Vascular Anomalies (Part II): Interventional Therapy of Peripheral Vascular Malformations

 

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Abstract

Background The International Society for the Study of Vascular Anomalies (ISSVA) categorizes vascular anomalies into vascular tumors and vascular malformations. Vascular malformations are further divided into slow-flow (venous, lymphatic, and capillary malformation) and fast-flow malformations (arteriovenous malformation and arteriovenous fistula). This interdisciplinary classification has therapeutic implications.

Methods The objective of this article is to provide concise information about the current terminology and treatment strategies of peripheral vascular malformations, based on the currently available literature, with a focus on interventional therapy of venous malformations (VM), lymphatic malformations (LM), arteriovenous malformations (AVM) and arteriovenous fistulae (AVF).

Results and Conclusion Accurate classification is crucial for appropriate therapy of peripheral vascular malformations. Modern imaging technologies and refined interventional treatment strategies are now central parts in the multidisciplinary management of these patients. Slow-flow and fast-flow vascular malformations can be treated successfully by percutaneous sclerotherapy and endovascular embolotherapy as first-line interventions.

Key points: 

• The ISSVA classification is essential for the correct diagnosis of vascular malformations

• The Schobinger classification as well as the Cho classification should be used for description of arteriovenous malformations (AVM)

• Sclerotherapy and embolotherapy are the primary treatments of choice for vascular malformations

Citation Format

• Müller-Wille R, Wildgruber M, Sadick M et al. Vascular Anomalies (Part II): Interventional Therapy of Peripheral Vascular Malformations. Fortschr Röntgenstr 2018; 190: 927 – 937

Zusammenfassung

Hintergrund Die International Society for the Study of Vascular Anomalies (ISSVA) teilt vaskuläre Anomalien in vaskuläre Tumoren und vaskuläre Malformationen ein. Letztere werden weiter in Läsionen mit langsamen Fluss (venöse, lymphatische und kapilläre Malformationen) und Malformationen mit schnellem Fluss (arteriovenöse Malformationen und Fisteln) unterteilt. Diese interdisziplinär akzeptierte Klassifikation hat Auswirkungen auf die Wahl der Therapie.

Methodik In diesem Artikel werden basierend auf der aktuellen Literatur die wichtigsten Informationen über Terminologie und Behandlungsstrategien peripherer Gefäßmalformationen präsentiert. Hierbei liegt der Fokus auf der interventionellen Behandlung von venösen Malformationen (VM), lymphatischen Malformationen (LM), arteriovenösen Malformationen (AVM) und arteriovenösen Fisteln (AVF).

Ergebnisse und Schlussfolgerung Eine korrekte Klassifizierung ist essentiell für die adäquate Behandlung von peripheren vaskulären Malformationen. Moderne Bildgebung und dedizierte interventionelle Methoden sind ein zentraler Teil der multidisziplinären Behandlung von Gefäßmalformationen. Malformationen mit langsamem Fluss können erfolgreich sklerosiert, Malformationen mit schnellem Fluss kurativ embolisiert werden.

Kernaussagen: 

• Die ISSVA Klassifikation ist entscheiden für die korrekte Diagnose und Einteilung von Gefäßmalformationen

• Die Schobinger Klassifikation sowie die Cho Klassifikation sollten für die Beschreibung von arteriovenösen Malformationen (AVM) verwendet werden

• Sklerotherapie und Embolisation sind die Verfahren der ersten Wahl zur Behandlung von Gefäßmalformationen

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