Contribution of Hungarian Experts to the Treatment of Venous Malformations

1
Contribution of Hungarian Experts to the
Treatment of Venous Malformations

• Dr Imre Bihari PhD

2
Vascular birthmarks and malformations

• For centuries the appearance of
• vascular birthmarks could not be rationally
  explained
• These cases were very rare, or only a few
  descriptions are known
• In the 19th century coincidences of physical
  signs were described. These are the syndromes
• They are named after the author of the most
  influential publications

3
Improvement

• With the new diagnostic possibilities mainly
  using angiography, the pathologic background
  could be clarified
• This was in the middle of the 20th century
• At the end of the last century correct
  anatomo-pathologic diagnosis is introduced
  instead of syndrome names (Hamburg
  classification, 1993)

4
The first Hungarian vascular surgeon who dealt
specifically with vascular malformations

• Géza de Takats (1892-1985)
• Graduated and began to work as a surgeon in
  Budapest
• Pioneer of vascular surgery in USA, founder of
  vascular surgery and the University clinic in
  Chicago
• He made distinctions between arterial, venous and
  arteriovenous malformations (1932).

5
Contributed to the treatment of AV-shunts

• Emerick Szilagyi (1910-2009)
• He worked in the USA, in Detroit, was a highly
  regarded arterial surgeon
• He dealt with arterio-venous shunts and wrote
  about their influence on the venous system

6
A pioneer in the Angiographic approach to venous
malformations

• Csaba Sztankay
• Venous malformations in the lower limb (1968)
• A comprehensive description with a modern
  approach

7
Founder of modern arterial and venous surgery in
Hungary

• Lajos Soltész (1917-1982)
• Founder of the first vascular surgical University
  clinic in Hungary
• Dealt with arterial and venous surgery and the
  treatment of lymphatic diseases and vascular
  malformations
• The founding father of Hungarian vascular surgery

8
Lajos Soltészs contributions

• He published his first paper about vascular
  malformations Cervical haemangioma compressing
  the spinal cord
• His PhD dissertation was about Congenital
  arterio-venous fistulas of the limbs (1964)
• According to his opinion, oxygen content was more
  informative about AV shunts than pulsating murmur
• He proved experimentally that AV shunts open
  after a while in hypoxic limbs

9
Soltészs international relationships

• E. Malan, Milan, Italy J. Vollmar,
  Ulm, Germany S. Belov, Sofia, Bulgaria R.
  May, Innsbruck, Austria

10
Internationally renowned scientist and teacher
11
Fontányi developed a new instrument

• Sándor Fontányi
• Toe plethysmography
• Suitable to detect pulsation e.g. in AV
  malformations

12
Interventional radiological treatment of venous
malformations

• László Szlávy (1937-2004)
• He wrote a book about the interventional
  radiological treatment of vascular anomalies
  (stents, coils, sclerotherapy, etc.)

13
Venous and Lymphatic anatomy

• István Kubik (1923-2003)
• Dealt with vascular anatomy mainly with veins and
  lymphatic vessels
• He could find the embryonic origin of some
  pathologic veins in adulthood e.g. marginal veins
• He worked together with the Földis in lymphatic
  research

14
One of the current leaders of phlebology in the
world

• Peter Gloviczki, professor of vascular surgery at
  the Mayo Clinic
• All-round vascular surgeon including the surgery
  of lymphatic vessels and vascular malformations
• His comprehensive scientific analytic work and
  books are highly esteemed

15
Renowned expert on vascular malformations in
Hungary

• Géza Tasnádi pediatric and vascular surgeon
• He consults almost every vascular malformation
  and vascular tumour child in Hungary
• Coordinates the treatment of vascular
  malformation children in Hungary

16
The first relevant epidemiological data in the
literature about venous malformations

• More than 3000 children were examined
• Vascular malformations are present in 1.2
• Venous malformations make up half of them (48 )

17
Creation of A common language for vascular
malformations

• Participated in the drafting of the
  anatomo-pathological classification of vascular
  malformations (Hamburg classification 1993)

18
Influence of hypoxy on the development of limbs

• There is a difference in the development of
  extremities according to the malformation type.
  If an AV shunt causes hypoxia of the periphery of
  the limb, hypertrophy develops
• If there is diffuse dilatation of marginal or
  deep veins, or the absence of valves, hypotrophy
  develops
• Not only the oxygen content but also the venous
  blood pressure matters

19
He Introduced a useful new instrument The Sonotom

• The ultrasonic dissector (Sonotom) is a
  multifunctional instrument providing
• vibration
• irrigation
• aspiration
• It makes atraumatic dissection of parenchymal and
  subcutaneous tissue
• It preserves nerves and healthy vessels

20
International relationships of Tasnádi
BB Lee, USA P Berlien, Germany R
Mattassi, Italy DA Loose, Germany
M Vaghi, Italy JB Mulliken, USA
J Weber, Germany WF Yakes, USA
21
He Wrote chapters in several books
22
Further colleagues who are working on vascular
malformations in hungary
László Entz Kálmán Hüttl Zoltán
Harkányi Csaba Dzsinich György Balázs
István Szikora Zsuzsanna Szalai Éva Török
Imre Bihari Attila Szabó
23
Thank you for your kind attention