Vascular Malformations

What Are Vascular Malformations?

A vascular malformation is a non-cancerous growth caused by abnormalities in the blood vessels. Vascular malformations are often congenital, meaning they are present at birth, but they can also be acquired, meaning that they develop later in life, often as the result of an injury or trauma. Successful treatment of vascular malformations involves multidisciplinary care; when they occur in the upper extremities, hand and arm surgeons need the diagnostic resources and specialized experience to choose the best treatment option for each individual patient.

The highly skilled surgeons at The Institute for Hand Surgery at New York Plastic Surgical Group, a division of Long Island Plastic Surgical Group are experienced in treating vascular malformations. Their extensive training gives them the unique knowledge needed to restore form and function for patients with vascular malformations.¹

Types of Vascular Malformations

Vascular malformations are categorized based on the component type of involved structures, as well as the type of blood flow. Types of vascular malformations include:

• Capillary malformations involve capillary vessels and are commonly called port wine stains. They affect approximately .5% of the population.²
• Venous malformations are fairly common growths of veins that may have a bluish color and are usually present at birth and continue to grow if left untreated.
• Arteriovenous malformations involve arteries and veins without capillaries.
• Lymphatic malformations are relatively rare abnormalities which involve only lymph vessels.
• Veno-lymphatic malformations involve both veins and lymph vessels.
• Hemangiomas These benign vascular tumors are red bumps caused by a clump of abnormal blood vessels that grow rapidly in the first three months. They are common in young children and infantile hemangiomas are the most common congenital vascular malformation.³

Causes of Vascular Malformations

Many vascular malformations are congenital and do not have a known cause. Some types, such as hemorrhagic telangiectasia, are hereditary. Other types may be associated with rare genetic conditions, such as Klippel-Trenaunay syndrome, Parkes-Weber syndrome, Maffucci’s syndrome, CLOVES syndrome, and Kasabach-Merritt phenomenon (KMP).⁴⁵⁶ Occasionally, a vascular malformation may be the result of an injury.

Symptoms of Vascular Malformations

Vascular malformations can vary greatly in symptoms, depending on the location, size and type of the growth. Some common symptoms include:

• Abnormally enlarged digit or extremity
• Cold intolerance
• Increased temperature and hair growth
• Infection
• Numbness or paresthesias from nerve compression
• Pain
• Swelling
• Visibly enlarged blood vessels
• Ulceration
• Bleeding

Diagnosing Vascular Malformations

Some types of vascular malformations can be diagnosed upon sight, but most require testing to confirm a diagnosis. Tests such as ultrasound, X-ray, MRI with or without contrast, and angiogram or CT angiogram may be used.

Treating Vascular Malformations

There is no one-size-fits-all treatment for vascular malformations. Treatment plans must be tailored to appropriately address the type of growth, as well as the location and the severity of symptoms. Small or early stage vascular malformations may be treated with a compression garment. Other treatment methods include surgical removal, surgical debulking, or partial excision. Sclerotherapy, an injectable treatment, may be used alone or in combination with surgical excision. In rare and severe cases, amputation may be necessary. Our team is committed to restoring function and providing aesthetic improvement through the most advanced and minimally invasive treatment options. Contact us with any questions about vascular malformations of the hand, arm, and upper extremities.

Vascular Malformation of the Hand—One LIPSG Patient’s Story

When a young woman came to the The Institute for Hand Surgery at NYPS Group with a painful mass growing in her hand, our surgeons were ready to help her. Her vascular malformation had been recognized several years earlier, but had ballooned in size and scope while left untreated. Her NYPS Group surgeon was able to remove the mass and she recovered full function and returned to work within a year of surgery.

Surgical Photos

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¹ Balakrishnan G. Vascular anomalies of the upper limb. Indian J Plast Surg. 2011;44(2):276-282. doi:10.4103/0970-0358.85349
² Cox JA, Bartlett E, Lee EI. Vascular malformations: a review. Semin Plast Surg. 2014;28(2):58-63. doi:10.1055/s-0034-1376263
³ Richter GT, Friedman AB. Hemangiomas and vascular malformations: current theory and management. Int J Pediatr. 2012;2012:645678. doi:10.1155/2012/645678
⁴ Mahajan P, Margolin J, Iacobas I. Kasabach-Merritt Phenomenon: Classic Presentation and Management Options. Clin Med Insights Blood Disord. 2017;10:1179545X17699849. Published 2017 Mar 16. doi:10.1177/1179545X17699849
⁵ Asilian A, Kamali AS, Riahi NT, Adibi N, Mokhtari F. Proteus Syndrome with Arteriovenous Malformation. Adv Biomed Res. 2017;6:27. Published 2017 Mar 7. doi:10.4103/2277-9175.201684
⁶ Jacobs BJ, Anzarut A, Guerra S, Gordillo G, Imbriglia JE. Vascular anomalies of the upper extremity [published correction appears in J Hand Surg Am. 2011 Jan;36(1):183. Guerra, Sara [added]; Gordillo, Gayle [added]]. J Hand Surg Am. 2010;35(10):1703-1709. doi:10.1016/j.jhsa.2010.08.005