The special nature of the anatomopathological structure and of the haemodynamic disturbances in congenital vascular defects causes certain peculiarities in their operative treatment. In our experience therapeutical strategy should be based on the following basic principles: active causal therapy combating pathogenesis, individual treatment, early operation, functionally radical operation, operation by stages and combined treatment. The numerous operative techniques are subdivided as follows according to surgical tactics: reconstructive operations, operations to remove the vascular defect, operations to reduce haemodynamic activity of the vascular defect and other nonhaemodynamic operations. Good postoperative results obtained after the use of the principles indicated above in a large number of patients treated by vascular surgeons in six different countries proved the validity of active and causal treatment of these severe diseases.

Arteriovenous Malformations↗

PubMedDate not supplied

Surgical treatment in predominantly arterial defects.

The predominantly arterial defects are not common. Four anatomical forms are distinguished: truncular aplasia or obstruction, truncular dilatation, extratruncular infiltrating form and extratruncular limited form. They are demonstrated through an analysis of 40 cases treated by the authors. The therapeutic principles for them are the same as those applying to standard vascular surgery. Regarding the infiltrating extratruncular lesion, an initial embolization through the afferent artery and a series staged operation are suggested.

Adolescent↗

PubMedDate not supplied

The surgical treatment of predominantly venous defects.

The predominantly venous defects consist of the truncular forms, as there is aplasia or obstruction in the truncular dilatation; and they consist of the extratruncular forms as there are the infiltrating ones and the limited ones, according to the Hamburg classification. The web or membranous obstruction of the inferior vena cava (IVC), dilatation or aneurysm of the jugular vein, infiltrating "cavernous angioma" and localized venous defects are the main lesions of those classifications reported in this communication. Jugular dilatation and localized extratruncular lesions have had good therapeutic results. Webs of the IVC can be treated by membranectomy, either by finger, transcardially, or balloon, percutaneously, and cavo- or mesoatrial shunt; however, membranectomy, along with cavoplasty as a radical treatment for such an entity, is advocated by the authors. The infiltrating extratruncular form is the unsolved important issue concerning its thorough resection. Skin graft taken from a resected tissue mass through a reversal split thickness skin graft by a drum type dermatome, removal of the lesion along with muscle layer(s), and staged operations are recommended.

Adolescent↗

PubMedDate not supplied

Iatrogenic vascular lesions: tactical procedure and late follow-up studies.

The problems associated with postoperative iatrogenic vascular lesions in 13 patients are discussed. In general surgery, there is no particular procedure which entails an extremely high risk of iatrogenic vascular lesions. Depending on the kind of lesion, hemorrhage and ischemia are the most frequent symptoms. The IVL was recognized during the initial operation in only two cases. Interposition of autologous saphenous vein is the safest therapeutic procedure. End-to-end anastomosis and patches to enlarge the anastomosis can also be used. In venous lesions, we recommend the creation of a temporary AV-fistula. In one case a thigh amputation was necessary because of progressive venous gangrene; operation was performed five days after the lesion. Postoperatively, two cubital interpositions were occluded; but the patients did not suffer from circulatory problems. One female patient died following resection of a carotid aneurysm originating from a glomectomy. Good postoperative results were reported for the other patients.

Adult↗