Kutanöz vasküler lezyonlarda klinik yaklaşımlarımız

Kutanöz vasküler lezyonlar sıklıkla çocukluk çağında görülür. Hemanjiomlar ve vasküler lezyonlar olmak üzere iki alt gruba ayrılır. Hemanjiomlar vasküler endotelial hücrelerin benign neoplastik proliferasyonu olup spontan involüsyon karakteristiktir. Vasküler malformasyonlar tümör değildir fakat kapiller, ven, arter yada lenfatik damarlarda kalıcı morfojenik anomaliler mevcuttur. Kutanöz vasküler lezyonların, klinik, histolojik ve vasküler akım karakteristikleri esas alınarak yapılan yeni sınıflandırma, lezyonların bilimsel adlandırılmasını ve en uygun tedavi yönteminin belirlenmesi işlemini basitleştirmiştir. Hemanjiom ve vasküler malformasyon vakalarının çoğunda herhangi bir tedavi yöntemi uygulanmadan lezyon spontan involüsyona bırakılabilir. Eğer lezyon kendiliğinden kaybolmazsa veya yerinde kabul edilemeyecek bir iz bırakmışsa cerrahi ya da cerrahi dışı tedavi yöntemleri kullanılabilir. Ancak kontrol edilemeyen kanamalar, büyüme ya da vital fonksiyonlarda bozukluğa neden olan lezyonlarda erken medikal veya cerrahi tedavi yöntemleri kullanılır. Vasküler malformasyonların her tipi için tedavi yöntemi farklıdır. Kapiller malformasyonlar genellikle lazerle tedavi edilir. Lenfatik malformasyonlar cerrahi olarak tedavi edilirken venöz malformasyonlarda en iyi tedavi yöntemi sklerozan bir ajanın lezyon içine enjeksiyonu ve cerrahi tedavidir. Arteriel malformasyonların tedavisinde ise esas yöntem embolizasyondur. Ancak vasküler malformasyonlar sıklıkla karşımıza kombine lezyonlar olarak çıkar ve birden fazla tedavi yöntemini bir arada kullanmak gerekebilir. Bu makalede, kutanöz vasküler lezyon nedeniyle kliniğimize başvuran 50 olgunun retrospektif analizi sunulmuştur.

Our clinical approach to cutaneous vascular lesions

Cutaneous vascular lesions are commonly encountered in children and are classified as either hemangiomas or vascular malformations. Hemangiomas are benign neoplastic proliferations of vascular endothelial cells characterized by spontaneous involution. In contrast, vascular malformations are not neoplasm but permanent morphogenic abnormalities of capilleries, veins, arteries or lymphatic vessels. A new classification based on clinical, histologic and vascular flow characteristics of these lesions has been used to simplify the present nomenclature and to help in selection of the most appropiate treatment. In the majority of cases, no treatment is recommended for hemangiomas and vascular malformations, and they are allowed to involute on their own. If the lesions do not disappear completely or if they disappear but leave scarring or redundant skin, surgical or non-surgical treatment methods may be recommended later in life. Early medical and surgical intervention for hemangiomas is generally reserved for those rare hemangiomas which cause uncontrolable bleeding, growth disturbances or impairment of vital functions such as vision, feeding or breathing. In such cases, treatment may consist of steroid medications, interferon, embolization or surgical excision. Each type of vascular malformation is treated differently. Capillary malformations are usually treated by laser. Lymphatic malformations are most often treated surgically. Venous malformations are usually best treated by direct injection with a scleroting agent and surgery. Arterial malformations are best treated by embolization. Since malformations frequently occur as combined lesions consisting of more than one type of blood vessel, more than one type of treatment may be necessary. In this report, a retrospective analysis of 50 patients suffering from cutaneous vascular lesions is presented.

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