Surgery for Congenital Arterial and Venous Anomalies Workup

  • Author: Jeff L Myers, MD, PhD; Chief Editor: Mary C Mancini, MD, PhD   more...
 
Updated: Oct 13, 2010
 

Laboratory Studies

As discussed above, the workup of vascular anomalies relies heavily on history, physical, and overall clinical assessment. Typically, laboratories studies are not required in the workup and diagnosis of vascular anomalies. However, in patients with multiple venous malformations, Kasabach-Merritt syndrome, and combined malformations, coagulation studies are warranted, as coagulopathies are often present.

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Imaging Studies

Hemangiomas

Most hemangiomas can be managed without imaging studies. However, MRI is warranted in the following circumstances:

  • Lesions consistent with PACHES syndrome should undergo imaging to evaluate the carotids and cerebral vasculature.
  • The presence of multiple cutaneous lesions warrants screening with ultrasonography/MRI to assess concomitant visceral lesions.
  • Lumbosacral lesions require imaging of the spinal cord (ultrasonography/MRI) to rule out synchronous cord lesions.
  • Preoperative imaging may be required at the discretion of the surgeon.

Venous malformations

MRI and/or venography may be required to delineate the full extent of complex venous malformations. Such information may be useful for assisting in treatment and operative management.

Capillary malformations

Imaging of the spinal cord should be considered in the presence of capillary malformations, as developmental defects of the central neural axis are common with these lesions.

Lymphatic malformations

Large lymphatic malformations may be diagnosed in utero with ultrasonography.[29] Such malformations are classified based on their radiographic and histologic characteristics. Hence, multimodality imaging is often used for proper delineation. MRI and Doppler ultrasonography yield insight into the extent and flow characteristics, respectively.

Arteriovenous malformations

Ultrasonography with Doppler imaging is a very useful tool to confirm the diagnosis of suspected AVM. Further imaging with MRI can delineate the full extent of the lesion and involvement of other structures. Angiography may also be useful to aid in embolization and preoperative planning.

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Histologic Findings

See Clinical.

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Contributor Information and Disclosures
Author

Jeff L Myers, MD, PhD  Chief, Pediatric and Congenital Cardiac Surgery, Department of Surgery, Massachusetts General Hospital; Associate Professor of Surgery, Harvard Medical School

Jeff L Myers, MD, PhD is a member of the following medical societies: American College of Surgeons, American Heart Association, and International Society for Heart and Lung Transplantation

Disclosure: Nothing to disclose.

Coauthor(s)

Ahmad Y Sheikh, MD  Resident Physician, Department of General Surgery, Massachusetts General Hospital

Ahmad Y Sheikh, MD is a member of the following medical societies: American College of Surgeons and American Heart Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeff L Myers, MD, PhD  Chief, Pediatric and Congenital Cardiac Surgery, Department of Surgery, Massachusetts General Hospital; Associate Professor of Surgery, Harvard Medical School

Jeff L Myers, MD, PhD is a member of the following medical societies: American College of Surgeons, American Heart Association, and International Society for Heart and Lung Transplantation

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jonah Odim, MD, PhD, MBA  Senior Medical Officer, Transplantation Immunology Branch, Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health

Jonah Odim, MD, PhD, MBA is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physician Executives, American College of Surgeons, American Heart Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, Association for Academic Surgery, Association for Surgical Education, Canadian Cardiovascular Society, International Society for Heart and Lung Transplantation, National Medical Association, New York Academy of Sciences, Royal College of Physicians and Surgeons of Canada, Society of Critical Care Medicine, and Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Mary C Mancini, MD, PhD  Professor and Chief of Cardiothoracic Surgery, Department of Surgery, Louisiana State University School of Medicine in Shreveport

Mary C Mancini, MD, PhD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons, and Southern Surgical Association

Disclosure: Nothing to disclose.

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