Principles of Treatment of Vascular Malformations

Abstract

Precise knowledge of the haemodynamic and pathological characteristics of vascular malformations allows individualised treatments to be planned. The therapeutic approach should be flexible and should be addressed to maximise the benefits and to reduce the risks of the treatment. Haemodynamic treatments are beneficial in cases of truncular malformations and AV shunts. Devascularization procedures are useful in cases of infiltrating extratruncular malformations. Each congenital vascular malformation (CVM) should be investigated according to its type, localization and symptoms in order to find the best treatment option [1].

Pediatric patients affected by CVM and vascular bone syndromes should be treated by vascular intervention in order to achieve a normalization of limb length. Orthopedic interventions should be undertaken only in older patients and in children who present a huge limb length discrepancy [2].

Sometimes it may be difficult for a single specialist to successfully treat a complex CVM. This is due to the difficulty in managing a multi-vessel disease which can infiltrate any kind of tissue. The advice of different specialists, according to the location of the malformation, may offer the best option for safely and successfully treating some types of extended and infiltrating CVM.

For each patient, the following issues should be addressed:

• 1. Therapy should be chosen in order to remove the vascular malformation or the hemodynamic disturbances caused by the vascular malformation.

• 2. The removal of the vascular malformation may or may not be radical; a strategy based on multiple interventions may often be indicated.

• 3. Multiple interventions strategy needs a treatment plan and a goal for each single step of treatment.

• 4. As different strategies may be available, the least invasive and simplest should be selected.