A vascular malformation is an abnormal development of blood vessels.
Any malformation (i.e. congenital deformity) involving vessels is referred to as a “vascular malformation” in this context.
The body can have vascular malformations wherever.
There are venolymphatic malformations (veins and lymph vessels), lymphatic malformations (just lymph vessels), venous malformations (only veins), and arteriovenous malformations (veins and lymph vessels) (arteries directly connected to veins without capillaries in between).
All vascular abnormalities are present at birth, however they don’t all manifest themselves until various ages. Although we are aware that they happen throughout embryonic development, we do not understand their origin. The genetics of vascular abnormalities are now the subject of scientific study.
They could hurt locally. Birthmarks on the skin’s surface may accompany a bulge under the skin caused by venous and lymphatic abnormalities. Klippel-Trenaunay syndrome may be accompanied with venous and lymphatic abnormalities.
They might hurt you. They may stress the heart and lead to cardiac failure if they have a high blood flow. Depending on where they are, they could result in bleeding (in organs like the bowels, the uterus and the bladder). They could also result in ischaemia, which is a significant decrease in blood flow to further-reaching tissues.
By causing a shunt of blood from arteries to veins, an arteriovenous malformation at the ankle level, for instance, may result in ischemic rest discomfort in the forefoot.
Hemangiomas are benign tumours that may be present at birth rather than vascular malformations. Unlike vascular malformations, which develop proportionately to the child’s growth, they expand fast early in life and then exhibit spantaneous involution at a later time (although this process may take years).
How are they diagnosed?
The diagnosis of these lesions is frequently aided by a physical examination. Digital subtractive angiography or magnetic resonance imaging (MRI) may be utilised to examine deeper tissues or show arteriovenous shunts.
How are they treated?
The kind of vascular malformation will determine how it is managed.
When the lesion is somewhat localised, surgical excision in some circumstances may be extremely radical and consequently highly successful. However, a relatively significant vascular abnormality is typically challenging to entirely eliminate and will come back if not.
A multidisciplinary team of medical professionals, including an interventional radiologist, plastic surgeon, orthopaedic surgeon, general surgeon, ENT or thoracic surgeon, may be needed to treat some vascular malformations because they are complex lesions (extensive, affecting multiple tissues or vital organs, etc.). These medical professionals may be needed in addition to the vascular surgeon.
If the feeding artery of a lesion is identified (as is the case with an arteriovenous malformation), embolization can be carried out using an appropriate substance (such as absolute alcohol or “glue,” or N-butyl-2-cyanoacrylate), which is injected via an angiography catheter until the lesion is completely devascularized and has stopped pumping blood through it. Although it could need a succession of treatments, embolization is often a successful technique. With direct puncture and embolization (often using pure alcohol or 3% sodium tetradecyl sulphate, STD), some venous and lymphatic abnormalities may be addressed.
All vascular malformations require long-term surveillance following treatment.
Most importantly at puberty, pregnancy, menopause or after injury, because new symptoms may appear speeding up the need for interventional treatment.
• Cerebrovascular accidents/ Stroke is the 2nd most common cause of disability or death after cardiac illness – in elderly populations.
• 20 % of strokes can be cause by narrowing/ stenosis in carotid arteries (neck vessels)
• Suitable patients can be treated with either Carotid endarterectomy (Open Surgery) or Carotid artery stenting ( Endovascular)
• The benefit of early intervention is highest within 2 weeks of stroke, at which time the risk of recurrent or worsening stroke is highest.
• Early referral to a higher center with dedicated vascular surgeons, is essential for proper management of such cases.
