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Critical Issues in Management of Congenital Vascular Malformation

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Annals of Vascular Surgery

Abstract

Congenital vascular malformation (CVM) has long been a challenging problem. Recently, a new classification of CVMs was launched, opening up a new era. This improved definition provides critical information on CVM etioanatomopathophysiology. Advanced diagnostic technology has also provided more accurate and safer diagnosis. Finally a new, improved method of managing CVMs based on a new, multidisciplinary approach has emerged. In this study, various noninvasive diagnostic tests were adopted for contemporary diagnosis, and invasive studies were reserved for use as a road map for treatment. A new treatment strategy evolved, following proper identification of absolute and relative indications for treatment, which integrates surgical therapy and embolosclerotherapy. Three hundred and sixty-two patients selected for treatment, among a total of 1007 patients with various indications, were retrospectively reviewed. Various embolosclerotherapy techniques were performed on 333 patients, including 640 sessions of ethanol-based therapy. The immediate success rate was excellent (96.2%) but was accompanied by various complications mostly of a minor nature during 212 sessions (22%). The interim results were also excellent, with no evidence of recurrence. A total of 102 patients underwent 128 surgical procedures, consisting of a variety of different therapies, either independently (29/102) or in conjunction with preoperative embolosclerotherapy (73/102). Most of the interim results were excellent (111/128). The use of a complex therapy regimen through a multidisciplinary approach leads to a more manageable and satisfactory outcome.

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Acknowledgments

I acknowledge the following departments and individuals at Sungkyunkwan University School of Medicine and Samsung Medical Center: Vascular Center: E.S. Kim, J.Y. Moon, M.A. Han; Vascular Laboratory: C.H. Lee and D.Y. Kim; Radiology Department: Y.H. Choe, J.W. Choe, W.K. Roe, and Y.S. Do; Nuclear Medicine Department: J.K. Yoon, H.J. Jang, and B.T. Kim; Department of Anesthesiology and Pain Medicine: H.S. Cho and B.S. Shin; Vascular Medicine Department: D.K. Kim; Pediatric Surgery Department: J.M. Suh; Plastic Surgery Department: W.S. Hyun; Orthopedic Surgery Department: J.S. Shim. Also special thanks go to E.K. Cho and Yoona Lee for editing.

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Authors and Affiliations

  1. Department of Surgery, Sungkyunkwan University School of Medicine and Samsung Medical Center, Seoul, Korea

    B.B. Lee MD, PhD, FACS

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  1. B.B. Lee MD, PhD, FACS
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Correspondence to B.B. Lee MD, PhD, FACS.

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Lee, B. Critical Issues in Management of Congenital Vascular Malformation. Ann Vasc Surg 18, 380–392 (2004). https://doi.org/10.1007/s10016-004-0020-y

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  • DOI: https://doi.org/10.1007/s10016-004-0020-y

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