Introduction to Peripheral Vascular Malformations

A vascular malformation is an abnormal mass/ growth  of blood vessels that can occur anywhere in the body. Most common location is head and neck area followed by limbs and abdomen/chest wall. Uncommonly, vascular malformations are seen affecting abdominal organs and lungs.  These malformations are benign noncancerous masses. They unfortunately tend to grow over period of time invading surrounding structures. This growth can be slow or rapid with some periods of rapid growth seen especially during puberty. Vascular malformations can present at any age group contrary to popular perception that these are usually conditions affecting children and young.

There are different types of vascular malformations encountered in clinical practice.

Some of the common types include:

• Arteriovenous malformations (AVM): These are usually large pulsating masses tending to more localised in nature.
• Venous malformations (VM): Abnormal enlargements of the wall of veins, appear as bluish or skin-coloured, soft lumps under the skin. These are usually more diffuse.
• Lymphatic malformations (LM): These are usually localised skin-coloured soft tissue masses that are composed of abnormal lymphatic channels.
• Lymphovenous malformations (LVM): These are usually combination of above two and are less commonly seen.
• Hemangioma: This is a benign tumor of blood vessels. This is commonly known as  red birthmark on infants, which can be anywhere on the body (often on the face, scalp, back or chest).

Clinical Presentation

Vascular malformations usually present as soft tissue masses or lumps. Other symptoms include enlargement of affected parts, bleeding, infection or inflammation that my be recurrent. Since they can affect any part of the body, the presenting symptoms may be variable depending on the location involved.

Diagnosis

Diagnosis usually is made after a clinical examination. Most useful scan for diagnosis is MRI scan with some patients needing US or CT scan for further treatment planning.

Treatment of Vascular Malformations

Treatment of vascular malformations is complex often requiring multidisciplinary approach to treatment. It often requires dedicated treatment that is best managed by practitioners well versed with management of these conditions.

Some of the treatment options include:

1. Medical management: Some of these lesions respond well to medication.
2. Surgical excision: These can often recur rapidly especially after incomplete excision row again if not completely excised. Surgery can often be complex and disfiguring.
3. Sclerotherapy: This is a interventional technique that is used to stop the growth of the malformation. Depending on the size and type of the malformation, multiple treatment sessions may be needed.
4. Embolization: An interventional treatment used to block off blood flow to abnormal blood vessels without affecting the normal blood vessel.
5. Laser treatment: Used more commonly for hemangioma that cause symptoms and do not resolve with medication or spontaneously. A significant number of hamangiomas resolve by the time a child reaches 6 years of age.
6. Cryoablation