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Peripheral Vascular Malformations: Imaging, Treatment Approaches, and Therapeutic Issues¹

¹ From the Department of Radiology, Sapporo Medical University, S1 W16 Chuo-ku, Sapporo 060-8543, Japan. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received February 7, 2005; revision requested March 2 and received March 28; accepted April 15. All authors have no financial relationships to disclose. Address correspondence to H.H. (e-mail: hyodoh{at}sapmed.ac.jp).

Peripheral vascular malformations are now described according to some accepted guidelines, and the principle of proper treatment (nidus ablation) is becoming clear. An appropriate classification scheme for vascular anomalies and definite indications for treatment are important to successful treatment overall. The findings from noninvasive imaging (ie, Doppler ultrasonography, computed tomography, or magnetic resonance imaging) in association with clinical findings are critical in establishing the diagnosis, evaluating the extent of the malformation, and planning appropriate treatment. Direct opacification of the nidus is useful, not only in making a correct diagnosis, but also in treating the lesion with sclerotherapy. In most cases, conservative treatment is recommended, but when a patient suffers clinical complications (eg, ulceration, pain, hemorrhage, cardiac failure, or unacceptable cosmetic consequences), the nidus sclerotherapy becomes mandatory. If the vascular malformation has blood outflow to a drainage vein during nidus opacification, flow control (with balloon occlusion, tourniquet, or embolization) is necessary to achieve sclerosant stasis within the nidus. Embolotherapy (with a coil, n-butyl cyanoacrylate, or small particles) should be used for subsequent multifaceted palliative therapy. A multi-disciplinary approach is needed in the treatment of a high-flow lesion, and a dedicated team approach is necessary for appropriate management in most cases.

© RSNA, 2005

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