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Disease Information : CVM : Treatment

CVM : Treatment

CVM Treatment Options

As a general rule, CVMs should be treated for specific indications: persistent pain, ulceration, bleeding, causing blood clots, obstructing major vessels, causing progressive limb asymmetry by overgrowth, and for cosmetic indications or because the vascular mass is cumbersome and leads to a badly misshapen limb or interferes with extremity function in a mechanical way. Since most of the patients with the worst CVMs present early in life, the timing of any intervention should be done with a mind to interfering the least with the child’s growth and development. Often it is better to delay operating on very young children, if possible.

In the past, the only treatment for these vascular anomalies was surgical removal. However, only a minority, around 10 to 15 percent of those CVMS that were significant enough to justify operation could be totally removed by surgery. Even then, removing even the simplest of these vascular malformations could lead to a procedure with significant blood loss and therefore surgical risk.

Surgery may still be appropriate for localized, accessible lesions, but in the last few decades, techniques using catheters have been developed. Catheters are placed (usually through a groin vessel) and advanced into the lesions and the malformed vessels are blocked, or emblolized, with a variety of injectable particles, substances, or devices such as polyvinyl foam, biological glues, and absolute alcohol.

These catheter embolization techniques can be used to control lesions without surgery. They can also shrink larger CVMs to make them more readily treatable by surgery. Laser therapy may also be effective for small, localized birthmarks (port wine stains). Patients with a rare venous malformation (Kleppel –Trenaunay Syndrome) of the limbs frequently benefit from elastic garments and bandages used for compression of the large veins. After careful evaluation, surgery or less invasive therapy of the enlarged superficial veins can also be helpful.