MAJOR VASCULAR MALFORMATIONS OF THE UPPER EXTREMITY - LONG-TERM OBSERVATION

Vascular malformations of the upper extremity continue to be a therape utic challenge to the hand surgeon. In the past 22 years, the authors treated 17 patients with major vascular malformations of the upper ext remity. The lesions were evaluated with the aid of plain radiographs, angiography, and histology. Thirteen of the patients were female and 4 were male. The average age at treatment was 18 years, ranging from bi rth to 64 years. The average follow-up period was 12 years, ranging fr om 4 months to 36 years. The main indications for surgery were pain, p rogressive enlargement, neurologic compromise, diminished function, or a combination of these. The progression of these lesions under observ ation led to surgical management in all cases. A total of 36 excisions , 3 embolizations, and 4 amputations were done. Postoperative angiogra ms were obtained in selected individuals. Diffuse lesions defied total surgical removal. Recurrence and persistence was evident in 12 of the 17 patients. A knowledge of the progressive nature of these lesions a nd the need for long-term observation are the keystones to the success ful management of these challenging yet unresolved problems.