Vascular malformations occur as a result of an arrest in the development of the vascular system. The modified Hamburg classification distinguishes arterial, venous, arteriovenous, capillary, lymphatic, and mixed vascular malformations. Each malformation is further subdivided based on anatomy and on the time when arrest in development of the embryogenesis occurred; malformations can be truncular or extratruncular. Progress in the last decade in management has been significant because of improvements in open surgical procedures and perfection of percutaneous and hybrid endovascular interventions and devices, such as balloons, stents, and stent-grafts. There has been increasing use of embolization for the treatment of malformations with coils, other particles, glue, or with endovascular placement of occlusive plugs. Absolute alcohol, detergent liquids, or foam have been used for sclerotherapy with improved efficacy. The agents are delivered percutaneously or through a catheter placed either into the feeding arteries or the draining veins. This review aims to aid vascular and endovascular specialists in staying familiar with vascular malformations. These specialists need to be able to evaluate the patients, perform treatment if appropriate, or refer complex cases to multidisciplinary vascular malformation clinics and vascular centers.

To better understand risk factors associated with early postoperative death or failure, we reviewed our entire experience with 702 consecutive patients who had the modified Fontan operation at the Mayo Clinic between October 1973 and December 1989. The event rate for takedown of repair or death during the initial hospitalization or within 30 days of the operation was 14.8% (successful takedown of the repair, n = 6; death, n = 98). To identify variables associated with early death or Fontan takedown, we analyzed 33 clinical and hemodynamic variables in a univariate and multivariate manner. On the basis of a stepwise logistic discriminant analysis, patients who were younger and operated on before 1980 with a higher preoperative pulmonary artery mean pressure, asplenia, higher intraoperative (after Fontan operation) right atrial pressure, longer aortic crossclamp time, and pulmonary artery ligation were more likely to have the outcome event of interest (p values < 0.05). A new variable, corrected pulmonary artery pressure (that is, mean preoperative pulmonary artery pressure divided by the ratio of pulmonary to systemic flow if the ratio of pulmonary to systemic flow is greater than 1.0), was significantly associated with the outcome event univariately (p = 0.002), but was no more predictive than the preoperative pulmonary artery mean pressure. Variables less predictive of the outcome event in this analysis included multiple prior operations, polysplenia syndrome, complex anatomy other than asplenia syndrome, and systemic atrioventricular valve regurgitation. These results represent the largest single-institution review of the Fontan operation and suggest that some anatomic and hemodynamic variables previously predictive of poor early outcome have been nullified by current operative methods.

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Objectives: Compression therapy is routinely used after endovenous saphenous ablation therapy (EVLT) for the treatment of varicose veins. The rationale for compression therapy is enhancement of vein closure and prevention of superficial thrombophlebitis (STP). A common patient complaint postoperatively is the discomfort elicited by the compression. The present work aims to determine whether compression therapy is necessary as an adjunct to EVLT.Methods: A total of 77 consecutive lower extremities in 62 patients were treated with EVLT. Forty-two of the treated extremities had postoperative compression, and 35 did not. All patients had duplex evaluation at 1 week after EVLT and then were clinically evaluated at 1 and 3 months. Primary end points were status of the treated vein, presence or absence of STP, and the degree of varicose vein resolution.Results: There was no difference between compression and no-compression groups in sex (63% vs 63% female), age (59 vs 55 years), CEAP class (C 2 -C 3 , 81% vs 91%; C 3 -C 4 , 19% vs 9%), extent of varicose veins (<6 mm, 60% vs 66%; >6 mm, 40% vs 34%), type of vein treated (great saphenous vein, 80% vs 66%; small saphenous vein, 9% vs 20%; accessory, 11% vs 14%) and operative variables. There was a 95% follow-up rate at 1 week, and all lower extremities demonstrated saphenous vein closure. Three patients in the compression group and no patients in the no-compression group had STP. No patients had deep venous thrombosis. At 1 month, both groups had the same rate of varicose vein regression and need for secondary procedures.Conclusions: Compression therapy does not add any further benefit to EVLT and therefore consideration should be given to eliminating it, thus simplifying and improving the postoperative recovery.