The combined treatment of congenital vascular defects.
Eighty-one patients with a vascular malformation on the extremities were evaluated. In 32 patients the abnormality was localised in the upper and in 49 in the lower extremity. Signs, symptoms, treatment modalities and long-term results were tabulated. In the upper extremity pain was the most frequent presenting symptom. Three types of malformation were distinguished: purely venous, venous with microshunts and malformations with macroshunts. The treatment of the first group consisted of excision of varices and superficial naevi, in the second group the combined treatment of embolisation and excision was the treatment of choice, in the last group the selective embolisation without resection was most frequently done. The treatment was most successful in those cases, where there was a malformation with macrofistulas in the shoulder-region or only a localised lesion, that could be excised. The first sign and symptom of the lower extremity was swelling or a naevus vasculosus. After inventarisation 4 groups of vascular malformations have been distinguished, the cavernous (venous), the cavernous (venous) with microshunts, the arteriovenous with macrofistulas and a purely venous (truncular) group, which we did not have in our patients with an upper extremity abnormality. Conservative treatment in purely venous malformations prevented progression, the combined treatment was successful in patients with an AV-malformation of the pelvis, or around the knee or in patients with a small excisable lesion.


CONCLUSIONS
the purely venous abnormality can be successfully treated with conservative measures, the arteriovenous malformation with macroshunts in pelvis and shoulder region should be embolised, and circumscript lesions excised with or without embolisation, depending on the character of the lesion.
Kromhout
J G
JG
Department of Vascular Surgery, Academisch Ziekenhuis, Amsterdam, The Netherlands.
vd Horst
C
C
Peeters
F
F
Gerhard
M
M
D000328:Adult; D001132:Arm / Q000098:blood supply*; D001165:Arteriovenous Malformations / Q000175:diagnosis / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male