Congenital vascular malformations: When and how to treat them

Congenital vascular malformations may involve arterial, venous, and lymphatic structures, can present in a variety of forms, and present many diagnostic and therapeutic challenges. Two-thirds of all congenital vascular malformations are predominantly venous, and their management will be emphasized in this article, because of the focus of this issue. The majority of the venous malformations are asymptomatic and should be treated conservatively. However, the clinical presentation of venous malformations associated with lymphatic anomalies is variable, and management may be more challenging. The diagnosis and management of arteriovenous malformations is straightforward. Selective catheter-directed embolization of the feeding arteries, occasionally followed by tumor excision, is the treatment of choice. Hemangiomas often will grow rapidly and then begin to regress. When they produce troublesome symptoms and are well localized, they should be excised. Deeply seated or diffuse malformations require a complete diagnostic evaluation to select the most appropriate time and type of intervention. Both our own experience and that of others can provided some basis for therapeutic recommendations in treating the different vascular malformations.