Vascular malformations

Blood vessels and lymph vessels form in the early weeks of pregnancy. Sometimes a group of vessels forms the wrong way and ends up enlarged, tangled or connected in the wrong places. This is called a vascular malformation. It is present at birth, even if it is not noticed until childhood, the teen years or adulthood. It is not cancer and does not spread to other parts of the body.

Malformations grow along with the body and often enlarge during puberty, pregnancy, or after an injury or surgery. They do not go away on their own. They are different from a hemangioma, a common birthmark in babies that grows for several months and then usually shrinks by itself.

Most malformations happen by chance and are not inherited. A few are linked to gene changes, sometimes as part of a syndrome, and genetic testing can help guide treatment in those cases.

Doctors group malformations by which vessels are involved and how fast blood flows through them. The type decides the treatment.

Symptoms depend on the type, size and location. A small malformation may cause no trouble at all. A larger one can affect how a limb works or how you feel about your appearance.

Pregnancy can make malformations bigger and, for venous malformations, raise the risk of blood clots. If you have a malformation and are planning a pregnancy, talk with us first.

The first goal is to make sure it really is a vascular malformation and not a tumor, and to find out which type it is.

What we see

Not every malformation needs treatment. We treat when it causes pain, bleeding, swelling that limits function, sores, or a change in appearance that bothers you. Treatment is planned for each person, and complex cases are reviewed by a team that includes interventional radiology and vascular surgery. Most treatments are done in stages, several weeks to months apart.

When I see someone with a vascular malformation, I start by listening to what bothers them most, because the goal is to fix that, not to erase every vessel on the MRI. I look at the images to see how fast the blood flows and how close the malformation is to nerves, skin and muscle. I am honest that many malformations are controlled rather than cured, and that we usually work in stages to get the most benefit with the least risk.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos

1. 1
   Preparation

   The procedure is done as an outpatient at El Camino Hospital, with numbing medicine and moderate sedation, or general anesthesia for large or sensitive areas and for children.

2. 2
   Finding the channels

   Using ultrasound, we place a thin needle into the malformation and inject contrast dye to see how it drains.

3. 3
   Treating

   The sclerosant, sometimes mixed with air into a foam, is injected slowly while we watch on X-ray. Several spots may be treated in one session.

4. 4
   Going home

   The needle is removed and a bandage or compression wrap is applied. After about 2 hours of monitoring, most people go home the same day.

1. First 2–3 days
   Swelling and soreness peak. It can be significant. Rest, elevate the area, use ice and take the pain medicine prescribed. Sometimes a short course of steroids helps.
2. First 1–2 weeks
   Swelling settles. The area may feel firm or lumpy as the vessels scar down. Return to normal activity as comfort allows.
3. 1–3 months
   The treated area keeps shrinking. We usually see you in clinic and decide whether another session is needed.

Most people have less pain and swelling after treatment, often after 1 to 3 sessions. Small, well-defined malformations can sometimes be cured. Large or widespread ones are usually controlled rather than cured, and they can regrow over years, so repeat treatment is common.

Living with a malformation often means long-term follow-up. Wear compression garments if we recommend them, stay active, and let us know about changes in size, pain or skin color. Tell any doctor treating you, including your dentist or obstetrician, that you have a vascular malformation.