Rutherford's 171: Congenital Vascular Malformations Surgical Management скачать в хорошем качестве

Rutherford's 171: Congenital Vascular Malformations Surgical Management

#VascularMalformations #CongenitalAnomalies #VascularSurgery #ISSVA #AVM #LM #VM #SlowFlow #FastFlow #Embolization #Sclerotherapy #Rutherfords #MedicalEducation #SurgicalManagement This video, drawing on summaries from Rutherford's Vascular and Endovascular Therapy textbook, provides a detailed overview of congenital vascular malformations and their surgical management. Unlike vascular tumours which involve cell growth, malformations are developmental errors present from birth, likened to "developmental miswiring". The International Society for the Study of Vascular Anomalies (ISSVA) classification system, updated in 2018, brought clarity by dividing these conditions into vascular tumours and vascular malformations. The focus is on malformations, further subclassified by the type of vessel affected (capillary, lymphatic, venous, arterial) and blood flow rate (slow flow vs. fast flow). Slow flow types include Capillary Malformations (CMs), Lymphatic Malformations (LMs), and Venous Malformations (VMs). Fast flow types are Arteriovenous Fistulas (AVFs) and Arteriovenous Malformations (AVMs). Combined malformations involving multiple vessel types also exist, as seen in syndromes like Klippel-Trenaunay Syndrome (KTS) and CLOVES Syndrome. Accurate diagnosis using imaging like ultrasound, CT, MRI, and angiography is paramount to determine the extent and flow dynamics, guiding treatment decisions. Surgical intervention is a key treatment but is part of a broader approach including conservative measures like compression, medications like Sirolimus, and endovascular treatments such as sclerotherapy. Surgical strategies vary by type: *CMs:* Surgery is usually not the primary treatment for isolated lesions (laser is standard), but staged excision may be used for combined lesions with underlying overgrowth. *LMs:* Macrocystic types often respond to sclerotherapy, while microcystic ones typically require surgical resection. Managing lymphatic fluid leakage is a significant consideration, sometimes requiring long-term drains or complex bypass procedures. *VMs:* Localised VMs may be surgically excised. For larger, symptomatic ones, debulking or sclerotherapy, sometimes combined with surgery, is used. Techniques account for the spongy, bleeding-prone nature of VMs. *AVMs:* The standard approach often combines pre-operative embolization to reduce flow with complete surgical excision of the nidus. Reconstruction using grafts or flaps is frequently needed after removal. Recurrence is a significant risk if not completely removed. Combined syndromes like KTS and CLOVES involving extensive overgrowth often require staged surgical debulking procedures tailored to the affected areas. Post-operative care frequently involves managing fluid drainage, with drains sometimes remaining for weeks or months. Recurrence is possible, necessitating long-term follow-up. Overall, managing congenital vascular malformations requires a multidisciplinary approach, accurate diagnosis, and an individualised treatment plan, often combining various modalities with surgery.