Diagnosis and Management of Vascular Malformations of Bone

  • Wayne F. Yakes


Vascular malformations of bone are extremely complex lesions that can present with a myriad of symptomologies. Ethanol endovascular and direct puncture embolization can cure or significantly obliterate these lesions at long-term follow-up. Further, ethanol sclerotherapy in conjunction with coil embolization can treat massive lesions and cure them at long-term follow-up. In low-flow lesions, direct puncture injection of the vein malformation can be curative, lead to new bone formation or obliteration of the vascular cyst, and obviate the need for complex surgeries and their attendant complications.

Vascular malformations, whether of soft tissues or bones, should be managed in centers that routinely treat these lesions. In this fashion, complications can be better managed, minimizing patient morbidity, and practitioners can gain greater experience. Significant experience leads to improved judgment and the refinement of techniques for the management of these challenging lesions.


Vascular Malformation Bone Cyst Aneurysmal Bone Cyst Venous Malformation Direct Puncture 
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  1. 1.
    Mulliken JB, Golawacki J (1982) Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg 69:412–422CrossRefPubMedGoogle Scholar
  2. 2.
    DeTakats G (1932) Vascular anomalies of the extremities. Surg Gynecol Obstet 55:227–237Google Scholar
  3. 3.
    Wollard HH (1922) The development of the principal arterial stems in the forelimb of the pig. Contrb Embryol 14:139–154Google Scholar
  4. 4.
    Reid MR (1925) Studies on abnormal arteriovenous communications acquired and congenital. I Report of a Series of Cases. Arch Surg 10:601–638Google Scholar
  5. 5.
    Boseker EH, Bickel WH, Dahlin DC (1968) A clinical pathologic study of simple unicameral bone cysts. Surg Gynecol Obstet 127:550–560PubMedGoogle Scholar
  6. 6.
    Broder HM (1968) Possible precursor of unicameral bone cysts. J Bone Joint Surg 50A:503–507Google Scholar
  7. 7.
    Chigira M et al (1983) The etiology and treatment of simple bone cysts. J Bone Joint Surg 65B:633–637Google Scholar
  8. 8.
    Cohen J (1960) Simple bone cysts; studies of the cyst fluids and six cases with a theory of pathogenesis. J Bone Joint Surg 42A:609–616Google Scholar
  9. 9.
    Mirra JM (1980) Bone tumors: diagnosis and treatments. Lippincott, Philadelphia, pp 462–477Google Scholar
  10. 10.
    Gebhart M, Blaimont P (1996) Contribution to the vascular origin of the unicameral bone cyst. Acta Orthopaedica Belgica 62:137–142PubMedGoogle Scholar
  11. 11.
    Yakes WF (1992–2008) Personal observation in Budapest (Hungary), Garbagnate (Italy), and Denver (Colorado, USA) during direct injection of multiple unicameral bone cysts of the humerus, vertebral body hemangioma, tibial and aneurysmal bone cysts.Google Scholar
  12. 12.
    Spence KF, Sell KW, Brown RH (1969) Solitary bone cysts: treatment with freeze-dried cancellous bone allegraft. J Bone Joint Surg 51A:87–96Google Scholar
  13. 13.
    Widlus DM, Murray RR, White RI Jr et al (1988) Congenital arteriovenous malformations: tailored embolotherapy. Radiology 169:511–516PubMedGoogle Scholar
  14. 14.
    Yakes WF (2002) Diagnosi e terapia delle malformazioni vascolari ossee. In: Mattassi R, Belov S, Loose DA, Vaghi M (eds) Malformazioni va scolari ed emangiomi. Testo-atlante di diagnostica e terapia. Springer-Verlag Milano, pp 60–65Google Scholar
  15. 15.
    Yakes WF, Rossi P, Odink H (1996) How I do it: arteriovenous malformation management. Cardiovasc Intervent Radiol 19:65–71CrossRefPubMedGoogle Scholar
  16. 16.
    Yakes WF, Luethke JM, Merland JJ et al (1990) Ethanol embolization of arteriovenous fistulas: a primary mode of therapy. J Vasc Intervent Radiol 1:89–96CrossRefGoogle Scholar
  17. 17.
    Yakes WF (1996) Diagnosis and management of vascular anomalies. In: Castaneda-Zuniga WR, Tadavarthy SM (eds) Interventional radiology. Williams and Wilkins, Baltimore, pp 103–138Google Scholar
  18. 18.
    Yakes WF, Pevsner PH, Reed MD et al (1986) Serial embolizations of an extremity AVM with alcohol via direct percutaneous puncture. AJR 146:1038–1040PubMedGoogle Scholar
  19. 19.
    Yakes WF, Luethke JM, Parker SH et al (1990) Ethanol embolization of vascular malformations. Radio Graphics 10:787–796Google Scholar
  20. 20.
    Yakes WF, Luethke JM, Merland JJ et al (1990) Ethanol embolization of AVF: a primary mode of therapy. JVIR 1:89–96PubMedGoogle Scholar
  21. 21.
    Keljo DJ, Yakes WF, Andersen JM, Timmons CF (1996) Recognition and treatment of venous malformations of the rectum. J Pediatr Gastroenterol Nutr 23:442–446CrossRefPubMedGoogle Scholar
  22. 22.
    Yakes WF, Krauth L, Ecklund J et al (1997) Ethanol endovascular management of brain AVMs: initial results. Neurosurgery 40:1145–1154CrossRefPubMedGoogle Scholar
  23. 23.
    Connors JJ, Khan G (1977) Hemangioma of striated muscle. South Med J 70:423–1424Google Scholar
  24. 24.
    Heiss JD, Doppman JL, Oldfield EH (1994) Brief report: relief of spinal cord compression from vertebral hemangioma by intralesional injection of absolute ethanol. N Engl J Med 331:508–511CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2009

Authors and Affiliations

  • Wayne F. Yakes
    • 1
  1. 1.Vascular Malformation CenterSwedish Medical CenterEnglewoodUSA

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