Objective:

The clinical characteristics of high-flow vascular malformations are complex and often exhibit an unpredictable course. Generally, this type of vascular lesion tends to display an aggressive nature, advancing over time and leading to increased destructiveness. The most common symptoms include pain, bleeding, neuropathy, and tissue destruction, which can lead to disfigurement. However, relying solely on surgery often yields limited success, particularly when the lesion is not entirely removed. Consequently, a multidisciplinary approach involving surgical intervention and endovascular management is now employed to enhance outcomes. Hence, the primary objective of this article is to share our experiences in treating high-flow vascular malformation located in the head and neck, trunk, and extremities using endovascular management. We aim to demonstrate how employing different approaches and embolization agents can enhance treatment outcomes while reducing the recurrence rate.

Material and methods:

A 43-year-old male with a high-flow vascular malformation on his left chin, who had previously undergone feeding vessel open ligation in 2007, first presented to our hospital in 2020. The initial magnetic resonance imaging (MRI) revealed multiple hypertrophied and dilated vessels in the left chin area, along with a large drainage venous pouch in the submandibular area.

A 19-year-old male with a high-flow vascular malformation in his left thigh, who had previously undergone incomplete excision several years ago, presented to our hospital for the first time in 2019. The initial imaging revealed a vascular malformation originating from the deep femoral artery and superficial femoral artery, with drainage into the engorged greater saphenous vein (GSV).

Results:

Trans-arterial embolization (TAE) therapy was performed, and we targeted the feeding vessel using a super-selective approach, along with using coils to embolize the drainage vein. As a result, the lesions significantly decreased in size, and the patient's symptoms improved. Follow-up imaging also demonstrated a dramatic reduction in the abnormal vascular lesions.

Conclusion:

The effectiveness of embolization therapy for high-flow vascular malformations can be predicted based on the angiographic classification and the extent of the lesion. For trans-arterial approaches, it is crucial to opt for super-selective embolization while avoiding proximal occlusion. The trans-venous approach becomes essential to enhance the overall effectiveness of embolization due to flow reduction. Whenever possible, the primary objective of interventional treatment should be the complete occlusion of the nidus or fistulous connections.