Combined Glue Embolization and Surgical Excision for Management of Genitourinary and Perineal Vascular Anomalies in Pediatric and Adolescent Patients Assigned Female at Birth.

STUDY

OBJECTIVE

Vascular anomalies (VAs) are tumors and malformations of blood vessels that may involve the genitourinary-perineal (GUP) region, causing pain, debility, or aesthetic concerns. N‑butyl‑2 cyanoacrylate (n-BCA) glue embolization followed by surgical excision is an innovative management option for vascular malformations. This case series reviews the clinical outcomes of this approach for GUP-VAs.

METHODS

Female patients with GUP-VAs who underwent glue embolization followed by surgical excision were identified from a tertiary children's hospital from 1998 to 2024. Demographic characteristics, operative procedure(s), complications, and previous and subsequent treatment history were collected.

RESULTS

Five female patients underwent glue embolization and excision (mean age 12.6 years, range 3-22). Four patients had congenital vulvar arteriovenous or venous malformations; one had a perineal venous malformation noted after saddle injury. Indications were swelling (100%), pain (40%), and bleeding (20%). Two patients had previous therapies: sclerotherapy (n = 2) and previous surgical excision with recurrence (n = 1). Targeted embolization was performed with 1:3 or 1:4 n-BCA glue in ethiodized oil, and excision was performed within 1 day. Procedures were successful in all patients: all had symptomatic improvement, and none experienced recurrence. One had nontarget glue thromboembolism to a segmental pulmonary artery treated by suction thrombectomy without clinical sequela. One patient had wound separation healed by secondary intention. Mean and median surgical blood loss volumes were 46 and 50 mL (0-100 mL). Mean and median follow-up duration were 12.6 and 3 months (range 1-37 months).

CONCLUSION

Glue embolization and excision is safe and effective for pediatric and adolescent patients with GUP-VAs.