Diagnosis of congenital vascular malformations of the extremities: new perspectives.
Congenital vascular malformation (CVM's) have traditionally been evaluated angiographically. Unfortunately, this approach does not always give definitive information about the various components, particularly microfistulous lesions and venous angiomata, and it provides little physiologic information. Furthermore, it is expensive, invasive, and is not needed to guide therapy in the majority of patients who either do not need or will not benefit from surgery or embolotherapy. We propose a different approach which begins initially with simple noninvasive screening tests, then selectively uses labelled-albumin microspheres to quantify the AV shunt fraction and/or magnetic resonance imaging (MRI) to define the anatomic extent and involvement of adjacent structures. This approach gives sufficient anatomic and physiologic information in the vast majority of cases to allow reasonable prognostication and to guide future therapy. Angiography is then reserved for patients identified as probably having localized lesions or for those with more extensive CVM's whose symptoms ultimately justify therapeutic intervention.
Rutherford
R B
RB
University of Colorado Health Sciences Center, Denver.
Anderson
B O
BO
D001164:Arteriovenous Fistula / Q000175:diagnosis*; D003952:Diagnostic Imaging / Q000379:methods; D005121:Extremities / Q000098:blood supply*; D006801:Humans