Diagnosis and management of venous malformations: An overview

Venous malformations pose some of the most difficult challenges in the practice of medicine today. Clinical manifestations of these lesions are extremely protean. Because of the rarity of these lesions, most clinicians have limited experience in their diagnosis and management, which augments the enormity of the problem and can lead to misdiagnoses, inadequate treatment, high complication rates, and poor patient outcomes. Vascular malformations are best treated in medical centers where patients with these maladies are seen regularly and the team approach is used. The occasional embolizer will never gain enough experience to treat these problematic lesions adequately. More importantly, when complications do occur, the morbidity of that complication is worsened because of this lack of experience and the absence of an experienced team of physicians. All too frequently, the patient ultimately pays for a physician's initial enthusiasm, inexperience, folly, and lack of necessary clinician backup. A cavalier approach to the management of venous malformations will always lead to significant complications and dismal patient outcomes. These patients should be referred to centers that regularly treat vascular malformations, appropriately manage complications in a timely manner, and routinely deal with the dilemmas they present. Only in this fashion can significant experience be gained, improved judgment in managing these lesions develop, and definitive appropriate statements in the treatment of vascular anomalies evolve.