|Year : 2021 | Volume
| Issue : 3 | Page : 264-265
Management of thigh hemangioma by laser ablation
Rusy S Bhalla, R Ashish Kapadia
Orchid Centre for Laser Surgery, Mumbai, Maharashtra, India
|Date of Submission||04-Aug-2020|
|Date of Decision||07-Aug-2020|
|Date of Acceptance||28-Sep-2020|
|Date of Web Publication||6-Jul-2021|
Rusy S Bhalla
Orchid Centre for Laser Surgery, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
Intramuscular hemangiomas are 0.8% of soft-tissue swellings. They can be present in adipose tissue or intramuscular compartment. Conventional management includes Compression, sclerotherapy, embolization, corticosteroids, and surgical excision. The laser is now advocated for hemangiomas due to no cosmetic deformity and high effectiveness. Presenting a case of Thigh hemangioma involving Vastus lateralis muscle.
Keywords: Congenital hemangioma, laser ablation, thigh hemangioma
|How to cite this article:|
Bhalla RS, Kapadia R A. Management of thigh hemangioma by laser ablation. Indian J Vasc Endovasc Surg 2021;8:264-5
| Introduction|| |
Thigh hemangioma is an uncommon condition occurring in adults. Most treatment options available are currently not satisfactory for the patient [Figure 1]. Laser ablation offers a viable alternative to close the venous spaces under direct ultrasonography control.,,,,,,,
There is no cosmetic mutilation of the patient and a better acceptance factor.
The aim of the management of this case was to ablate the venous spaces by laser and follow the results thereafter.
| Settings and Design|| |
The case was a 28-year-old male patient presenting with a gradually increasing thigh circumference and soft swelling in the anterior part of the thigh. Other symptoms included progressive pain at rest and increasing while walking.
Magnetic resonance imaging (MRI) showed and extensive lesion in vastus lateralis muscle of the thigh [Figure 2].
The patient had been advised surgical excision but was unwilling for such a mutilating procedure.
| Materials and Methods|| |
The patient was counseled for possible side effects of procedure, including infection and further sessions of laser.
The procedure was performed Under spinal anesthesia. The hemangioma was localized under ultrasonography control.
The vascular spaces were identified, and so was the main femoral artery and vessels.
The vascular spaces were laserized under sonography control on real-time basis. The laserization and consequent defunctionalization of vascular spaces were confirmed under sonography Doppler control.
The patient tolerated the procedure well; the multiple needle marks disappeared in 2 weeks, and no skin burns were seen.
The patient was discharged on 2nd day.
| Results|| |
The pain of the thigh was decreased to a negligible level within 24 h.
Repeat MRI at 2 months showed a total resolution of the lesion [Figure 3].
|Figure 3: Resolution of thigh hemangioma with no muscle loss after 2 months|
Click here to view
The patient presented again after 4 months with swelling of thigh locally. He was again scanned, and an avascular mass was noted at the site. The patient was counseled, and the excision of the mass was undertaken, which was found to be the necrosed leftover of the hemangioma in the subcutaneous tissue.
The patient recovered uneventfully. He has been symptom-free with no recurrence at the end of 5 years.
| Discussion|| |
Interstitial laser ablation for vascular malformations using neodymium: yttrium aluminum garnet laser was reported as early as 1986.
Laser ablation works by imparting heat energy to the endothelium and denaturation of blood proteins.
This leads to clotting of the vascular spaces and consequent retrograde thrombosis. Eventually, it leads to fibrosis of the compartment.
| Conclusions|| |
Laser ablation of thigh hemangioma is a very good alternative and adjunct to surgery and sclerotherapy. It affords real-time demonstration of the closure of vascular spaces. Any recurrences can also be managed by relaserizing the affected area.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]