A vascular malformation is a blood or lymphatic vessel that formed abnormally, usually before birth. Unlike a hemangioma, which appears in infancy and typically involutes on its own, a malformation is present from the start, grows in proportion with the person, and does not disappear.
They are classified by the vessels involved, and the classification drives everything that follows. Capillary malformations — the flat vascular birthmark often called a port-wine stain — are usually managed with laser. Venous malformations are soft, compressible, often bluish, and characteristically swell and ache when the area is dependent or after exertion. Lymphatic malformations form cystic collections that can swell abruptly with infection. Arteriovenous malformations, in which arteries connect directly to veins without the capillary bed in between, are the most complex and the most demanding to treat.
Malformations are commonly mislabeled for years — called hemangiomas, bruises, cysts or hematomas — and treated with approaches that were never going to work. Partial or poorly planned treatment can make a malformation harder to treat later.
Our approach begins with imaging that establishes exactly what is present and how it is fed: ultrasound, MRI with dedicated sequences, and where necessary direct puncture or catheter angiography. Only then do we choose between sclerotherapy, transcatheter embolization, a combination of the two, or a plan staged over multiple sessions.
What the procedure involves
Classification before treatment
Ultrasound and MRI establish the type, extent and flow characteristics. This step is not a formality — treating a high-flow lesion as though it were low-flow is how malformations get worse.
Direct puncture or catheter access
Low-flow venous and lymphatic lesions are usually treated by direct needle puncture under ultrasound. High-flow arteriovenous lesions require catheter access to the feeding arteries.
Targeted treatment
Sclerosant is delivered into low-flow lesions to collapse the abnormal channels. High-flow lesions require embolization of the nidus itself — not merely the feeding arteries, which simply recruits new supply.
Staged follow-through
Extensive malformations are treated in planned stages over months, with imaging between sessions. This is a program of care, not a single appointment.