Article information
Abstract
Diagnosis of vascular malformations is essentially clinical, based on the evolution and morphology of lesions. A biopsy is rarely needed to evaluate the nature of the vessels. Imaging examinations are necessary to assess the extension of malformations as well as the osteomuscular and visceral compromise. New techniques such as 3D angio-CT scan and angio-MRI improve the diagnosis of some vascular malformations, especially the large combined ones such as Klippel-Trénaunay syndrome, thus limiting the need for invasive procedures. On the other hand, the advances in laser technology, particularly pulsed dye laser for port-wine stains and Nd:YAG laser for superficial venous malformations constitute new alternatives for the management of these patients. Other emergent treatments include microfoam sclerotherapy for venous and combined, slow-flow malformations, and new embolizing materials associated to surgery for arteriovenous malformations. The second part of this review is focused on the complementary diagnosis (imaging exams, pathology and accessory tests) and multidisciplinary and specific treatment based on the different groups.
Key words:
angio-CT scan
angio-MRI
pulsed dye laser
microfoam sclerotherapy
embolization
surgery
Resumen
El diagnóstico de las malformaciones vasculares es fundamentalmente clínico, y está basado en la evolución y morfología de las lesiones, siendo necesaria en muy raras ocasiones la realización de una biopsia para valorar histológicamente la naturaleza de los vasos. Para delimitar la extensión de las malformaciones, así como el compromiso músculo-esquelético y visceral, son necesarias las pruebas de imagen. La incorporación de nuevas técnicas como la angio-tomografía computarizada (TC) o la angio-resonancia magnética (RM) en 3D agilizan el diagnóstico de algunas malformaciones vasculares, especialmente las combinadas extensas tipo síndrome de Klippel-Trenaunay, limitando la necesidad de procedimientos invasivos. Por otra parte, los avances en tecnología láser, concretamente el láser de colorante pulsado para la mancha en vino de Oporto y el láser de Nd:YAG para las malformaciones venosas superficiales, la escleroterapia con microespuma en las malformaciones venosas y combinadas de bajo flujo, y los nuevos materiales embolizantes asociados con la cirugía en malformaciones arteriovenosas, son terapias emergentes para el seguimiento de los pacientes. La segunda parte de esta revisión está enfocada al diagnóstico complementario (pruebas de imagen, histología y pruebas accesorias) y al tratamiento multidisciplinar y específico según los diferentes grupos.
Palabras clave:
angio-TC
angio-RM
láser de colorante pulsado
esclerosante en microespuma
embolización
cirugía
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