Ultrasound-Navigated Interstitial Nd:YAG LaserCoagulation of Congenital Vascular Disorders

Summary The treatment of voluminous hemangiomas or vascular malformations, particularly of the infiltrative type, is difficult and requires a combination of methods such as surgical excision, embolisation, laser therapy, sclerotherapy and magnesium spiking. The goal of this study was to investigate the efficacy of ultrasound-navigated interstitial Nd:YAG (Neodymium:Yttrium-Aluminium-Garnet) laser coagulation of hemangiomas and vascular malformations. Ultrasound-navigated interstitial Nd:YAG laser coagulation was performed on 21 patients with cavernous hemangiomas or vascular malformations. 12 patients had vascular malformations primarily of the venous kind, whereas arteriovenous components were predominant in 5 patients. In 4 children, an extensive hemangioma was the indication for interstitial laser therapy. Laser energy with a power of 7–10 W was applied via puncture canula through a 600 μm glass fiber and with support of ultrasound guided to the vessel wall. Immediately after laser application the blood flow was controlled with color-coded duplexsonography. Three months after lasertreatment, a volume reduction between 60% and 80% in hemangiomas (n = 4), between 20% and 70% in venous malformations (n = 12) and 0% to 70% in arteriovenous malformations (n = 5) was achieved. With exception of necrosis in one patient which healed spontaneously, no further complications occurred. Ultrasound-navigated interstitial Neodym-YAG-laser coagulation is an effective and minimally invasive method for treating voluminous hemangiomas and vascular malformations and is an alternative or complimentary to other therapies.