Vascular malformations of upper and lower extremity – from radiological interventional therapy to surgical soft tissue reconstruction – an interdisciplinary treatment

Issue title: Selected papers of the 36th Conference of the German Society for Clinical Microcirculation and Hemorheology, 5–8. June, 2017, Greifswald, Germany

Guest editors: M. Jünger, A. Krüger-Genge and F. Jung

Article type: Research Article

Authors: Ranieri, M.^a | Wohlgemuth, W.^{b; d} | Müller-Wille, R.^c | Prantl, L.^a | Kehrer, A.^a | Geis, S.^a | Klein, S.^a | Lamby, P.^a | Schiltz, D.^a | Uller, W.^b | Aung, T.^a | Dolderer, J.H.^{a; *}

Affiliations: [a] Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany | [b] Department of Radiology, University Hospital Regensburg, Germany | [c] Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Germany | [d] Institute of Radiology, University Hospital Halle, Germany

Correspondence: [*] Corresponding author: Juergen H. Dolderer, MD, PhD, Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. Tel.: +49 941 944 6862; E-mail: drdolderer@hotmail.com.

Abstract: This article presents our experience in managing peripheral vascular malformations of upper and lower extremities over a 4-year period in a series of 46 patients of the Department of Plastic Surgery treated in the Interdisciplinary Center of Vascular Anomalies (ICVA) at the University of Regensburg. The patients presented vascular malformations of upper and lower extremity and were selected from our prospective vascular anomalies file archive from 2012 to 2016. During this period in the ICVA at University of Regensburg were performed more than 1400 radiological interventional treatments in patients with vascular malformations. The purpose of this retrospective study was to review combined embolotherapy, sclerotherapy (embolo/sclerotherapy), and surgical procedures (surgical excision and soft tissue reconstruction) to manage vascular malformations. Treatments were principally induced to reduce pain, daily physical limitations, social discomfort and recover tegument continuity after ulceration. The 46 patients were first examined with noninvasive radiological procedures. After diagnosis was posed, embolo/sclerotherapy, surgical procedures and clinically as well as radiological follow-ups were coordinated and established by the multidisciplinary team. All vascular malformations were categorized according to the classification approved at the April 2014 General Assembly of International Society for the Study of Vascular Anomalies (ISSVA) in Melbourne, Australia. Arteriovenous malformations (AVMs) were further classified following the Cho-Do and Schobinger classification. Embolo/sclerotherapy shows to be the most appropriate procedure in vascular malformations treatment. Nevertheless was found that in case of complications or lack of improvement as well as to improve functional or aesthetical results, a following partial or complete surgical excision and immediate soft tissue reconstruction seems to be the gold-standard treatment. In addition, the precise clinical and radiological diagnosis as well as an intensive postoperative patient care have a significant positive influence on the clinical outcome and patient satisfaction while decreasing morbidity and recurrence during early and late follow-up. Vascular malformations require a multidisciplinary approach and individual treatment after complex excision and indispensable reconstruction.

Keywords: Vascular malformations, vascular malformations surgical therapy, vascular malformations soft tissue reconstruction, interdisciplinary treatment vascular malformations

DOI: 10.3233/CH-179216

Journal: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 355-372, 2017