Congenital vascular malformations: diagnostic evaluation.

The management of CVMs is indeed difficult and is particularly frustrating because in most cases, complete cure or long-lasting control is not often possible by surgery or embolotherapy. However, the majority of patients with peripheral CVMs can be well-managed by conservative measures with only occasional intervention, and this provides some consolation. Nevertheless, it is important to be able to make a reasonable prognosis and set forth a therapeutic plan to the patient or the patient's parents, when the patient first presents. The approach recommended here allows one to establish the appropriate diagnosis and classify the CVM according to its vascular components. In addition, by assessing its hemodynamic or physiological effects and defining its anatomic extent and involvement of adjacent structures, one is in a position to provide definitive advice at the outset and continue to follow and manage the patient in a logical fashion using angiography sparingly, often only before the ultimately needed therapeutic intervention.