The Hip: Preservation, Replacement and Revision

Arterio-venous malformations



- See: venous malformations

- Discussion:
    - high flow lesion
    - may start small in childhood and be triggered to enlarge after trauma
    - spontaneous bleeding may occur
    - associated conditions:
          - Klippel-Trénaunay syndrome: capillary, lymphatic, and venous malforma-tions with skeletal overgrowth;
          - Parkes Weber syndrome: capillary, lymphatic, and venous malforma-tions with arteriovenous fistuli;
          - Proteus syndrome: capillary and venous malformations, macro-dactyly, hemihypertrophy, lipomas, pigmented nevi, and scoliosis;
          - Maffucci’s syndrome: lymphatic and venous malformations and multiple enchondromas;

- Clinical Findings:
    - possible thrill
    - dilated surrounding veins
    - ischemic ulcers distal to the lesion;

- Diagnosis:
    - doppler: continuous murmur
    - MRI: high versus low flow
    - constrast arteriography

- Treatment:
    - resection may be dangerous
    - consider embolization therapy
    - ligation of feeding vessels of no help
    - high-flow arteriovenous malformations are difficult to treat, & staged partial excisions are mostly palliative;
         - proximal ligation only increases collateralization, and embolization carries a high risk of digital ischemia;
         - YAG laser, used in direct contact with tissue for incision & thermal coagulation, has allowed subtotal excision of complicated hemangiomas of the hand previously thought to be untreatable;
               - laser will not stop bleeding from blood vessels w/ lumen diameters greater than 1 mm



Distinguishing Soft-Tissue Hemangiomas From Vascular Malformations Using Technetium-Labeled Red Blood Cell Scintigraphy.

Arteriovenous malformations of the extremities: MR imaging.

Hemangiomas, vascular malformations, and lymphovenous malformations: classification and methods of treatment.

Vascular abnormalities of the extremities: clinical findings and management.

Major vascular malformations of the upper extremity: long-term observation.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, August 13, 2012 2:39 pm