Woman benefits from precision-guided needle to glue shut dangerous and disfiguring blood vessel growth

November 12, 2012
Woman benefits from precision-guided needle to glue shut dangerous and disfiguring blood vessel growth
Susan Adams, 43, of Owings, Md., in January of this year, before her surgery.

(Medical Xpress)—Using a technique performed at Johns Hopkins but rarely elsewhere, imaging specialists and surgeons have successfully used precision, image-guided technology to glue shut a tangle of abnormal blood vessel growths in a 43-year-old woman's upper lip, face and nose. Surgery had earlier been ruled out because traditional approaches were considered too risky.

Susan Adams, an accountant from Owings, Md., says her arteriovenous malformation (AVM) had caused a decade of spontaneous nose and lip bleeds that were difficult to control, and that more than a half dozen previous operations had failed to stop the bleeding or facial disfigurement.

Adams' condition is rare and notoriously difficult to treat. Her AVM had grown –for no known reason – between her upper lip and base of her nose. As it grew, her upper lip and skin above it had bulged out, causing the lower-left side of her face to droop. If left untreated, the condition can lead to life-threatening from a burst vessel.

Woman benefits from precision-guided needle to glue shut dangerous and disfiguring blood vessel growth
The glued shut tangle of blood vessels (bright mass, at right), as seen by DynaCT, before surgeons could safely remove it.

For her May 14 procedure, which took about two hours at The Johns Hopkins Hospital, interventional neuroradiologist Monica Pearl, M.D., used an ultrathin needle, precisely guided from the outside in by real-time ultrasound scanning and angiography, to puncture Adams' and several of the outermost and largest tangled . Once the needle was inside the , which are no more than 1 to 2 millimeters wide, Pearl injected a glue-like substance to block each vessel and cut off the to any smaller, abnormal branching blood vessels. Pearl says this effectively destroyed the blood vessels making up the AVM.

Pearl was able to select which blood vessels to block using a contrasting dye injected into the tangle immediately prior to the glue-sealing embolization treatment. Using digital subtraction angiography (DSA) – in which computer software removes the images of bones and other organs, showing only the blood vessels – Pearl was able to track reduced blood flow through the AVM after every individual embolization. After three major blood vessels were sealed, blood flow through the tangle became nearly invisible on the DSA images.

Woman benefits from precision-guided needle to glue shut dangerous and disfiguring blood vessel growth
Susan Adams in June 2012, eight weeks after her surgery. Her wounds still healing.

Pearl cautioned that the procedure she and her team used is riskier than traditional AVM therapies. Typically, says Pearl, an assistant professor at the Johns Hopkins University School of Medicine who sees an AVM patient about once a week, interventional neuroradiologists and surgeons use the glue sealant to destroy—from the inside—the larger, misshapen arteries, using catheters through major blood vessels elsewhere in the body.

This "inside-in" approach usually lowers the risk of any life-threatening bleeding from burst arteries. However, scarring and postsurgical infections from Adams' earlier procedures led Pearl and plastic and reconstructive surgeon Amir Dorafshar, M.D., to decide in favor of an "outside-in" approach. Although, other surgeons had ruled Adams situation too risky for further surgery, Pearl and Dorafshar thought success was still possible if Adams AVM could be sealed.

Woman benefits from precision-guided needle to glue shut dangerous and disfiguring blood vessel growth
Johns Hopkins physicians and surgeons used a needle (at right) and precise, image-guided technology to glue shut Adams’ abnormal tangle of blood vessels.

Once the tangle was glued shut, Dorafshar threaded a protective line of sutures around Adam's facial outgrowth, as protection against any sudden blood loss during Adams' reconstructive surgery, performed immediately after embolization. In that operation, lasting almost four hours, he cut out the destroyed AVM tangle and put Adams' upper lip back together, repairing the mucosa, muscle and skin, and re-aligning her nose.

"Our success with this alternative outside-in approach shows our ability to look at medical problems from a different perspective and the potential capabilities for treating what was once considered untreatable," says Pearl. "People with complex vascular malformations require individualized treatment plans that rely on close collaborations across physician specialties and disciplines."

Explore further: Stem cell technology used in unique surgery

Related Stories

Stem cell technology used in unique surgery

May 9, 2011
Surgeon and Professor Michael Olausson was able to create a new connection with the aid of this blood vessel between the liver and the intestines, necessary to cure the girl. The girl is now in good health, and her prognosis ...

Surgeons use woman's own tissue to rebuild ear lost to cancer

September 27, 2012
(Medical Xpress)—In a series of a half-dozen operations spanning 20 months, surgeons at Johns Hopkins have successfully reconstructed the entire ear and part of the skull of a 42-year-old woman from Bel Air, Md.

Adult stem cells from liposuction used to create blood vessels in the lab

July 25, 2012
Adult stem cells extracted during liposuction can be used to grow healthy new small-diameter blood vessels for use in heart bypass surgery and other procedures, according to new research presented at the American Heart Association's ...

Recommended for you

World's first child hand transplant a 'success'

July 19, 2017
The first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said Tuesday, declaring the ground-breaking operation a success after 18 months.

Knee surgery—have we been doing it wrong?

July 18, 2017
A team of University at Buffalo medical doctors have published a study that challenges a surgical practice used for decades during arthroscopic knee surgery.

New tools help surgeons find liver tumors, not nick blood vessels

July 17, 2017
The liver is a particularly squishy, slippery organ, prone to shifting both deadly tumors and life-preserving blood vessels by inches between the time they're discovered on a CT scan and when the patient is lying on an operating ...

Researchers discover indicator of lung transplant rejection

July 13, 2017
Research by scientists at Dignity Health St. Joseph's Hospital and Medical Center's Norton Thoracic Institute was published in the July 12, 2017 issue of Science Translational Medicine titled "Zbtb7a induction in alveolar ...

New device could make closing surgical incisions a cinch

July 7, 2017
Like many surgeons, Dr. Jason Spector is often faced with the challenge of securely closing the abdominal wall without injuring the intestines. If the process goes awry, there can be serious consequences for patients, including ...

Success with first 20 patients undergoing minimally invasive pancreatic transplant surgery

June 29, 2017
Surgeons at Johns Hopkins Medicine report that their first series of a minimally invasive procedure to treat chronic pancreas disease, known as severe pancreatitis, resulted in shorter hospital stays, less need for opioids ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.