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Congenital vascular Malformations are birthmarks treated by vascular surgeons and interventionalists.
There are two types of vascular anomalies according to ISSVA are –
- Vasoproliferative or vascular neoplasms like hemangioma
- Developmental vascular abnormalities called congenital vascular malformations (CVMs) which include venous (VM), arterial (AM), capillary (CM), and lymphatic (LM), and arteriovenous (AVM) malformations.
Clinical Manifestations -
- Infantile hemangiomas observed after birth appear as strawberry marks which require no immediate intervention. They may have spontaneous involution (shrinkage) or recovery (60%–70% involution- 2 years and 90% involution- – 7 years).
- Venous malformations appear bluish, soft compressible masses (subcutaneous or mucosal) without any bruit (spread)/thrill. Thrill presence is typical of AVM.
- Lymphatic malformations are cystic variants (lymphangioma) or soft but non-compressible masses (microcystic variety).
- Some vascular malformations show swelling, pain, ulcer or bleeding according to location and degree of the malformation.
Diagnosis -
First a clinical examination is done and then a Doppler ultrasound followed by an MRI or a CT angiography
Treatment
Not all CVMs require aggressive treatment and some can be managed by compression stockings. CVMs are slowly progressive and may suddenly increase during puberty or post pregnancy.They are best managed using multidisciplinary approach combining nonsurgical, surgical and endovascular methods.
SCLEROTHERAPY
Main treatment for most CVMs.
A single or multiple injections of sclerosant solution (STS, bleomycin or alcohol) are given in the lesion using Doppler or fluoroscopy to reduce swelling size. Though initially hardness or bruising at the injection site may be felt.