Peripheral vascular malformations (2022 – CME) – online course
Authors: I. McCafferty and L. Marques
Reviewers: A. Ierardi, M. Krokidis, G. Makris, C. Nice and B. Peynircioglu
This course corresponds to chapter 188.8.131.52.6 Vascular Malformations in the European Curriculum and Syllabus for IR.
Vascular anomalies are a complex group of developmental abnormalities due to inborn errors of vasculogenesis or angiogenesis that present significant challenges in diagnosis and management. The rarity and diverse presentation often mean patients are seen by multiple specialists before the correct diagnosis is made and treatment can be instigated. Accurate and timely diagnosis is crucial, and a multidisciplinary team approach is essential for appropriate evaluation and management.
The understanding of vascular anomalies was significantly improved with the first classification by Mulliken and Glowacki in 1982  and the subsequent formation of the International Society for the Study of Vascular Anomalies (ISSVA), which modified the classification in 2014 . The ISSVA classification of vascular anomalies has further been updated in May 2018 and is available on their website www.issva.org.
Vascular malformations can occur anywhere within the body. The majority are present at birth, although occasionally high flow malformations can be acquired following trauma. They are often referred to as “iceberg lesions” as the clinically visible area is often the tip of the underlying malformation. The clinical presentation and timing, however, often varies depending on the site and nature of the underlying abnormality.
The management of vascular malformations is dependent on the clinical symptoms, features and the extent of the underlying abnormality. Imaging, therefore, plays a crucial role in diagnosis and treatment planning. As the vast majority of vascular malformations have an underlying cellular abnormality of angiogenesis, called “field defects”, treatments are aimed to relieve symptoms rather than cure them.
This course is designed to help students understand the principles in diagnosis and management of common vascular malformations, both low flow and high flow. Although not covered in detail in this course there are certain specific rare complex situations where further advice and planning maybe required in addition to the information supplied here. As examples one may need further discussion with extensive oropharyngeal or laryngeal malformations prior to treatment due to the risk of airway compression. Consideration for a tracheostomy or extended ETT with GA in a PICU setting is important. Complex lesions affecting the feet and hands within fascial spaces need consideration for the risk of compartment syndrome post treatment. This can be monitored clinically or with pressure transducers but may require early intervention with fasciotomy if it develops.
Management of vascular malformations requires an understanding of the underlying anatomy and classification, which guides the various treatment options available to interventional radiologists.
- Understand the classification of vascular anomalies
- Understand the common clinical presentations and features of vascular malformations
- Understand the common syndromes associated with vascular malformations
- Understand the imaging of vascular malformations and how that affects management planning
- Understand the principles underpinning the treatment options for vascular malformations
- Common techniques employed
- Common sclerosant agents used
- Understand the potential complications of vascular malformations and their management
This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for IR and corresponds to chapter 184.108.40.206.6 Vascular Malformations.
The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around two hours and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award 2 European CME credits (ECMEC). The CME accreditation for this course will expire on February 24, 2024. A non-CME accredited version of the course will remain available for two more years.
The enrolment period of this course is set to 90 days and may be extended throughout the year with a valid All-Access Pass.
The CME certificate will be available in the myCIRSE area past the enrolment period if the course is completed before February 24, 2024.
Release date: February 2022