Peripheral limb vascular malformations: an update of appropriate imaging and treatment options of a challenging condition

Abstract

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.

A Clinical Feasibility Study to Image Angiogenesis in Patients with Arteriovenous Malformations Using 68Ga-RGD PET/CT

“…These 68 Ga-RGD PET/CT findings may have implications for treatment planning in patients with no clear nidus visible on angiography or patients with a complex or large AVM. Previous studies demonstrated that, for complex AVMs, the lack of standardized and accurate interpretation of images from conventional techniques hampers correct diagnosis and accurate treatment planning (25). Furthermore, 4D-CTA and plain angiography provide detailed information on the extent and angioarchitecture of the AVM, but further investigation is needed to evaluate if the angiogenic status of AVM can be used to determine which part of the AVM should be considered as therapeutic target.…”

ACR Appropriateness Criteria® Clinically Suspected Vascular Malformation of the Extremities

“…Vascular malformations more commonly represent isolated spontaneous lesions yet can be part of one of several syndromes such as Parkes Weber syndrome [1,3]. These typically grow commensurate with patient age, often in conjunction with hormonal changes, such as puberty and pregnancy [3][4][5][6]. Therefore, vascular malformations that are present at birth may not present clinically until adolescence or adulthood.…”

Arteriovenous malformation manifested after subclavian central venous catheterization

“…1,3,4 AVM is commonly present at birth in a quiescent stage. 3,4 The aberrant vascular growth is triggered by a variety of stimuli such as hormonal changes during puberty or pregnancy, thrombosis or infection.…”

“…3,4 The aberrant vascular growth is triggered by a variety of stimuli such as hormonal changes during puberty or pregnancy, thrombosis or infection. [1][2][3] AVM can also emerge after trauma in adults. 2 Herein, we describe a case of AVM that manifested after subclavian central venous catheterization (CVC).…”

“…Dear Editor, Arteriovenous malformation (AVM) is a vascular malformation composed of multiple vascular dysplastic channels called a "nidus", which shunts blood from the arterial system to the venous one. [1][2][3] Histopathologically, AVM contains many vessels of varying size, including thick-walled arteries and thinwalled veins, with normal proliferation of endothelial cells. 4 Vascular malformations are rheologically subdivided into fastflow and slow-flow types.…”