Veins play a crucial role in carrying blood throughout our body. While arteries helps distribute oxygen and nutrients to the body’s cells, our veins act as the highways and roads that guide the blood back to our heart. Veins have one-way valves that let blood go in one direction, towards the heart. The circulatory system is also responsible for getting rid of toxins or unwanted materials in our body.

What are venous malformations and how do they affect the body?

A venous malformation (VM) is an anomaly in the body where veins do not develop properly. It is characteristed by enlarged and intricately tangled veins. When a venous malformation is located near the skin’s surface, it typically manifests as a maroon, blue, or purple spot. Children are born with venous malformations, and these malformations may not be immediately apparent. They might become visible later as the veins enlarge or expand. Deeper venous malformations within muscles or the body may remain undetected until a person experiences pain, swelling, and other symptoms. A venous malformation tends to grow as a child grows, and it may become more conspicuous in response to injuries or if only partially removed.

What are the different types of venous malformations?

(image source: https://www.mayoclinic.org/diseases-conditions/arteriovenous-malformation/symptoms-causes/syc-20350544)

There are several types of venous malformations which can be described as:

1.Arteriovenous Malformations happen when veins and arteries grow unusually large in place of tiny capillaries. Patients with arteriovenous malformations may feel an unusual pulse in the affected area. AVMs can appear shortly before or after birth, impacting more than 1% of the population. They can replace the tiny capillaries that usually link arteries and veins, disrupting regular blood circulation. These abnormal growths are often located in the head and neck and can lead to serious issues like seizures, strokes, and breathing difficulties.

Most arteriovenous malformations don’t show any initial signs, and they can remain symptom-free for a person’s entire life. However, there’s a risk that an arteriovenous malformation might bleed, and the impact can vary depending on its size and severity. Typically, symptoms become noticeable between the ages of 10 and 40, but they can emerge at any age. Some pregnant women might experience worsened symptoms around their arteriovenous malformations due to increased blood pressure during pregnancy. Symptoms can include skin discoloration, swelling, increased vulnerability of the skin over the arteriovenous malformations leading to ulcers, and discomfort. For brain arteriovenous malformations, additional symptoms may appear, such as headaches localized to one area of the head, muscle weakness or numbness in specific parts of the body, seizures, speaking difficulties, and confusion.

The exact causes of brain arteriovenous malformations are not known, but they are believed to be congenital, meaning a person can be born with them. Some individuals may have a family history of arteriovenous malformations, although it’s unclear whether there’s a direct hereditary link. However, it’s possible to inherit other conditions that increase the likelihood of developing this type of malformation. Luckily, arteriovenous malformation treatment options are available in Singapore.

(image source: https://kidshealth.org/Hackensack/en/parents/venous-malformations.html)

2.Venous Malformations are lumps under the skin that have a bluish or skin-colored appearance. Vascular malformations can develop anywhere in the body, and the symptoms vary based on their location and type. Many individuals only become aware of these malformations and receive a diagnosis later in life, typically between the ages of 30 and 50. While some individuals, including newborns, may have these malformations from birth, noticeable symptoms tend to appear as a person gets older.

These symptoms may include visible, cosmetically displeasing growths or soft lumps that can be seen without special equipment, pain, and gradual changes in the skin’s color around the growth, and loss of limb function, which can manifest as muscle weakness, numbness, and, in severe cases, limb paralysis. If a vascular malformation occurs in the brain and is left untreated, it can lead to bleeding, resulting in a stroke or seizures due to increased pressure on the brain. Vascular malformations are typically present from birth (congenital). In rare cases, trauma can also cause vascular malformations to develop.

(image source: https://www.childrensmn.org/services/care-specialties-departments/fetal-medicine/conditions-and-services/lymphatic-malformation/)

3.Lymphovenous Malformations are non-cancerous masses made of fluid-filled channels. They form because the body’s lymphatic system doesn’t develop correctly. Lymphatic malformations are infrequent, benign growths characterized by fluid-filled spaces due to abnormal development of the lymphatic system. They can emerge anywhere within the body. Some superficial lymphatic malformations may resemble small, soft bumps beneath the skin, while others remain hidden from view. Irrespective of their size, these have the potential to impede nearby structures or organs’ normal function and alter the appearance of the affected areas.

Typically, symptoms arise from the compression or blockage of nearby structures, and they vary depending on the size and specific location of the malformation. Complications can arise, including recurrent inflammation or bleeding in the malformation. The inflammation results in skin swelling and redness (cellulitis). Repeated episodes of cellulitis can lead to pain and disfigurement in the affected region. Bleeding can cause intense pain, swelling, and an increase in the size of the malformation in a specific area. The development of lymphatic malformations is associated with the improper formation and development of lymphatic vessels during pregnancy.

(image source: https://www.svin.org/i4a/pages/index.cfm?pageid=3316)

4.Dural Arteriovenous Fistula is a rare vascular condition that arises when abnormal connections, known as fistulas, form between arteries and veins within the protective brain covering known as the dura mater. These fistulas allow high-pressure arterial blood to flow directly into veins that typically carry blood at lower pressure. As a consequence, the brain’s venous system may become congested, potentially leading to brain dysfunction. These can be found in both the brain and the spine, and they tend to manifest later in life.

In some cases, individuals may not experience any symptoms, while others may exhibit a range of mild to more severe symptoms. A distinctive indication of dural arteriovenous fistulas is pulsatile tinnitus, a persistent whooshing sound near the ear caused by the flow of blood from arteries through the fistula into the veins.

