Vascular malformations of upper and lower extremity – from radiological interventional therapy to surgical soft tissue reconstruction – an interdisciplinary treatment

Abstract

This article presents our experience in managing peripheral vascular malformations of upper and lower extremities over a 4-year period in a series of 46 patients of the Department of Plastic Surgery treated in the Interdisciplinary Center of Vascular Anomalies (ICVA) at the University of Regensburg. The patients presented vascular malformations of upper and lower extremity and were selected from our prospective vascular anomalies file archive from 2012 to 2016. During this period in the ICVA at University of Regensburg were performed more than 1400 radiological interventional treatments in patients with vascular malformations.The purpose of this retrospective study was to review combined embolotherapy, sclerotherapy (embolo/sclerotherapy), and surgical procedures (surgical excision and soft tissue reconstruction) to manage vascular malformations. Treatments were principally induced to reduce pain, daily physical limitations, social discomfort and recover tegument continuity after ulceration.The 46 patients were first examined with noninvasive radiological procedures. After diagnosis was posed, embolo/sclerotherapy, surgical procedures and clinically as well as radiological follow-ups were coordinated and established by the multidisciplinary team. All vascular malformations were categorized according to the classification approved at the April 2014 General Assembly of International Society for the Study of Vascular Anomalies (ISSVA) in Melbourne, Australia. Arteriovenous malformations (AVMs) were further classified following the Cho-Do and Schobinger classification.Embolo/sclerotherapy shows to be the most appropriate procedure in vascular malformations treatment. Nevertheless was found that in case of complications or lack of improvement as well as to improve functional or aesthetical results, a following partial or complete surgical excision and immediate soft tissue reconstruction seems to be the gold-standard treatment. In addition, the precise clinical and radiological diagnosis as well as an intensive postoperative patient care have a significant positive influence on the clinical outcome and patient satisfaction while decreasing morbidity and recurrence during early and late follow-up.Vascular malformations require a multidisciplinary approach and individual treatment after complex excision and indispensable reconstruction.

Efficacy and Tolerance of Sirolimus (Rapamycin) for Extracranial Arteriovenous Malformations in Children and Adults

“…Romain GABEFF 1-3# , Olivia BOCCARA 4# , Véronique SOUPRE 5 , Gérard LORETTE [1][2][3] , Christine BODEMER 4 , Denis HERBRETEAU 1,2,6 , Elsa TAVERNIER 7,8 and Annabel MARUANI [1][2][3]8…”

“…When AVMs are not complicated, the "wait and see" attitude might be relevant. If necessary, therapeutic management results, at best, after multidisciplinary consultations (4,5), considering arterial embolization alone or followed by radical surgery of the lesion (5,6). In some cases, embolization and surgical intervention are not possible or are not sufficiently effective, and we lack efficient background drugs.…”

Vascular Anomalies (Part II): Interventional Therapy of Peripheral Vascular Malformations

“…Invasive therapy is indicated in conjunction with conservative management in symptomatic VMs to reduce pain, disfigurement, hemorrhage, and impairment of neighboring structures or to reduce the thromboembolic risk. Percutaneous sclerotherapy is the first-choice invasive treatment method and can be combined with additional laser therapy or surgical procedures [22]. However, evidence is low and the choice for the invasive method remains a shared decision between the patient and a multidisciplinary team of specialists [22,23].…”

“…Embolization as the therapy of first choice offers a way of treatment with low morbidity and acceptable results, but is prone to recurrence. In some cases preoperative embolization is an option when complete surgical resection of the nidus is achievable [22].…”

Simultaneous Opponensplasty and Free Gracilis Muscle Flap for Thenar Reconstruction after Arteriovenous Malformation Resection

“…Embolectomy or sclerotherapy followed by complete surgical excision and immediate soft tissue reconstruction are considered the gold-standard treatment. 1 However, the risk of reappearance, bleeding, and alterations of the collateral vascularization are an important limitation, as well as the need for large margins that may oblige to sacrifice contiguous structures. 1 We report a case of a high-flow AVM on the thenar eminence in which excision endangered the left thumb vascularization and obliged to completely resect the thenar muscles.…”