Physicians discuss radiological images of a patient at the 2007 NOVA Conference

NOVA asked Dr. George Bisset, III Chairman of the Department of Pediatric Radiology at Duke University Medical Center to help us describe the different approaches to treating vascular malformations.

There are a couple different approaches to treating vascular malformations and hemangiomas in the radiology department. Our treatment strategies are based on experience over the last ten years with these types of lesions. While it is difficult to generalize about the different therapeutic procedures, I will try to summarize the basic approach.

Initially magnetic resonance imaging is usually performed in order to characterize the exact location and extent of the lesion. We are looking to soft tissue and bony extensions, as well as the velocity of blood flow within the vascular malformations.

If the malformation is amenable to trans-arterial embolization, we would prefer to use this approach. This technique involves placing a tiny catheter into the femoral artery, (in the groin). With the use of very small catheters, we can enter some of the blood vessels, which feed the malformation. After appropriate position is documented within the malformations, we inject solid, non-absorbable particles of various sizes. These particles are made from polyvinyl alcohol foam and look similar to Styrofoam. Our hope is to decrease the flood flow to the malformation by clotting the vessels that supply it.

Some malformations, particularly in the extremities, are difficult to reach with the trans-arterial embolization method. In these cases, particularly if large venous structures are identified, the optimal approach may be through direct injection of the malformation vessels with a sclerosing agent. Our experience with these lesions is based on 100% alcohol. Using ultrasound as a tool, the alcohol is injected directly into the malformation. X-ray contrast is mixed with the alcohol, allowing us to visualize the flow of the alcohol, under radiographic techniques.

Overall, we have seen our best results in malformation, which have relatively high blood flow. In these cases, markedly decreasing blood flow with the particles has resulted in regression of the malformations. We have also had good results in patients who have small low flow venous malformation. With the use of a tourniquet above the lesion, we can maintain direct contact of the alcohol to the blood vessel lining for up to ten minutes. This results in intense inflammation and subsequent sclerosis. Patients report seeing improvement in 3-6 months following treatment in 60% of the cases.

NOVA PROVIDES THIS INFORMATION TO FAMILIES AS A RESOURCE. IT IS NOT INTENDED TO ENGAGE IN THE PRACTICE OF MEDICINE OR TO REPLACE THE PHYSICIAN. NOVA DOES NOT CLAIM TO HAVE MEDICAL KNOWLEDGE. NOVA DOES NOT ENDORSE ANY PARTICULAR PHYSICIAN, TREATING FACILITY OR TREATMENT PROTOCAL. IN ALL CASES NOVA AND ITS BOARD OF DIRECTORS RECOMMENDS THAT YOU SEEK THE OPINION OF A PHYSICIAN EXPERIENCED IN THE MANAGEMENT OF HEMANGIOMAS AND VASCULAR MALFORMATIONS. 

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