Chirurgische therapieoptionen bei angeborenen gefäßfehlbildungen

Abstract

Background. For purely surgical treatment of congenital vascular malformations only certain forms of disease can be taken into consideration; therefore, the ideal patient population for surgical therapy is limited. Aim. The surgical treatment of vascular malformations requires precise consideration and a differentiated evaluation of the indications that demonstrates and allows allocation in the Hamburg classification. Methods. Evaluation of the patient population in our clinic and a selective search for references. Results. The diagnosis and treatment of congenital vascular malformations have always been controversially discussed. A thorough knowledge of the pathophysiology of vascular malformations is often underestimated, which in our experience is essential for the correct selection of the therapeutic procedure. Discussion. Selecting the right timing for surgical treatment of extratruncular vascular malformations is difficult and should always be considered critically. Early surgery may be pathophysiologically unnecessary and even stimulate the persistent lesions in their progression when the surgical procedure does not lead to a radical and complete elimination of malformations. Accordingly, serious complications at the time of surgery are a sign of previous inappropriate delay of treatment. Conclusion. Surgical treatment of vascular malformations requires the cooperation of the various surgical disciplines. The results of treatment in the sense of a combined therapy using additive endovascular techniques have been principally improved. Depending on the patient age, the anatomical areas involved and the often demanding reconstructive procedures, excellent surgical results can be achieved in multidisciplinary cooperation. © 2014 Springer-Verlag.