Multidisciplinary Management of Vascular Anomalies Workup

Updated: Nov 17, 2021
  • Author: Jaime Shalkow, MD, FACS; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Laboratory Studies

The workup of vascular anomalies relies heavily on history, physical examination, and overall clinical assessment. Typically, laboratory studies are not required in the workup and diagnosis of these anomalies. However, in patients with multiple venous malformations, Kasabach-Merritt syndrome, and combined malformations, coagulation studies are warranted because coagulopathies are often present. 


Imaging Studies

MRI is the leading imaging modality in the diagnosis and follow-up of patients with vascular malformations. Arteriography is the criterion standard for the evaluation of high-flow vascular anomalies, particularly for arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs). [2]


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

  • Lesions consistent with PHACE syndrome (posterior fossa malformations, hemangiomas, arterial anomalies, coarctation of the aorta, cardiac defects, and eye anomalies) should undergo imaging to evaluate the carotids and cerebral vasculature
  • The presence of multiple cutaneous lesions warrants screening with ultrasonography (US) or MRI to assess concomitant visceral lesions 
  • Lumbosacral lesions require imaging of the spinal cord (US or MRI) to rule out synchronous cord lesions
  • Preoperative imaging may be required at the discretion of the surgeon 

Venous malformations

Magnetic resonance angiography (MRA) or computed tomography (CT) angiography (CTA) 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; developmental defects of the central neural axis are common with these lesions. 

Lymphatic malformations

Large lymphatic malformations may be diagnosed in utero with US. [37] Such malformations are classified according to their radiographic and histologic characteristics. Hence, multimodality imaging is often used for proper delineation. MRI and Doppler US yield insight into the extent and flow characteristics, respectively. 

Arteriovenous malformations

US 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. Hardwicke et al described a case in which office-based thermography was used adjunctively in the assessment of an AVM of the hand. [48]