Mild symptoms may include vision problems, eye bulging, swelling in the eye lining, while more aggressive symptoms often result from bleeding in the affected area, leading to seizures, sudden onset headaches, speech difficulties, dementia, coordination problems, and sensations of burning or prickling around the affected region. Additionally, nausea or vomiting may occur in some cases.

What is the role of vascular surgeons in treating venous malformations?

Vascular surgeons are well-equipped to diagnose the malformation’s type, size, and location through imaging techniques. The treatment would depend on your condition and the complexity of the malformation. In some cases, only a minimally invasive treatment would suffice.

Vascular surgeons carry out these procedures with precision to either block or repair the abnormal blood vessels while preserving normal function. To actively prevent further complications, vascular surgeons will also recommend having regular check-ups with you.

(image source: https://snc2dmri.weebly.com/components–functions.html)

How do vascular surgeons diagnose and screen patients for vascular malformations?

Diagnosis typically involves a clinical examination, and further imaging tests like computerized tomography scans (CT scans), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and cerebral angiograms (also referred to as digital subtraction angiography or DSA) might be conducted. These imaging procedures help identify the malformation’s location, its characteristics, and the extent of damage to surrounding tissues. These tests are often repeated to monitor any changes in the size of the malformation.

What are the risks and complications associated with venous malformations?

While some malformations might not pose any immediate issues and can be closely monitored, many often result in pain and swelling. This condition can interfere with your daily activities. Patients with this condition can have a hard time performing basic tasks like exercise, work, or sports. Vascular malformations can cause varying levels of discomfort.

In more severe cases, large malformations can gradually lead to heart failure. Vascular malformations situated in solid organs like the liver, kidney, or uterus can disrupt organ function and potentially cause other health complications. When there are arteriovenous malformations (AVMs) in the brain or spine, they can block the flow of oxygen-rich blood to the brain. This can lead to dangerous complications like aneurysms, brain bleeds, and strokes.

(image source: https://www.drugs.com/mcd/spinal-arteriovenous-malformation-avm)

What are the various treatment options for venous malformations in Singapore?

Your treatment method will depend on the complexity of the malformation and your overall condition. One option is excision, in which the malformation is removed using traditional surgery. Depending on the malformation’s size, patients may need multiple sessions. There are also minimally invasive methods to halt the malformation’s growth. These treatments may require several sessions and are chosen based on the malformation’s size and type. Two such methods are embolization, a procedure that blocks blood flow to abnormal blood vessels effectively, and sclerotherapy, a non-surgical approach that involves injecting scarring solutions into veins or lymphatic components to shrink the problematic vessels.

What are some common misconceptions about venous malformations?

1. Myth: Venous malformations are always painful.

Truth: Venous malformations don’t always cause pain; some can be painless and only become symptomatic if they grow or press on nearby structures.

• Myth: Venous malformations are always harmless.

Truth: While some venous malformations may remain benign and symptom-free, others can cause pain, functional impairment, or complications if left untreated.

• Myth: Venous malformations are contagious.

Truth: They are congenital conditions, meaning they are present from birth, and they cannot be transmitted to others through contact.

• Myth: Venous malformations do not need medical intervention.

Truth: While some small and asymptomatic venous malformations may be observed without treatment, others may necessitate medical procedures or surgery to alleviate pain, prevent complications, or improve cosmetic appearance.

• Myth: Venous malformations can only be treated with traditional methods like surgery.

Truth: Treatments for venous malformations may include minimally invasive procedures such as sclerotherapy or embolization to block or shrink the abnormal vessels, surgical excision for larger or complex malformations, or laser therapy for skin-related venous malformations.

FAQs:

References:

1. https://my.clevelandclinic.org/health/diseases/23409-vascular-malformations
2. https://www.sgvascularctr.com/tag/venous-malformations/
3. https://www.stanfordchildrens.org/en/service/dermatology/vascular-anomalies/venous-malformation

Dr Chen Min Qi profile

Dr. Chen Min Qi is a fellowship-trained Vascular and Endovascular Surgeon who graduated from the National University of Singapore in 2005. He subsequently completed his basic and advanced training in General and Vascular Surgery while obtaining the Member of Royal College of Surgeons of Edinburgh (MRCSed) qualification in 2010, and the Master of Medicine (General Surgery) qualification in 2015. Dr Chen was subsequently successful at the fellowship exams obtaining the Fellow of Royal College of Surgeons of Edinburgh (FRCSed) qualification in 2016.

Upon completion of his advanced surgical training, Dr Chen Min Qi joined the newly opened Ng Teng Fong General Hospital (NTFGH) as a specialist in the Vascular Surgery division. In 2018, Dr Chen was awarded the Health Manpower Development Plan (HMDP) grant from MOH to undergo further subspeciality Vascular training at the internationally renowned St Mary’s Hospital in London, United Kingdom. There Dr Chen gained further experience in surgeries on complex abdominal and thoracoabdominal aortic aneurysms, redo open repair of abdominal aortic aneurysms following failed EVAR surgeries as well as carotid endarterectomy surgery and lower limb revascularization surgeries.
Upon his return in 2020, Dr Chen Min Qi joined the newly formed Woodlands Health as head of their Vascular service, before joining his current practice at the Vascular and Interventional Centre in January 2023.