Vascular malformations

Vascular malformations are abnormalities in the formation of blood or lymphatic vessels. They are present from birth, although sometimes they do not show until childhood, adolescence or adulthood. Unlike haemangiomas, they do not go away on their own.

Types

They are classified according to the international classification of the ISSVA (International Society for the Study of Vascular Anomalies), which mainly distinguishes:

Symptoms

• A lump or patch on the skin, sometimes present from birth.
• Pain, swelling or heaviness, which may worsen with exercise or hormonal changes.
• Clotting inside the malformation (phleboliths) in venous malformations.
• In high-flow malformations, bleeding, ulcers or, in extensive cases, strain on the heart.

Diagnosis

• Medical history and physical examination.
• Duplex ultrasound: shows whether the malformation is low-flow or high-flow.
• MRI: shows its extent and its relationship to muscles, nerves and bones.
• Angiography in high-flow malformations, when treatment is being planned.

Treatment

Not all of them need treatment: many are managed with compression stockings and follow-up. When they cause symptoms or complications, the options are:

• Sclerotherapy: ultrasound-guided injection of a sclerosing drug, for venous and lymphatic malformations.
• Embolisation: closing the abnormal vessels with specific materials delivered through catheters, mainly in high-flow malformations.
• Skin laser for capillary malformations.
• Surgical resection for localised lesions, often combined with the techniques above.

Because of their complexity, treatment is planned by a multidisciplinary team including plastic, paediatric and maxillofacial surgery, interventional radiology and dermatology. For years I was a member of the Interdisciplinary Committee on Vascular Anomalies at Hospital Universitari Son Espases.

References

Patient information reviewed by Dr Óscar Merino, vascular surgeon. It does not replace an individual medical assessment.