Vascular Abnormalities of the Extremities

Rogalski, Roger P.; Hensinger, Robert N.; Loder, Randall T.

doi:10.1097/01241398-199301000-00003

Cited by 50 publications

(24 citation statements)

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“…There was no correlation found between the pathology, only available in 55%, and the initial symptoms. In the literature, several authors have noted female preponderance of patients with these lesions [1,3]. We, however, did not find this with 20 males and 18 females in this series.…”

Section: Discussioncontrasting

confidence: 84%

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Haemangiomas and vascular malformations of the limb in children

et al. 2007

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Haemangiomas and vascular malformations of the limb in children are often difficult to manage. The role of surgery and intervention in current management is still not clear. The aim of this study was to review our experience of such patients. Patients were identified using the health board database of inpatient admissions between 1999 and 2003. Clinical notes were reviewed and data collected looking at patient demographics, site of lesion, clinical findings, investigative procedures, intervention and follow-up. A total of 288 patients were identified with a diagnosis of "Haemangioma" or "vascular malformation". Thirty-eight of these patients were found to have limb haemangiomas or vascular malformations (20 boys and 18 girls). The median age at referral was 1.9 years (0-13.2). The clinical presentation included gigantism, swelling, bruising, bleeding and cosmetic concern. Cosmetic concerns and bleeding being the most frequent. Investigative modalities were used in 19 patients. These included ultrasound, CT, MRI and angiography. Many patients had more then one imaging modality employed. Treatment options included observation, steroids, laser, embolisation and surgical excision. Twenty-five patients (66%) required surgical intervention. Most patients were required one or two procedures, mainly laser or simple excision. However two patients required multiple procedures while one patient with Kasabach-Merritt syndrome required a limb amputation. Patients were followed-up for a median of 3.75 years (0.08-14). Two patients were lost to follow-up. Two patients were noted to have related psychological problems. Haemangiomas and vascular malformations of the limb can be associated with significant functional impairment, especially if they are extending to deeper tissue planes. Such patients are likely to require surgical intervention. For many patients referred to tertiary care, surgery is still the mainstay of treatment and the only curative option. Serious complications were more common in patients with arterio-venous malformations and Kasabach-Merritt syndrome. Two of 38 patients (5.3%) were referred for formal psychological assessment. Given the potential for psychological morbidity we fear this is an aspect of care that may be under-recognised and require further specialist input.

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Section: Discussioncontrasting

confidence: 84%

“…There have been many different classifications described with regard to haemangiomas and vascular malformations. Until recently no one system was regarded as the gold standard [1]. This led to difficulty and confusion when trying to interpret data, as well as correctly diagnose lesions and treat them.…”

Section: Discussionmentioning

confidence: 99%

Haemangiomas and vascular malformations of the limb in children

et al. 2007

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“…They occur most often in the trunk and extremities, and are uncommon in the head and neck region. Over 90% of all intramuscular hemangiomas are misdiagnosed [2]. We report here a case of intramuscular cavernous hemangioma of the masseter muscle, which was misdiagnosed preoperatively as a parotid tumor, along with its imaging and pathologic findings.…”

Section: Introductionmentioning

confidence: 79%

“…Large vessel (cavernous) and mixed vessel intramuscular hemangiomas have a longer history of symptoms, involve the lower trunk and extremities, and tend to be larger in size [4]). Only 8% of all cases of intramuscular hemangioma are accurately diagnosed before operation [2]. The lack of objective clinical findings, and the rare incidence of this lesion, often lead to misdiagnosis.…”

Section: Discussionmentioning

confidence: 96%

Intramuscular cavernous hemangioma arising from masseter muscle: a diagnostic dilemma (2006: 12b)

Lee

Kwon

2007

Eur Radiol

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We report here a case of intramuscular cavernous hemangioma of the right masseter muscle in a 41-year-old woman-misdiagnosed preoperatively as parotid tumor-along with its imaging and pathologic findings. Preoperative diagnosis of intramuscular cavernous hemangiomas of the masseter muscle is problematic, in that they may be confused with parotid tumor or other muscular lesions. In a patient with soft-tissue mass suspected of representing a hemangioma, MR imaging may provide more specific information regarding the characteristics, the origin, and the extent of the lesion than other imaging modalities.

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“…1,2 Because of the complications that they produce in advanced stages, arteriovenous malformations should be regarded as malignant tumors. 3,4 Although the lower extremities are among the most common locations of arteriovenous malformations, they are infrequent in comparison with other types of lesions that affect the foot, and are usually not considered in the differential diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Prevention of a Foot Amputation: A Large Arteriovenous Malformation Reconstructed with a Composite Free Flap

Aubá

Hontanilla

2007

Plastic and Reconstructive Surgery

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A case of a patient with a large arteriovenous malformation in the medial plantar aspect and dorsum of the foot is presented. Embolization and surgical management of the malformation allowed a successful outcome, avoiding amputation of the foot and preventing recurrence of the lesion. Although arteriovenous malformations are not frequent entities, they have to be considered in the differential diagnosis of lesions that may affect the lower extremities. The earlier the diagnosis and treatment of these malformations, the lower the morbidity. In large arteriovenous malformations, before radical treatment is envisaged, surgery combined with embolization may achieve good results. CASE REPORTA 33-year-old man with an unremarkable medical history had been diagnosed with arteriovenous malformation of the right foot ( Fig. 1). The patient presented an interdigital ulceration in the first space between the toes, not related to previous trauma. Four years previously, a competent deep venous system had been visualized by echography-Doppler, and saphenectomy and ulcer debridement of the ulceration were performed. However, the ulcer reappeared after the wound was grafted. Two years later, arteriography was performed and provided diagnosis of an arteriovenous malformation located on the dorsum and medial plantar aspect of the right foot. The arteriovenous malformation was dependent on the posterior tibial artery and dorsalis pedis artery.In our department, the patient reported an increasing limitation of daily activities and the inability to wear shoes because of ulceration in the distal dorsal aspect of the right foot. Amputation of the right foot had been advised at another center. Physical examination showed a 4 ϫ 2-cm ulceration with local signs of infection in the first interdigital space of the foot, which extended to the dorsal area ( Fig. 1, above, left). A firm soft-tissue mass was palpable in the medial side of the plantar right foot, extending from the metatarsophalangeal joints to the distal border of the talus (Fig. 1, above, right). It was not pulsatile and the mass lacked a bruit or thrill. There were hyperpigmented changes overlying the lesion in the plantar side of the foot. The extremities were equal and symmetrical in size and appearance. Digital subtraction arteriography showed a high-flow arteriovenous malformation affecting the soft tissue of the dorsal and medial plantar aspects of the right foot (Fig. 1, below, left).The vessels involved in the arteriovenous malformation were the metatarsal plantar branches of the posterior tibial artery and dorsalis pedis artery branches. The posterior tibial artery showed a lobular and tortuous morphology, with aneurysmatic dilatations. Once the extent of the nidus, its blood supply, and its collateral supply had been mapped using digital subtraction arteriography, surgical excision of the lesion was proposed. Magnetic resonance images showed an enlargement of vessels into the flexor muscles of the foot together with an increased signal from the skin paddle (Fig. 1, be...

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Vascular Abnormalities of the Extremities

Cited by 50 publications

References 0 publications

Haemangiomas and vascular malformations of the limb in children

Haemangiomas and vascular malformations of the limb in children

Intramuscular cavernous hemangioma arising from masseter muscle: a diagnostic dilemma (2006: 12b)

Prevention of a Foot Amputation: A Large Arteriovenous Malformation Reconstructed with a Composite Free Flap

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