Treatment of Congenital Vascular Malformations - a Single Centre Experience

Abstract

Introduction - Peripheral vascular malformations are congenital lesions containing of arterial, venous and lymphatic component and because of severe clinical consequences such as: functional and esthetic impairment caused by significant impact on local tissue structures, unpredictable clinical course, influence on the cardiovascular system and high recurrence rate require extensive treatment. A multidisciplinary approach and modern diagnostic and therapeutic techniques are key factors improving their management. Methods - 42 patients with congenital vascular malformations (14 males, 28 females) aged 14,2-59,9 years were treated between 2002-2017 in our Department, six of whom underwent previously a surgical operation of ligation of the arteries supplying the anomalous network of low-resistance blood vessels with blood that did not contribute to any reduction of the lesion. All the patients underwent a physical examination, Duplex-Doppler examination and angio-CT scan preoperatively as well as during planned follow-up visits at periodic intervals. In some cases MRI scans were also performed. Treatment inclusion criteria covered: pain (28,6%), swelling (28,6%), ulceration or bleeding (9,5%), organ malfunction (19%) and disfiguring lesion (100%). Embolization procedures were performed with the use of commercially available agents – 95% ethyl alcohol -23 patients, Ethylene vinyl alcohol copolymer (Onyx) – 8, synthetic surgical glue (Glubran) – 3, Polidocanol -3, Polivinyl alcohol (PAV) and Histoacryl simultaneously – 2, Ethanol 95% with Onyx – 1, Ethanol 95% with PAV – 1, Bleomycin -2 . Clinical outcomes of the treatment were assessed during 1 - 144 months follow up period. Results - Immediate good morphological and hemodynamic results were obtained in all 42 (100%) cases, clinical success (which is very difficult in assessment) was achieved in 40 (95,2%) patients. The complications appeared in two patients: peroneal and tibial nerve palsy in the former, hand phlegmon in the latter. Vast majority of patients remained asymptomatic (or the symptoms were significantly reduced) during the follow up period. Conclusion - 1. Therapy of the vascular malformations still remains a challenge for the therapists.2. Surgical operation should not be the first line of treatment of vascular malformations.3. Embolisation with alcohol is now considered a treatment of choice in patients with low-flow malformations.