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 veno-lymphatic malformations (veins and lymph vessels), lymphatic malformations (just lymph vessels), venous malformations (only veins), and arterio-venous malformations (veins and lymph vessels) (arteries directly connected to veins without capillaries in between).
Although all vascular malformations are present at birth, they become obvious and visible at different ages. We know that they occur during embryonic development, but we do not know what causes them. These may occur within families(genetic) or may occur without any familial history of similar problems (sporadic). There is much scientific work done with regard to the genetics of vascular malformations, and newer information becomes available to us daily to guide further treatment.
Venous Malformations – They may result in localised discomfort or swelling that gradually gets bigger.
Venous and lymphatic malformations may result in a birthmark on the skin’s surface as well as an under-the-skin swelling. Klippel-Trenaunay syndrome may be accompanied with venous and lymphatic abnormalities.
Arteriovenous malformations – They are seen as swellings which pulsate with heart beat or abnormal enlargement of one side of body with enlarged veins. These may also cause pain. Occasionally there may be a break in the skin with ulcer formation. If there have a very high blood flow, they may cause cardiac failure. Depending on their location they may cause bleeding (in organs like the bowels, the uterus and the bladder). They may also cause ischaemia, i.e. significant reduction of blood flow to distal tissues; for example, an arteriovenous malformation at the level of the ankle may cause ischaemic pain in the foot because of drawing of blood from arteries to veins.
A haemangioma is not the same as a vascular malformation, but a benign tumour which may be present at birth.
Haemangiomata may also present as birthmarks, however, they grow rapidly early in life and at a second stage they show spontaneous resolution (although this process may last for several years), as opposed to the vascular malformations which grow proportionally to the child’s growth. Vascular malformations do not resolve spontaneously.
Physical examination is essential in the initial evaluation of these lesions. To study deeper tissues or to demonstrate arteriovenous shunts, magnetic resonance imaging (MRI) or digital subtractive angiography may be used.
The kind of vascular malformation will determine how it is managed.
In some circumstances, surgical removal may be feasible and highly successful if the lesion is reasonably localised. 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.
When a lesion’s feeding artery is identified (as in the case of an arteriovenous malformation or a haemangioma), embolization can be carried out using a suitable 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 embolization may need numerous treatment sessions, it is often a successful approach. With direct puncture and embolization (often using pure alcohol or 3% sodium tetradecyl sulphate, STD), some venous and lymphatic abnormalities may be addressed.
Most particularly during puberty, pregnancy, menopause, or after injury since new symptoms and swellings may arise that may necessitate extra interventional therapy, all vascular abnormalities require long-term observation – even after treatment.
