What Is a Vascular Anomaly?
Vascular anomaly is a general term that covers conditions like the congenital vascular malformation of the veins, lymph vessels, veins, and vessels, or both arteries and veins. The vascular anomalies include the following:
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Venous Malformations: When the veins do not form normally.
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Lymphatic Malformations: This is a clump of abnormal lymph vessels that forms a cyst.
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Venolymphatic Malformations: Both veins and lymph vessels.
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Arteriovenous Malformations: Arteries are connected directly to the veins without any capillaries.
What Causes Vascular Malformations?
Most conditions are present during birth but become noticeable at different ages. Pulmonary arteriovenous malformations are linked to hereditary hemorrhagic telangiectasia, inherited genetically. It is noted that most of these conditions occur at the time of development of the arteries, veins, and lymph vessels but without any specific cause. The cause of these conditions is yet to be studied and understood fully.
What Are the Symptoms of Vascular Malformations?
Vascular malformations result in various symptoms, which depend on the location of the body. They are explained below:
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Venous Malformations - These malformations cause pain in their locations. The venous and lymphatic malformations cause a lump in their location under the skin. There can be an overlying birthmark above these malformations. Also, there can be bleeding or leakage of lymph fluid from the skin lesions. The lymphatic lesions can recur, get infected, and require antibiotic treatment. The syndrome associated with venous and lymphatic malformations is Klippel-Trenaunay syndrome.
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Arteriovenous Malformations - Arteriovenous malformations can cause pain. They can cause stress on the heart due to the rapid shunting of blood from the arteries to the veins. Depending on the location, they may also result in bleeding (for example - bowels, uterus, or from the bladder).
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Pulmonary Arteriovenous Malformations (PAVMs) - They are different from other malformations as they shunt blood from the right side of the heart to the left side without the process of oxygenation from the lungs. The malformation presents as shortness of breath, low oxygen, and fatigue. They can also bleed, cough up, or pool blood in the chest. They can also result in stroke or brain abscess as the clots can travel from the lungs to the arteries through the pulmonary artery to the pulmonary veins shunt. This is the main reason to block these shunts in people with a non-inherited pulmonary arteriovenous malformation or anyone who has inherited pulmonary arteriovenous malformation along with the HHT syndrome (hereditary hemorrhagic telangiectasia, also known as Osler Weber Rendu).
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Hemangioma - This is another common term used to address vascular anomalies. This term commonly applies to childhood vascular anomaly with a rapid growth phase between the time of birth to three months of age. Also, they will resolve completely by the age of seven years. The main reason to treat this is the low platelet count that does not respond to other medical treatments or in the liver due to massive shunting with a strain on the heart.
How Are Vascular Malformations Treated?
Vascular malformations are treated using surgery, but it is difficult to remove these malformations completely. If the malformations are not removed completely, they can recur. An interventional radiologist can close blood or lymph flow into these malformations through a non-surgical method.
Embolization is the main way to treat vascular malformations. The arteriovenous malformations are closed by inserting a tiny plastic tubing, equivalent (size) to a pencil point, into the feeding artery to the malformation. This is done without any incision or stitches with mild sedation. Then medical glue or small beads are floated into these malformations until full, and no blood flows through them. For pulmonary arteriovenous malformations, the flow through the feeding artery to the malformation is blocked using a platinum coil. Finally, the venous malformations and lymphatic malformations are closed by injecting alcohol into the sacs filled with venous blood or lymph till the sacs collapse and can no longer fill.
How Effective Is the Treatment?
Pulmonary arteriovenous malformations are treated effectively by embolization, which blocks the abnormal artery feeder and preserves the normal lung arteries. With an immediate increase in oxygen levels, the patient experience improved symptoms. Other arteriovenous malformations are more difficult to treat since they tend to pull in new artery feeders occasionally.
However, embolization is useful in blocking abnormal artery feeders while preserving normal arteries. Arteriovenous malformations will often require treatments to block all abnormal feeders. The lymphatic and venous malformations respond better to alcohol embolization. They might also require a series of treatments to block the abnormal vessels. All vascular malformations require long-term surveillance as the changes during growth spurts with puberty or pregnancy, or menopause can be monitored for recurrence. Pulmonary arteriovenous malformations are monitored over time to ensure that they collapse and there is no refilling.
What Is the Appropriate Age for the Treatment?
From newborns to adults, anyone is eligible to receive this treatment. However, the best treatment age is conditional upon the vascular malformation and the symptoms and will differ from person to person.
How Long Will It Take for the Recovery After the Procedure?
The treatment for arteriovenous malformation will require only one night's stay in the hospital. There can be minimal discomfort for one to three days after the procedure. However, the malformations can swell after treatment with alcohol, and the swelling or the pain can last up to three to five days. Medications for pain and swelling will be prescribed to relieve these symptoms. The malformation can take up to four to six weeks to shrink fully.
How New Is This Technique?
The embolization procedure has been used globally for the past thirty years. Also, this procedure has proven effective in treating these malformations.
Conclusion
Vascular anomalies can be due to various reasons. There are many ways to manage the condition. If there are any signs and symptoms of vascular malformations, consult a doctor to get the treatment at the right time to avoid further complications.
