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Minimally Invasive Care for Vascular Malformations

NEW YORK (Jun 1, 2012)

Bradley Pua, M.D.
Bradley Pua, M.D.

Vascular malformations are characterized by abnormally formed blood vessels. Most are congenital (present since birth). They can range from raised bluish masses or marks on the skin – which can be disfiguring if they occur on the face – to larger masses that may compress a patient's airway and interfere with the ability to breathe.

Today physicians and surgeons can take a minimally invasive approach to treating vascular malformations, which occur in 1 to 2 percent of all births. Treatment varies depending on the size and location of the abnormality and whether it is a "low-flow" or "high-flow" malformation. Patients can typically go home the same day as the procedure.

Low-flow malformations, which make up the vast majority of these abnormalities, receive blood via small vessels. Doctors can treat them by administering a chemical "sclerosant" (irritant) through a needle inserted into the malformation. After two to three sessions, the chemical treatment destroys the malformation, which generally does not recur. An anesthesiologist typically sedates the patient during the procedure with an intravenous anesthetic, since giving the chemical through the needle would otherwise be uncomfortable.

(click to enlarge)
scan of vascular malformation

MRI of a baby born with a large lymphatic
malformation (contained by arrows). This
patient underwent surgery to remove the
mass.

For the less common high-flow malformations – those fed by a larger artery – doctors may insert a catheter into the patient via the femoral artery in the leg, and snake it to the site of the abnormality. Tiny plastic particles, metallic coils, or glue are sent through the catheter to block the blood supply to the malformation, causing it to wither. Physicians use magnetic resonance imaging to determine if a malformation is high-flow or low-flow.

Another related abnormality, lymphatic malformations, also present at birth and can occasionally impinge on the airway. As a result, most of these procedures are performed in infants. Doctors must treat these malformations immediately. "Some of these masses are very disfiguring, and can even resemble a second head," noted Bradley Pua, M.D., an interventional radiologist who treats patients with vascular malformations. The mass is typically a cyst-like structure that can continue to refill. Doctors administer a chemical agent to kill the cells producing the fluid, which leads to shrinkage of the mass.

The care of patients with vascular malformations is a team effort. Said Dr. Pua, "Treatment is best accomplished by a multidisciplinary team at an academic medical center, where specialists such as surgeons, interventional radiologists, pediatricians, and anesthesiologists can work together as needed to tailor care for each patient."

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