Combined Surgical and Endovascular Approaches
The “combined approach” to the treatment of CVMs represents a combination of traditional surgical therapy and endovascular therapy based on embolotherapy and sclerotherapy.
The ultimate goal of this combined treatment approach utilizing the two different modalities is to maximize the inherent treatment advantages both approaches have to offer while minimizing the associated risk and morbidity.
This new approach opened a new chapter for the traditional surgical approach which was severely hampered in the past and limited to the excision of “localized” lesions due to high morbidity. Throughout the last century, such poor surgical outcomes were inevitable due to the indiscriminate, “overzealous” surgical approach to all of the CVMs, using the same principles involved in oncologic surgery in order to minimize recurrence.
A new strategy that combines both the endovascular approach and a modernized surgical approach has demonstrated significantly improved efficacy when employed in sequence (e.g., preoperative embolotherapy and subsequent surgical excision), with fewer complications and reduced morbidity when compared to the outcomes achieved when utilizing the two individual treatment approaches alone.
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