Peripheral vascular malformations encompass a wide spectrum of lesions that can present as an incidental finding or produce potentially life-or limb-threatening complications. They can have intra-articular and intraosseous extensions that will result in more diverse symptomology and present greater therapeutic challenges. Developments in classification, imaging and interventional techniques have helped to improve outcome. The onus is now placed on appropriate detailed preliminary imaging, diagnosis and classification to direct management and exclude other more common mimics. Radiologists are thus playing an increasingly important role in the multidisciplinary teams charged with the care of these patients. By fully understanding the imaging characteristics and image-guided procedures available, radiologists will be armed with the tools to meet these responsibilities. This review highlights the recent advances made in imaging and the options available in interventional therapy.Peripheral vascular malformations (PVMs) encompass a wide spectrum of lesions that can present as an incidental finding or produce potentially life-or limb-threatening complications. PVMs are relatively common within the extremities and usually confined to the subcutaneous tissues and muscles. They can have, however, intra-articular and intraosseous extensions that will result in more diverse symptomology and present greater therapeutic challenges. Any misdiagnosis can lead to inappropriate management and treatment.
This study showed that the DMAA varies significantly in a linear pattern with axial rotation of the first metatarsal. Inclination of the first metatarsal also affects the magnitude of the angle. This study does not refute the DMAA as an entity but does confirm the inaccuracy of extrapolating the DMAA from plain anteroposterior radiographs.
cases of aortoesophageal fistula caused by corrosive ingestion are reported in the literature.In cases of surgically repaired aortoesophageal fistulas reported in the literature, 2,3 suture or prosthetic graft replacement of the aorta did not prove to be an adequate treatment because death from secondary hemorrhage often occurred because of late dehiscence and reopening of the aortic breach. The first case of aortoesophageal fistula repair with an endovascular stent graft was reported by Kato and associates 4 in 2000. In this case the fistula was caused by irradiation of an esophageal cancer, and therefore intervention was palliative. In our case the aim was a definitive and minimally invasive treatment in a critically ill young man with impending coagulopathy. Endovascular treatment after primary repair of the laceration in the esophagus and in the aorta and after extensive debridement was the only way to definitively treat this condition while avoiding further surgical stress to the patient. In our case the infective risk for the endoprosthesis was minimal because of preoperative broad-spectrum antibiotic therapy and deployment of the graft inside an intact aortic wall. Successful surgical treatment of aortoesophageal fistulas caused by corrosive injury is rarely reported in the literature, and no cases of endovascular repair of this condition have been reported. Because surgical treatment alone is not able to result in a definitive solution, endovascular repair of the fistula and strengthening of malacic aortic walls by means of a stent graft can be a life-saving and successful approach. Further experience and follow-up will eventually confirm this result.
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