Surgical Treatment of Low-Flow CVM

  • Raul Mattassi


Low-flow CVM are truncular or extratruncular type. Truncular superficial dilated dysplastic veins can be removed surgically if deep veins are normal. Venous aneurysm needs treatment because pulmonary embolism may happen. Tangential resection or vein transplant are the best treatment. Extratruncular forms, limited or infiltrating, may be sited in every part of the body. Often they are intramuscular. Treatment options are surgical removal, sclerosis by direct puncture with foam or alcohol injection, and laser treatment. According to great variability in site and extension, treatment strategy should be decided at a multidisciplinary discussion.


  1. 1.
    Lee BB, Laredo J, Lee TS, Huh S, Neville R. Terminology and classification of congenital vascular malformations. Phlebology. 2007;22(6):249–52.CrossRefPubMedGoogle Scholar
  2. 2.
    Lee BB, Antignani PL, Baraldini V, Baumgartner I, Berlien P, Blei F, Carrafiello GP, Grantzow R, Ianniello A, Laredo J, Loose D, Lopez Gutierrez JC, Markovic J, Mattassi R, Parsi K, Rabe E, Roztocil K, Shortell C, Vaghi M. ISVI-IUA consensus document diagnostic guidelines of vascular anomalies: vascular malformations and hemangiomas. Int Angiol. 2015) Aug;34(4):333–74.PubMedGoogle Scholar
  3. 3.
    Lee BB, Baumgartner I, Berlien P, Bianchini G, Burrows P, Gloviczki P, Huang Y, Laredo J, Loose DA, Markovic J, Mattassi R, Parsi K, Rabe E, Rosenblatt M, Shortell C, Stillo F, Vaghi M, Villavicencio L, Zamboni P. Diagnosis and treatment of venous malformations consensus document of the International Union of Phlebology (IUP): updated 2013. Int Angiol. 2015;34(2):97–149.PubMedGoogle Scholar
  4. 4.
    Mattassi R. Vascular malformations of the limbs: treatment of venous and arteriovenous malformations. In: Mattassi R, DA L, Vaghi M, editors. Hemangiomas and vascular malformations. An atlas of diagnosis and treatment. 2nd ed. Milan: Springer; 2015. p. 417–30.Google Scholar
  5. 5.
    Tomko T, Malý R, Jiska S, Chovanec V. Popliteal venous aneurysm as a cause of recurrent pulmonary embolism. Vasc Endovascular Surg. 2011;47(2):155–8. doi: 10.1177/1538574412473185. Epub 2013 Jan 10CrossRefGoogle Scholar
  6. 6.
    Johnstone JK, Fleming MD, Gloviczki P, Stone W, Kalra M, Oderich GS, Duncan AA, De Martino RR, Bower TC. Surgical treatment of popliteal venous aneurysms. Ann Vasc Surg. 2015;29(6):1084–9. doi: 10.1016/j.avsg.2015.02.009. Epub 2015 May 22CrossRefPubMedGoogle Scholar
  7. 7.
    Mattassi R, Vaghi M. Intramuscular venous malformations. Int Angiol. 2004;23(suppl I):23.Google Scholar
  8. 8.
    Rivas S, López-Gutiérrez JC, Díaz M, Andrés AM, Ros Z. Venous malformations. Diagnosis and treatment during the childhood. Cir Pediatr. 2006;19(2):77–80.PubMedGoogle Scholar
  9. 9.
    Dompmartin A, Acher A, Thibon P, Tourbach S, Hermans C, Deneys V, Pocock B, Lequerrec A, Labbé D, Barrellier MT, Vanwijck R, Vikkula M, Boon LM. Association of localized intravascular coagulopathy with venous malformations. Arch Dermatol. 2008;144(7):873–7. doi: 10.1001/archderm.144.7.873.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Mazoyer E, Enjolras O, Bisdorff A, Perdu J, Wassef M, Drouet L. Coagulation disorders in patients with venous malformation of the limbs and trunk: a case series of 118 patients. Arch Dermatol. 2008;144(7):861–7. doi: 10.1001/archderm.144.7.861.CrossRefPubMedGoogle Scholar
  11. 11.
    Loose DA. Surgical management of venous malformations. Phlebology. 2007;22(6):276–82.CrossRefPubMedGoogle Scholar
  12. 12.
    Su L, Fan X, Zheng L, Zheng J. Absolute ethanol sclerotherapy for venous malformations in the face and neck. J Oral Maxillofac Surg. 2010;68(7):1622–7. doi: 10.1016/j.joms.2009.07.094. Epub 2009 Dec 4CrossRefPubMedGoogle Scholar
  13. 13.
    Teresa O, Waner M. Upper airway congenital vascular lesions. In: Mattassi R, Loose DA, Vaghi M, editors. Hemangiomas and vascular malformations. An atlas of diagnosis and treatment. 2nd ed. Milan: Springer; 2015. p. 343–55.Google Scholar
  14. 14.
    Arneja JS, Gosain AK. An approach to the management of common vascular malformations of the trunk. J Craniofac Surg. 2006;17(4):761–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Wang S, Lang JH, Zhou HM. Venous malformations of the female lower genital tract. Eur J Obstet Gynecol Reprod Biol. 2009;145(2):205–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Burrows P. Vascular malformations involving the female pelvis. Semin Intervent Radiol. 2008 Dec;25(4):347–60. doi: 10.1055/s-0028-1102993.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Di Giuseppe P. Treatment of vascular malformations in the hand. In: Mattassi R, Loose DA, Vaghi M, editors. Hemangiomas and vascular malformations. An atlas of diagnosis and treatment. 2nd ed. Milan: Springer; 2015. p. 379–86.Google Scholar
  18. 18.
    Lopez-Oliva CL, Wang EH, Cañal JP. Synovial hemangioma of the knee: an under recognized condition. Int Orthop. 2015;39(10):2037–40. doi: 10.1007/s00264-015-2930-4. Epub 2015 Jul 31CrossRefPubMedGoogle Scholar
  19. 19.
    Hauert J, Loose DA. Orthopedic problems. In: Mattassi R, Loose DA, Vaghi M, editors. Hemangiomas and vascular malformations. An atlas of diagnosis and treatment. Milan: Springer; 2015. p. 369–78.Google Scholar
  20. 20.
    Dompmartin A, Vikkula M, Boon L. Venous malformations: update on etiopathogenesis, diagnosis & management. Phlebology. 2010;25(5):224–35.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Center for Vascular Malformations “Stefan Belov”Clinical Institute Humanitas “Mater Domini”CastellanzaItaly

Personalised recommendations