ORIGINAL ARTICLE   

Acta Phlebologica 2018 August;19(2):49-55

DOI: 10.23736/S1593-232X.18.00418-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

The main aspects of diagnostics and treatment of diffuse arteriovenous forms of congenital vascular malformations of extremities with the presence of microfistulas

Larysa CHERNUKHA ✉, Olena KASHYROVA, Georgiy VLAYKOV, Alla GUCH, Olena VLASENKO, Vadim KONDRATYUK

Shalimov’s National Institute of Surgery and Transplantation to NAMS of Ukraine, Kiev, Ukraine

BACKGROUND: The study goal was the development of a pathogenetic approach in the treatment of patients with arteriovenous congenital vascular malformations (AV CVM) of extremities, taking into account the pathogenesis data and the clinical-anatomical picture of the disease.
METHODS: During 2005-2017, 155 patients with AV СVM were investigated, mean age 25.2. Microfistulous AV CVM - 54 (35%) patients; combined (mixed) CVM - 45 (29%), which were a combination of the congenital defect of venous system with the presence of solitary (localized) microfistulas. Treatment strategy (169 operations): 1) individualized step-wise approach which includes endovascular methods during preoperative stage and combination of surgical interventions, embolization, laser and sclerotic methods during intraoperative stage (combined treatment); 2) correction of AV shunting (endovascular or surgical) - 44 (26%); 3) correction of secondary venous hypertension in superficial venous system (SVS) and/or deep venous systems (DVS) - 92 (54.4%) operations; 4) plastic surgery of trophic disorders - 5 (3%).
RESULTS: Satisfactory clinical immediate and long-term clinical outcomes were achieved in 94,4% of patients.
CONCLUSIONS: The optimal approach in treatment of diffuse CVM with microfistulas is a stage pathogenetic treatment with one-step use of surgical and mini-invasive additional techniques.

KEY WORDS: Vascular malformations - Surgery - Endovascular procedures - Combined modality therapy