Vascular Anomalies

Common misconceptions

• All vascular birthmarks are not “hemangiomas”!
• All vascular malformations are not “AVMs”!
• 50% of patients referred to the UCSF Vascular Anomalies Clinic carry an incorrect diagnosis            

AVM (arterial malformation) an abnormal connection between arteries and veins

Vascular birthmark: Classification

When patient comes to BVAC

• Diagnosis comes before treatment
  • Common errors in management come from misdiagnosis
  • Critical in understanding natural history
• Management
  • Treatment options
  • Supportive management 

     

• Education about AVM natural history
• Manage expectations
• Is there a window opportunity re: long term outcome
• Deciding how aggressive to be
• AVM Classification 

Lymphatic malformation cysts have different signal characteristics as some have little blood or little protein. A doctor can easily access the lesion with ultrasound and to see it we inject contrast into the lesion. Ultrasound can limit any kind of radiation which is pretty common topic nowadays. Draining the lymphatic malformation cyst will cause it to recur so you have do something with the cyst to stop the reoccurrence.

A patient came in with an enlarging chest wall mass, it could be vascular due to a vascular tumor or vascular malformation. To give a firm diagnosis the next step is to image that area. This mass did not enlarge or regress as an infantile hemangioma would at two years, and to behave as a typical venous malformation there would be growth. We usually can tell clinically, but sometimes we can tell with imaging.  Don’t let the skin stand between you and the diagnosis.  By imaging it was diagnosed as a venous malformation. 

AVM (Arteriovenous malformation) which is an abnormal connection between arteries and veins.  

Angiogram: special type of x-ray of blood vessels.

PTEN Hamartoma syndrome- PTEN germ mutations. These patient have macrocephaly which is an abnormally large head. Also, there are shunts that drain varices which involve muscle, so it not something you can cut out. The goals to palate his pain from transarterial approach accessing the artery to the avm. The key is to control his pain, even though we haven’t cured his syndrome or his avm.