Low‐flow vascular malformations of the hand and forearm: a multidisciplinary experience in a tertiary paediatric centre

Abstract

Background: Vascular malformations (VMs) involving the hand and forearm in children provide management challenges due to complex anatomy, indispensable functionality and developmental implications. Methods: The institution's Vascular Registry was searched for patients with hand and arm VMs, supplemented by chart review of included patients.Results: Twenty-one patients were identified, 52% male, with mean presenting age 5.2 years. Venous malformations predominated (71%), followed by lymphatic-venous (19%), lymphatic (5%) and glomuvenous (5%). Symptoms included pain (76%), swelling (71%), cosmetic concerns (81%), functional compromise (29%) and stiffness (5%). Imaging modality was ultrasound (100%), and magnetic resonance imaging (71%). Treatment included compression (62%), sclerotherapy (62%) and surgery (24%). Post-sclerotherapy ultrasounds showed complete sclerosis (25%), near complete sclerosis (58%) and partial sclerosis (17%). Post-surgery, patients reported improved cosmesis (80%), size (100%), pain (60%) and function (40%). Complications occurred in 24%, including bleeding, digital ischaemia and thrombosis. Mean follow-up was 3.4 years. Conclusion:Children with low-flow VMs of the hand and forearm experience significant symptoms and functional limitations. A multidisciplinary approach to management ensures optimal outcomes.

Congenital Vascular Malformations in Children: From Historical Perspective to a Multidisciplinary Approach in the Modern Era—A Comprehensive Review

“…Studies on treatment outcomes of sclerotherapy/embolization often focus on a specific CVM subtype, a specific anatomical location, or a specific agent, and the definition of a successful treatment outcome varies, all of which limits comparability. In recent studies on pediatric patients, a complete response was reported in 11-89% of the patients and improvement in 57-100% [34,48,49,51,54,69,70]. In LMs, bleomycin seems to be the most effective agent, and macrocystic lesions often showed a better response than microcystic and/or mixed lesions [49,53,70].…”

“…Cosmetic camouflage may be used to improve the appearance [33]. Compression garments can reduce symptoms and possibly prevent lesion-related complications [34]. Conservative approaches also include proper skin, wound and ulcer care.…”

“…In AVMs, the success rate of embolization was influenced by the angioarchitecture of the nidus [54]. Complication rates varied from 6-25% on the procedural level and from 10-54% on the patient level in recent studies [34,48,49,51,54,69,70], with historical data reporting complication rates up to 82% on the procedural level and 72% on the patient level [50,59,71]. Complications frequently reported include skin necrosis, infections, and (mostly temporary) nerve complications.…”

Effect of Flat-Knitted Medical Compression Stockings on Venous Malformations

“…Venous malformation, defined as a low-flow lesion among vascular anomalies, is the most common form of congenital vascular malformation, which accounts for more than 50% of all vascular malformations, with a prevalence of around 1% [ 1 , 2 , 3 , 4 ]. Formed at birth, venous malformations grow with age and might lead to pain, edema or compression on the surrounding structures, which can lead to a reduced quality of life and the requirement of repetitive medical treatments in order to relieve the discomfort [ 2 , 5 ]. Despite the fact that medical compression stockings are commonly provided as a noninvasive therapy to relieve symptoms of venous and lymphatic disorders, prospective studies verifying the benefit of medical compression therapy in venous malformations are lacking [ 6 , 7 ].…”