study reviewed 70 patients with HFVS (47 multifocal and 23 solitary). Most were flat (77%), warm to the touch (60%), and red or pink-red in color (35%), with heterogeneous color saturation (73%) and well-defined borders (71%). Regional soft tissue swelling/overgrowth was common (47%). Head and neck location was most common (38%). Among 34 HFVS with photographic review over time, all demonstrated changes in appearance.

Limitations

Retrospective design, recall bias, lack of standardized time points or visual analog scale, and image variability.

Conclusion

Heterogeneity of stain color saturation, warmth to touch, peripheral pallor, and overgrowth/soft tissue swelling help distinguish HFVS from port wine stains. Darkening of color and increased border demarcation may develop over time. These findings raise suspicion for HFVS and provide an indication to assess for extracutaneous involvement.

Le texte complet de cet article est disponible en PDF.

Key words : arteriovenous malformation, AVM, capillary malformation, CM, CM-AVM, dermatology, pediatric dermatology, port-wine stain, PWS, vascular anomaly, vascular birthmark, vascular malformation, vascular stain

Abbreviations used : AVM, CM, HFVS, MRA, MRI, PDL, PWS, US


Plan


 Funding sources: None.
 Conflicts of interest: Dr Frieden is a consultant for Venthera, BridgeBio. Dr Baselga is founder and consultant for Venthera, BridgeBio.
 IRB approval status: Reviewed and approved by all participating sites and the Columbia University (lead site) Institutional Review Board (protocol AAAR4255).
 Reprints not available from the authors.


© 2020  American Academy of Dermatology, Inc. Tous droits réservés.
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Vol 84 - N° 3

P. 654-660 - mars 2021 Retour au numéro
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