Vascular Malfor-mation

What is Vascular malformation?

Vascular malformation is a congenital disease. It contains abnormal blood vessels within the lesion. There are many confusing classification present for vascular malformation, mostly it’s confusing between heamangioma & vascular malformation . Many vascular malformation lesions name given in the memory of scientist who have detected it first. All this multiple classifications makes this disease more complex for understanding. I follow general classification for understanding disease & yakes classification for treatment of disease.
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Symptoms & Diagnosis

Venous malformation may cause pain where ever 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.Arteriovenous malformations 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).

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What is nidus?

Nidus means Nest in Latin word. Nidus of vascular malformation also looks like a bird’s nest. Arteriovenous malformations (AVMs) are defects in the vascular system, consisting of tangles of abnormal blood vessels (nidus) in which the feeding arteries are directly connected to a venous drainage network without interposition of a capillary bed.

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Treatment

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How are these malformations treated?

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 radiologist, who treat patients with image guided procedures. Vascular malformations are treated by embolization & sclerotherapy.
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. Absolute ethanol is injected within nidus of vascular malformation which destroy inner linning of cells of vascular malformation. This will give better results than any other treatment option for vascular malformation.
The VMs and LMs are closed by injecting ethanol into the sacs filled with venous blood or lymph until these sacs collapse and no longer fill.

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‍How effective is the treatment?

Glue , coils & sclerosant like setrol can block lumen of vascular malformation, but they can not destroy inner lining cell of nidus. Nidus cell has potential to grow faster, if they are not destroyed than lesion will regrow in future. By blocking lumen of nidus , hypoxic changes will send signals of neoangiogenesis , that is a reason that vascular malformation will regrow with faster rate after glue treatment.

AVMs may require a series of treatments to destroy nidus. Venous and lymphatic malformations respond well to alcohol embolization. These may also require a series of treatments about 6 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 monitor PAVMs over time to be sure they collapse and do not refill.

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Why do you need experienced interventional radiologist to treat with absolute ethanol embolization?

Absolute ethanol goes into systemic circulation and it will destroy normal vessels also. And also leads to other fatal complications. So one has to go to centre where they are treating such cases with absolute ethanol and enough experience of it. Bankers Vascular Centre is one of the pioneer in India to start absolute ethanol embolization technique & has lot of experience to treat with absolute ethanol embolization.

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Case 1:

Venous malformation of chest wall, suffering from many years. With our treatment pt’s pain disappeared within 3rd sitting.

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Patient Reviews

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