Correction of lower limbs length discrepancy in congenital vascular-bone diseases by vascular surgery performed during childhood.

The progress in the treatment of congenital vascular-bone diseases in lower extremities caused by vascular malformations has been reviewed, along with an analysis of our clinical material and methods of treatment, and the results of our attempts to correct lower limb length discrepancy by early and direct vascular surgery directed at the cause of the bony changes. This experience leads us to the following conclusions: 1. Congenital vascular-bone diseases in lower extremities have a hemodynamic pathogenesis. The resulting bone changes can be caused by each of the different types of congenital vascular defects, or by a combination of them, with the resultant bone elongation or shortening due to hemodynamic and metabolic effects on the bone growth areas. 2. The recommended approach demands early, active, and causal treatment. 3. Operative techniques must be individualized and often seem unconventional because of the polymorphism of congenital vascular defects and specific differences in their anatomic and hemodynamic features. In severe cases, vascular surgery must be combined with other non-hemodynamic operations and nonsurgical methods (eg, orthopedic surgery, embolotherapy). 4. Early and active vascular surgery in childhood allows the correction of congenital lower limb length discrepancy, as judged by late follow-up evaluation.