717 - Peripheral Vascular Malformations: Preventing and Addressing Treatment Complications

Learning Objectives: The learning objectives of this exhibit include identifying potential complications of peripheral vascular malformation treatment, discussing methods to prevent these complications, and reviewing management options for complications.

Background: Peripheral vascular malformations (PVM) are increasingly managed with minimally invasive techniques. Complications are highly variable based on the lesion location and architecture. Management may range from acute supportive care to long-term physical therapy or surgical intervention. It is imperative for the interventional radiologist to understand common PVM complications to prevent and manage them appropriately.

Clinical Findings/Procedure Details: The most common complication of PVM treatment are wounds, ranging from minor injuries requiring supportive care, to large necrotic wounds necessitating surgical debridement. Understanding basic wound care triage and management is crucial in the post-procedural management of PVMs. Functional complications involving nerve deficits may also occur. This review will discuss intraoperative neuromonitoring (IONM) techniques to limit potential nerve injuries. Management of acute nerve injuries includes short courses of steroids. Long-term nerve palsy may be irreversible, with supportive management including physical therapy and rehabilitation. Patients with predisposing intra-articular or intramuscular lesions, or lesions intimate with nerve bundles, should be closely monitored. Another known complication of PVM treatment is deep vein thrombosis. Thus, the use of duplex ultrasonography and anticoagulation are vital aspects of PVM management. Finally, monitoring for non-target embolization is crucial. This exhibit will review strategies to prevent and decrease the impacts of non-target embolization, including the use of specialized catheters and balloon occlusion techniques.

Conclusion and/or Teaching Points: Complications of PVM treatment can be highly variable depending on the lesion angioarchitecture and location. It is crucial for the clinical IR to be aware of the various complications to adequately counsel patients prior to procedure and appropriately manage post-procedural complications as they arise.