Unveiling the secrets of interventional treatment for vascular malformations: safe, accurate, and multiple?

Author: Shen Gang, Chief Physician, Children's Hospital, Capital Institute of Pediatrics

Reviewer: Liu Li, Chief Physician, Beijing Children's Hospital, Capital Medical University

In the complex and sophisticated vascular network of the human body, vascular malformations are like hidden undercurrents that silently affect health. These congenital or acquired vascular abnormalities not only affect appearance, but may also threaten life.

Fortunately, the advancement of medical technology has brought us new hope - interventional therapy. It can not only accurately locate, but also reshape blood vessels with minimal trauma, opening a door to health for patients.

The application scope of interventional treatment mainly covers venous malformations, lymphatic malformations and arteriovenous malformations. These types of vascular malformations can achieve good therapeutic effects through interventional means. Under the guidance of angiography, doctors can accurately deliver drugs or embolic agents to the lesion site to achieve the purpose of treatment.

However, although interventional treatment is effective, it is also accompanied by certain risks. Surgical risks include anesthesia reaction, drug allergy, bleeding at the puncture site, swelling, necrosis, infection in the surgical area, and possible vascular damage, thrombosis, and limb dysfunction. In particular, the treatment of arteriovenous malformations, if not handled properly, may also cause ectopic embolism or infection, and even lead to amputation in severe cases.

Fortunately, the complication rate of interventional treatment is low, about less than 1%, and the specific data may be as low as 1‰, indicating that the vast majority of patients can safely go through the treatment process. With the advancement of imaging technology, doctors can more accurately monitor the distribution of drugs and emboli, further improving the safety of treatment.

Figure 1 Original copyright image, no permission to reprint

In interventional treatment, doctors use catheters and guidewires to reach the lesion area under the guidance of images. For high-flow vascular malformations such as arteriovenous malformations and arteriovenous fistulas, coils or embolic materials are used to block abnormal vascular channels and restore blood flow to normal paths. For lesions, doctors will directly puncture and inject sclerosants or embolic materials to seal vascular malformations. The principle of treatment is to block what should be blocked and keep the areas that should be unobstructed unobstructed according to the condition of the lesion.

Figure 2 Original copyright image, no permission to reprint

For pediatric patients, general anesthesia is usually required for interventional treatment of vascular malformations. This is because interventional surgery requires delicate manipulation, and it is difficult for children to remain still. Any slight movement may cause the needle tip to deviate, affecting image observation and increasing treatment risks. Even if older children can follow instructions, general anesthesia is still recommended to ensure respiratory safety and smooth surgery, considering the size of the lesion and the required dose of sclerosant, as well as possible systemic reactions such as allergies.

The application of general anesthesia in interventional treatment is not limited to children. Adults also use general anesthesia when receiving treatment for arteriovenous malformations and venous malformations to ensure comfort and safety during treatment. Compared with open abdominal or open chest surgery, the depth of general anesthesia for interventional treatment is shallower, the duration is shorter, and the pain is less, so the overall safety is higher, similar to the gastroscopy and colonoscopy that are commonly performed under anesthesia today.

Interventional treatment of vascular malformations usually requires multiple visits, and a one-time cure is rare, especially for arteriovenous malformations and venous malformations, because the lesions are widely dispersed and a single treatment is difficult to completely resolve. The frequency of treatment depends on the size of the lesion. A review will be conducted one month after the initial treatment, and then the need for continued treatment may be reassessed every three to six months depending on the control of the disease. For low-flow vascular malformations, such as venous malformations, treatment intervals may be longer, even once every one or two years, and the main purpose is to control the disease rather than to cure it.

After interventional treatment, vascular malformations are at risk of recurrence. Just like chronic disease management, patients need regular follow-up examinations to monitor the disease status. The follow-up time is usually one month, three to six months after treatment, depending on symptoms and recovery status. In order to control the development of vascular malformations, patients may need to take targeted drugs for a long time or for life to inhibit the progression of lesions.

Conservative compression therapy is an important part of the management of vascular malformations, especially for cavernous vascular malformations and arteriovenous malformations. Wearing elastic stockings or using restraints can relieve symptoms and prevent the lesions from expanding. Elastic stockings are especially important during exercise, which can slow the expansion of lesions and reduce pain. For complications of complex vascular malformations, such as KT syndrome and PW syndrome, patients may need to wear elastic stockings for life to control swelling of the lower limbs, starting from a few months after birth to ensure stability of the condition.