PB1341 - Title: "Vascular Enigma Unveiled: Navigating the Intricacies of a 41-Year-Old's Complex Vascular Odyssey"

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Heghine S. Khachatryan, MD, PhD

Head of Hemophilia and Thrombosis Center
Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan Armenia YSMU, department of Hematology and Pediatric oncology
Yerevan, Yerevan, Armenia

Co-Author(s)

LP

Lilit S. Petrosyan

hematologist
Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan, Armenia
Yerevan, Yerevan, Armenia
Nelli S. Sargsyan

Hematologist
Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan, Armenia
Yerevan, Yerevan, Armenia
Liana G. Hambardzumyan, Master's degree

Hematologist
Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan, Armenia
Yerevan, Yerevan, Armenia
GT

Gevorg N. Tamamyan

Professor, hematologist-oncologist
Armenian Hemophilia and Trombosis center
Yerevan, Yerevan, Armenia
SD

Samvel H. Danelyan

hematologist-oncologist, Head of Yeolyan Oncology and Hematology Center
Armenian Hemophilia and Trombosis center
Yerevan, Yerevan, Armenia
AM

Alisa Movsisyan

Hematologist
Yeolyan Hematology and Oncology Center
Yerevan, Yerevan, Armenia
CS

Clodet Stepanians

Hematologist
Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan, Armenia
Yerevan, Yerevan, Armenia

Background: This article presents a detailed examination of a complex case involving a 41-year-old female with extensive vascular manifestations spanning over two decades. The patient's journey encompasses the discovery of vascular lesions during pregnancy, subsequent surgical interventions, deep vein thrombosis, and associated complications.

Aims: The clinical history of the 41-year-old female patient involves a protracted manifestation of vascular abnormalities, beginning with a vascular lesion on the right thumb during pregnancy and progressing to involve various anatomical regions. Surgical intervention in 2017 revealed intramuscular cavernous hemangioma, while 2022 witnessed the removal of the right Great Saphenous Vein and subsequent complications, including deep vein thrombosis and lymphadenopathy. A genetic analysis unveiled a heterozygous PAI-I mutation and elevated homocysteine levels. This case underscores the complexity of the patient's condition, necessitating a comprehensive approach for accurate diagnosis and effective management.

Methods: Histological analysis of the surgically removed nodular-vascular lesion confirmed intramuscular cavernous hemangioma. Laboratory evaluations, including D-dimer levels and genetic analysis, were conducted to assess the extent of thrombosis and identify underlying genetic factors.

Results: The patient's presentation of deep vein thrombosis in the left lower extremity was effectively managed with a combination of Rivaroxaban and Aspirin, resulting in a significant reduction in D-dimer levels. The subsequent genetic analysis revealed a heterozygous PAI-I mutation and elevated homocysteine levels, contributing to the overall complexity of the case.

Conclusion(s): This case report emphasizes the challenges in managing a 41-year-old female with intricate vascular manifestations, encompassing hemangiomas, deep vein thrombosis, and genetic mutations. The planned adjustments to the patient's treatment regimen and further investigations, including whole-body MRI, are crucial steps in refining our understanding of these cases and advancing therapeutic strategies. As we delve into the intricacies of this case and its broader implications, ongoing research remains essential to elucidate the most effective treatment modalities in the absence of clear guideline.