The surgical management of 73 vascular malformations and preoperative predictive factors of major haemorrhage--a single centre experience.

Abstract

In our series of patients with congenital vascular malformations (CVMs) we investigate the preoperative factors for predicting major haemorrhage at surgery and propose an algorithm for their surgical management. This is a partly prospective case series of patients with severe symptoms/complications due to CVMs. Data were collected on 73 consecutive procedures in 41 patients with CVMs from 1992 to 2006 at a large university hospital and the association of following factors with blood loss during the procedure were investigated: type of procedure, possibility of proximal tourniquet use, lesion flow characteristics, previous history of major haemorrhage with CVM surgery, platelet counts and length of hospital stay. Significantly higher blood loss was associated with debulking surgery (p=0.006) and with previous history of major haemorrhage during CVM surgery, (p=0.041). Blood loss was higher in lesions where proximal tourniquet application was not possible (p=0.093). High-flow lesions were not strongly associated with major blood loss (p=0.288). Major blood loss (>2l) occurred in 16 (20.8%) procedures performed on 11 (26.2%) patients, but this did not prolong hospital stay. Surgery can potentially improve morbidity/mortality in patients with life/limb-threatening complications or severe symptoms due to CVMs, providing they are managed in multidisciplinary specialised centres.