Vascular malformation is a general term that includes congenital vascular anomalies of only veins, only lymph vessels, both veins and lymph vessels, or both arteries and veins.
These are all present at birth and become apparent at different ages. We are just beginning to understand how malformations occur. The pulmonary arteriovenous malformation, when associated with Hereditary Hemorrhagic Telangiectasia (HHT) is inherited genetically. There is currently much work being done on the possible genetics of other malformations. Most are only known as something that occurs during development of the arteries, veins, and lymph vessels, but without specific cause.
These vascular malformations can cause a variety of symptoms depending on the location in the body:
may cause pain wherever they are located. Venous and lymphatic malformations may cause a lump under the skin. There may be an overlying birthmark on the skin. Bleeding or lymph fluid leaking may occur from skin lesions. Lymphatic malformations tend to become infected, requiring repeated antibiotic treatments. Venous and lymphatic malformations may be associated with a syndrome called Klippel-Trenaunay Syndrome.
is another common term used for vascular anomalies. However, this name actually applies to a childhood vascular anomaly that has a rapid growth phase between birth and 3 months of age. These will resolve completely by age 7.Haemangioma most commonly appears on the face, scalp, chest or back. Treatment of a hemangioma is usually unnecessary unless the nodule interferes with vision or breathing, or in rare cases of internal hemangiomas causes or contributes to other medical problems.
may cause pain. They are also more stressful on the heart because of the rapid shunting of blood from arteries to veins. Depending on their location, they may also result in bleeding (for example from the bowels, from the uterus or from the bladder).
Blood vessel abnormalities may accompany a variety of genetic or inherited syndromes. Patients that present with vascular malformations will receive multidisciplinary care to ensure coordinated treatment for all of their symptoms. A wide variety of combinations and syndromes commonly associated with vascular malformations are treated by Interventional Radiology, with additional collaboration from other multidisciplinary teams.These include:
These can often be seen on physical examination. Deeper vascular malformations can be diagnosed on MRI (magnetic resonance imaging).
Although surgery is sometimes useful, it is usually difficult for surgeons to completely remove vascular malformations, which will return if not removed completely. A nonsurgical method of closing down the blood or lymph flow into the malformation is done by interventional radiologists, who treat patients with image guided procedures. Vascular malformations are treated by embolization. The AVMs and hemangiomas can be closed by advancing a tiny plastic tubing, no larger than a pencil point, into the feeding artery to the malformation. This can be done without incisions or stitches, and with only mild sedation. Medical glue or alcohol or small beads are then floated into the malformation until it is full and no longer has blood flowing through it. For the VMs and LMs are closed by injecting alcohol into the sacs filled (sclerotherapy) with venous blood or lymph until these sacs collapse and no longer fill .
The arteriovenous malformations can be treated with a short hospital stay. There is usually minimal discomfort for one to three days. The venous and lymphatic malformations require no hospital stay. These malformations swell after treatment with alcohol, and the swelling and pain may last for three to five days. During this time, we give patients medication for any pain or swelling they may have. The full shrinkage of these malformations may take four to six weeks.
Arteriovenous malformations are more difficult to treat since they tend to pull in new artery feeders from time to time. However, embolization is very effective in blocking abnormal artery feeders while preserving normal arteries. AVMs may require a series of treatments to block all of the abnormal feeders. Venous and lymphatic malformations respond well to alcohol embolization. These may also require a series of treatments about six weeks apart to block all of the abnormal vessels. All vascular malformations require long term surveillance, so that if there is any change, such as a growth spurt with puberty or pregnancy or menopause, they can be monitored for symptoms that may warrant rechecking and possibly retreating.
We can treat any age from newborn to adult. The best age of treatment depends on the specific vascular malformation and its symptoms, and is best individualized to each person.
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For decades, women with uterine fibroids, or benign growths inside the uterus, commonly have been offered two options to manage the symptoms—get a hysterectomy, or just deal with the pain.
Male infertility often involves low sperm count. Varicocele, swollen veins within the testicles, is a common contributor and can impact sperm health.
Varicose veins are bulging, twisted veins that can be seen and felt right under the skin. They commonly occur on the legs, and are present in up to 30% of people.
