Extracranial (Head and Neck) and Paraspinal Vascular Malformations

Vascular malformations refer to abnormal vessels that form a direct connection between arteries and veins in the absence of blood flowing through the normal structures. Extracranial malformations occur in the tissues of the face and neck, whereas paraspinal malformations involve the tissues surrounding the spine.

These types of vascular malformations can produce problems by enlarging and putting pressure on the surrounding structures. Symptoms that may result include deformity of the tongue, lip, eyelid, or other facial features. Difficulty with vision or swallowing may also result. Pain may occur due to pressure applied to the nerves in the area.

Vascular malformations can lead to congestive heart failure.

Vascular malformations can lead to congestive heart failure - a condition that results when the heart is unable to pump enough blood to meet the body’s demands. This can occur if the blood flows through the abnormal vessels at a high volume and speed.

Vascular lesions are often congenital – present at birth—and can change or, in many cases, disappear as the child grows. Some types of birth marks seen in infants are actually the result of vascular malformations.

There are a number of instances, however, when vascular lesions may require treatment. When they do not disappear, when they increase in size with age, when they appear later in life, or when they result in symptoms, treatment may be recommended.

Depending on the type of malformation, various treatment modalities may be recommended. Surgery or laser therapy are some options. In other cases, embolization may be required. Embolization is similar to an angiogram in that a tube or catheter is inserted into the leg and guided to the blood vessels supplying the malformation through the use of x-ray technology. Material is then injected to block of the blood supply.

Embolization from start to finish
Prior to undergoing embolization, patients are expected to sign a consent form and will have the opportunity to have questions answered. The anesthesiologist will administer medications and fluids through the use of an intravenous line (IV) into a vein in the hand or arm. He or she will also administer general anesthesia so that the patient will be completely asleep for the procedure. Blood pressure will be monitored through an A-Line, a thin flexible tube or catheter placed in an artery in your wrist. An electrocardiogram (EKG) will monitor heart rate and rhythm as well as oxygen levels. A specific type of catheter known as a Foley will be placed in the bladder to allow urine to drain.

Once the procedure is complete, the patient will be transferred from the operating room to either the Surgical Intensive Care Unit (SICU) or the Post-Anesthesia Care Unit (PACU). Here, a heart monitor will closely monitor vital signs. This machine is very sensitive and often sounds inadvertently; this is not cause for alarm. The nursing staff will assist in changing positions, but bed rest is required. Eventually, the patient can look forward to a normal diet and transfer to a room on a surgical floor. The Foley catheter will also be removed prior to leaving the bed for the first time.

Patients are expected to keep the leg that underwent surgery straight for several hours and a tube may remain in place at the puncture sight for several days. Once it is removed, the physician will apply pressure for about 20 minutes to prevent bleeding, and a device may be used to seal the puncture.

A similar procedure may also be conducted in which a needle is inserted through the skin into the lesion, and material is injected to block off the malformation.