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  • Title: The surgical management of 73 vascular malformations and preoperative predictive factors of major haemorrhage--a single centre experience.
    Author: Maftei N, Howard A, Brown LC, Gunning MP, Standfield NJ.
    Journal: Eur J Vasc Endovasc Surg; 2009 Oct; 38(4):488-97. PubMed ID: 19660969.
    Abstract:
    OBJECTIVES: 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. DESIGN: This is a partly prospective case series of patients with severe symptoms/complications due to CVMs. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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