[Superficial vascular (arterial and venous) malformations: clinical aspects and complementary tests]
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O Enjolras1, M C Riche, J J Merland
1Service de Neuroradiologie, Hôpital Lariboisière, Paris.
Insights
A new classification distinguishes regressive hemangiomas from non-regressive vascular malformations. This system guides the management of vascular anomalies, improving patient outcomes.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Pediatric Medicine
Background:
- A decade-long international collaboration has yielded a refined classification system for vascular anomalies.
- This system categorizes lesions into hemangiomas (regressive) and vascular malformations (non-regressive, progressive).
Purpose of the Study:
- To present a clear classification of hemangiomas and vascular malformations.
- To define the diagnostic and management strategies for different types of vascular anomalies.
Main Methods:
- Clinical observation and international consensus.
- Diagnostic imaging techniques including CT scan, MRI, and Doppler ultrasound.
- Classification based on lesion characteristics: regression, growth potential, flow dynamics.
Main Results:
- Hemangiomas are identified as self-regressing lesions.
- Vascular malformations are classified into capillary, venous, and arteriovenous types, each with distinct clinical behaviors and management needs.
- Venous malformations are slow-flow, diffuse anomalies evaluated non-invasively (CT, MRI).
- Arteriovenous malformations are high-flow, dangerous lesions requiring detailed imaging (arteriography, CT, MRI) due to risks of necrosis and heart failure.
Conclusions:
- The established classification provides a precise framework for understanding and managing vascular anomalies.
- Tailored diagnostic approaches, prioritizing non-invasive methods, are crucial for effective patient care.
- Distinguishing between hemangiomas and vascular malformations ensures appropriate treatment and monitoring.
Abstract:
A simple and precise classification has been established during a ten-year international cooperation. There are two major groups: hemangiomas, always regressive; and vascular malformations, which never regress; they grow, throughout life, to varying degrees. Management of vascular malformations has been clearly defined. Capillary malformations do not require examination, unless they are associated with other anomalies, such as hypertrophic underlying bone, or the leptomeningeal vascular anomaly of the Sturge-Weber syndrome. Venous type malformations are diffuse, and consist of entirely anomalous channels, with low flow. CT scan and MRI clearly demonstrate the extent of tissue involvement in venous malformations; for these slow-flow malformations the evaluation is performed without resorting to invasive diagnostic techniques: phlebography is rarely performed, and arteriography is unnecessary. Arteriovenous malformations are dangerous high-flow vascular malformations, leading to skin ischemic necrosis, and congestive cardiac failure. Arteriography shows enlarged tortuous arteries, with arteriovenous shunting, and early venous drainage. CT scan and MRI show the deep components of the lesions. Doppler ultrasound evaluation is used to follow the course of the disease.