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Therapeutic Approach

Vascular malformations are congenital, well-demarcated lesions of malformed vessels. They tend to be localized, although sometimes they can be extensive or multifocal. Vascular malformations typically involve a single vessel type (capillary, venous, lymphatic, arteriovenous); however, combined malformations do exist, such as capillary-venous or venolymphatic malformations. Vascular malformations can be classified into “slow-flow” or “fast-flow” groups, with arteriovenous shunting present in the latter group. Slow-flow malformations are usually present at birth or shortly thereafter, whereas fast-flow malformations tend to present later in childhood or in adulthood. Vascular malformations can occur in isolation or in association with an underlying syndrome. For example, capillary malformations, commonly referred to as port wine stains, can be seen in isolation or in the setting of Sturge Weber Syndrome and phakomatosis pigmentovascularis, among other syndromes. A variety of factors must be considered in the treatment of vascular malformations, including the vessel type, location of the malformation, as well as the patient’s age and any associated symptoms. Oftentimes, a multidisciplinary team is required for management. See Table 133-1.

Table 133-1Vascular Malformations Treatment Table

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