Surgery for Congenital Arterial, Venous, and Lymphatic Anomalies Workup

Updated: Apr 18, 2018
  • 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, laboratories 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


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 and 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 or MRI to assess concomitant visceral lesions
  • Lumbosacral lesions require imaging of the spinal cord (ultrasonography or MRI) to rule out synchronous cord lesions
  • Preoperative imaging may be required at the discretion of the surgeon

Venous malformations

MRI 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; developmental defects of the central neural axis are common with these lesions.

Lymphatic malformations

Large lymphatic malformations may be diagnosed in utero with ultrasonography. [31] Such malformations are classified according to 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 arteriovenous malformation (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. [42]