Peripheral Vascular Malformations: Imaging, Treatment Approaches, and Therapeutic Issues

Abstract

Peripheral vascular malformations are now described according to some accepted guidelines, and the principle of proper treatment (nidus ablation) is becoming clear. An appropriate classification scheme for vascular anomalies and definite indications for treatment are important to successful treatment overall. The findings from noninvasive imaging (ie, Doppler ultrasonography, computed tomography, or magnetic resonance imaging) in association with clinical findings are critical in establishing the diagnosis, evaluating the extent of the malformation, and planning appropriate treatment. Direct opacification of the nidus is useful, not only in making a correct diagnosis, but also in treating the lesion with sclerotherapy. In most cases, conservative treatment is recommended, but when a patient suffers clinical complications (eg, ulceration, pain, hemorrhage, cardiac failure, or unacceptable cosmetic consequences), the nidus sclerotherapy becomes mandatory. If the vascular malformation has blood outflow to a drainage vein during nidus opacification, flow control (with balloon occlusion, tourniquet, or embolization) is necessary to achieve sclerosant stasis within the nidus. Embolotherapy (with a coil, n-butyl cyanoacrylate, or small particles) should be used for subsequent multifaceted palliative therapy. A multi-disciplinary approach is needed in the treatment of a high-flow lesion, and a dedicated team approach is necessary for appropriate management in most cases.

Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition

“…In addition, NBCA has been indicated for arterial redistribution and hepatic arterial catheter fixation during hepatic arterial infusion chemotherapy [68,159,180,181]. In the venous system, retrospective studies examining the use of NBCA for percutaneous transhepatic portal venous embolization have also been reported [19,45,48,49,77], and there have been several studies about the use of NBCA for pelvic congestion syndrome and varicoceles [27,65,109,157].…”

US and MRI features in venous vascular malformation of the abdominal wall. A case report

“…Ohgiya et al measured the time interval between the onset of enhancement and maximum percentage of enhancement in the lesion, the so-called "contrast rise time" (CRT). They showed that LFVM presented a mean contrast rise time of 88 s. A CRT threshold of 30 s was set, guaranteeing 100% specificity and sensitivity in the differentiation of low-flow from high-flow VMs [2,7]. Sclerotherapy is the mainstay of treatment; it is based on the injection of an agent (commonly absolute ethanol) to induce an inflammatory reaction and obliteration of the affected veins.…”

“…Sclerotherapy is the mainstay of treatment; it is based on the injection of an agent (commonly absolute ethanol) to induce an inflammatory reaction and obliteration of the affected veins. Selected cases should undergo surgical resection later [2] (Table 2).…”

“…It is classified as lowflow VM based on the angiographic features (Table 1) [1,2]. VVMs consist of thin-walled, dilated, sponge-like vessels with normal endothelial lining and deficient smooth muscle tissue.…”

Multiple Low Flow Vascular Malformation with Phleboliths – A Case Report

“…21 Hyodoh H et al reported excellent results with sclerotherapy in 53%-100% patients. 22 According to Lee BB et al, success rates using absolute alcohol have been reported in up to 95% with no evidence of recurrence. 23,24 Results In comparison to hemangiomas, vascular malformations diagnosed at birth shows no signs of involution with age and might expand close to puberty.…”