Vascular malformation – causes, symptoms, types and methods of treatment

Vascular malformation is a non-cancerous vascular lesion that is caused by abnormal vascular development. Vascular malformations arise in utero and come in various forms. They most often appear on the skin and mucous membranes in the head and neck area and in the central nervous system.

Types of vascular malformation

Vascular malformations come in the following varieties:

1. Arteriovenous malformations – are made up of a junction of arterial and venous vessels, bypassing the capillary network. They are most common in the central nervous system, lower and upper extremities, pelvis, and in the neck and head region.
2. Capillary (capillary) malformations – these are changes most often located on the scalp and neck, but they can also appear on the mucous membranes.
3. Venous malformations – these are non-neoplastic changes consisting of clusters of venous vessels that have an abnormal structure and shape. These types of malformations usually increase in size. They are located on the skin and subcutaneous tissue, and they can also be located in mucous membranes and muscles. They most often appear in the neck and head region.
4. Lymphatic malformations (lymphangioma and lymphatic cysts) – these types of lesions may take the form of a squamous or cavernous hemangioma. They resemble a soft cyst underneath unchanged skin. Most often they are located on the mucous membranes and in the neck, as well as on the upper limbs and on the chest.
5. Mixed malformations – these are different types of mixed congenital vascular malformations. They accompany some genetic diseases such as Sturge-Weber syndrome, Parks-Weber syndrome, Maffuci-Kast syndrome, Bean syndrome, Solomon-Riley-Smith syndrome and Proteus syndrome.

Due to the nature of vascular blood flow, there are high-flow vascular malformations (they contain arterial elements) and low-flow (containing elements of venous, capillary and lymphatic vessels).

Symptoms of vascular malformation

Vascular malformation is usually symptomatic of dark red spots on the skin. The symptoms of vascular malformations depend on their location, type and size. With venous malformations, blood clotting disorders appear, which lead to the development of venous thrombosis. There may also be pain and swelling as well as bleeding from malformed sites.

Lymphatic malformations are symptomatic of a soft, cystic lesion under the skin. Occasionally, tissue fluid can ooze out of it. Lymphatic malformations in the neck may increase when the patient coughs.

Arteriovenous malformations can present symptoms such as burning, swelling, ulceration, paraesthesia, inflammation, massive bleeding, and heart failure.

Vascular malformations in the brain can cause intracranial hemorrhage, which is a real life threat. These types of hemangiomas can also cause headaches, seizures, paresis and other disorders of the nervous system.

The most common type of vascular malformation are capillary changes (within the capillaries). They are often confused with hemangiomas because they produce similar cosmetic defects, most often in the face and neck area. These malformations arise as a result of a disturbance in the process of division and structure of vascular tissue and do not disappear spontaneously – what is more, it grows proportionally to the body height.

The causes of vascular malformation

The development of vascular malformations occurs in the womb, most often between the 4th and the 19th week of fetal life. The cause of their formation is not fully understood. Usually, the change is visible at the time of birth and grows with the child, but sometimes it becomes visible only after a few or even several months, in some cases even after several years. It may also happen that the vascular malformation is invisible (and undetected) throughout the patient’s life. The disclosure or growth of the lesion may be caused by injuries in its area, local inflammation and hormonal changes that occur during puberty, during the menstrual cycle and during pregnancy. Unlike hemangiomas, vascular malformations do not disappear on their own.

Methods of treating vascular malformation

The method of treating vascular malformation depends on where it is found, its type and size. With arteriovenous malformations, surgical treatment is used. In the case of capillary and venous malformations, laser photocoagulation is used. Vascular malformations are also treated with sclerotherapy and compression therapy. Inside the skull malformations are treated with neurosurgery, embolization and radiotherapy. However, they tend to renew themselves.

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