Kromhout J G, vd Horst C, Peeters F, Gerhard M
Department of Vascular Surgery, Academisch Ziekenhuis, Amsterdam, The Netherlands.
Int Angiol. 1990 Jul-Sep;9(3):203-7.
Eighty-one patients with a vascular malformation on the extremities were evaluated. In 32 patients the abnormality was localised in the upper and in 49 in the lower extremity. Signs, symptoms, treatment modalities and long-term results were tabulated. In the upper extremity pain was the most frequent presenting symptom. Three types of malformation were distinguished: purely venous, venous with microshunts and malformations with macroshunts. The treatment of the first group consisted of excision of varices and superficial naevi, in the second group the combined treatment of embolisation and excision was the treatment of choice, in the last group the selective embolisation without resection was most frequently done. The treatment was most successful in those cases, where there was a malformation with macrofistulas in the shoulder-region or only a localised lesion, that could be excised. The first sign and symptom of the lower extremity was swelling or a naevus vasculosus. After inventarisation 4 groups of vascular malformations have been distinguished, the cavernous (venous), the cavernous (venous) with microshunts, the arteriovenous with macrofistulas and a purely venous (truncular) group, which we did not have in our patients with an upper extremity abnormality. Conservative treatment in purely venous malformations prevented progression, the combined treatment was successful in patients with an AV-malformation of the pelvis, or around the knee or in patients with a small excisable lesion.
the purely venous abnormality can be successfully treated with conservative measures, the arteriovenous malformation with macroshunts in pelvis and shoulder region should be embolised, and circumscript lesions excised with or without embolisation, depending on the character of the lesion.
对81例四肢血管畸形患者进行了评估。32例患者的异常位于上肢，49例位于下肢。将体征、症状、治疗方式及长期结果制成表格。在上肢，疼痛是最常见的首发症状。区分出三种类型的畸形：单纯静脉型、伴有微分流的静脉型和伴有大分流的畸形。第一组的治疗包括切除静脉曲张和浅表痣；第二组首选栓塞和切除联合治疗；最后一组最常采用不切除的选择性栓塞治疗。在肩部区域存在伴有大瘘管的畸形或仅存在可切除的局限性病变的病例中，治疗最为成功。下肢的首发体征和症状为肿胀或血管痣。分类后区分出4组血管畸形：海绵状（静脉型）、伴有微分流的海绵状（静脉型）、伴有大瘘管的动静脉型和单纯静脉（主干型）组，上肢异常的患者中没有此组。单纯静脉畸形的保守治疗可防止病情进展，联合治疗对骨盆、膝关节周围的动静脉畸形患者或有小的可切除病变的患者有效。
单纯静脉异常可通过保守措施成功治疗，骨盆和肩部区域伴有大分流的动静脉畸形应进行栓塞治疗，对于局限性病变，根据病变特征决定是否在栓塞或不栓塞的情况下进行切除。
