Vascular malformations are abnormal clusters of blood vessels that develop while the foetus is in the womb.
There are a number of different types of vascular malformations.
- Venous malformations are veins, which have developed abnormally, and are the most common form of vascular malformations.
- Lymphatic malformations are sponge-like collections of abnormal growths that contain clear fluid.
- Venolymphatic malformations are vascular malformations that affect both veins and lymph vessels, resulting in cysts or varicose veins.
- Arteriovenous malformations are abnormal connections between veins and arteries.
While all forms of vascular malformation are congenital (present at birth), it may take weeks or even years for them to become noticeable.
What Type of Procedures Are Conducted?
Often, vascular malformations are visible in a physical examination. If you have superficial vascular lesions, these can be evaluated with ultrasound, but for deeper lesions ultrasound is limited in the information it can provide.
Ultrasound with Doppler sonography can be used to show the flow and speed of the blood.
MRI is the most useful diagnostic tool for evaluating vascular malformations. MRI can show the exact location of the core of the vascular malformation (known as the nidus), how far the malformation extends and how it is connected with the surrounding vessels. MRI can also be used to gain information on the blood flow in these lesions, and is useful for assessing the success of the treatment during follow-up.
Minimally invasive image-guided interventions, performed by an interventional radiologist, are the treatment of choice for vascular malformations.
These techniques include embolisation and sclerotherapy, and are carried out under fluoroscopy. During these procedures, the interventional radiologist will guide a catheter to the vascular malformation and will then insert alcohol, glue or small beads into the surrounding vessels to block blood or lymph flow to the malformation. The aim of this is to destroy the core of the malformation, and the success of the procedure will be confirmed using angiography. Patients have a local anaesthesia for these procedures and tend to be hospitalised for one day.
When Is A Procedure Conducted?
Procedures are generally conducted when a patient experiences and complains about pain. Depending on the location of the vascular malformation, patients may experience other symptoms such as birthmarks and swelling of the limbs.
If the patient has a lymphatic malformation, infection may cause complications. In some cases, arteriovenous malformations are stressful on the heart or cause bleeding complications. Patients with pulmonary arteriovenous malformations may experience symptoms such as low oxygen supply, shortness of breath, fatigue and coughing.
How Will I Feel After An Embolisation or Sclerotherapy?
You may experience minimal discomfort for a couple of days. If required, pain medication may be administered.
Depending upon the type of vascular malformation and procedure conducted, you will be able to return to your normal activities within a few days to a week.
How Successful Is An Embolisation or Sclerotherapy?
Pulmonary arteriovenous malformations are very effectively treated by embolization, which blocks only the abnormal artery feeder, and preserves the normal lung arteries. Patients usually notice an immediate improvement in symptoms with the immediate increase in oxygen level.
Other arteriovenous malformations are more difficult to treat since they tend to pull in new artery feeders from time to time. However, embolisation is very effective in blocking abnormal artery feeders while preserving normal arteries. AVMs may require a series of treatments to block all of the abnormal feeders.
Venous and lymphatic malformations respond well to alcohol embolization. These may also require a series of treatments about 6 weeks apart to block all of the abnormal vessels.
All vascular malformations require long term surveillance, so that if there is any change, such as a growth spurt with puberty or pregnancy or menopause, they can be monitored for symptoms that may warrant rechecking and possibly retreating. We monitor PAVMs over time to be sure they collapse and do not refill.
Embolisation techniques have been used extensively all over the world for the past 30 years. They have been well established for many years, and have proved invaluable in treating vascular malformations.
Summary of Benefits of Embolisation and Sclerotherapy in Treating Vascular Malformations.
- Embolisation is a highly effective way of controlling bleeding
- Embolisation is much less invasive than conventional open surgery. As a result, there are fewer complications and the hospital stay is relatively brief - often only the night after the procedure. Blood loss is less than with traditional surgical treatment, and there is no obvious surgical incision
- Embolisation is used to treat vascular malformations that either cannot be removed surgically or would involve great risk if surgery was attempted
- No surgical incision is needed - only a small nick in the skin that does not have to be stitched closed
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