Le malformazioni vascolari: necessità di un trattamento multidisciplinare. Considerazioni su di un caso clinico.

Abstract The case reported here is a paradigm of a complex vascular malformation with a therapeutic approach which involved both vascular radiology and surgery. The case came to our attention in 1999 and consisted in a tumefaction of the left gluteal region in a 14-year-old female coming from the south of Italy. The lesion had previously been evaluated by ultrasonography and magnetic resonance imaging. The lesion was described as a dysplastic malformation with a high vascular factor. After angiography, a surgical option was not considered as a first choice, beacisae of the wide excision it would have required. We decided to embolize the mass under angiographic guidance with fibrin spirals. After a first unsuccessfull attempt to reduce the mass, a second embolization also yielded no result, and therefore we decided to remove the dysplasia surgically. A wide excision was undertaken, extended to the muscles but sparing as much skin as possible to avoid reconstruction problems. The dysplasia, however, recurred after one year and was finally resolved only in 2001 after a third embolization. Because of the multiple types of symptoms, a multidisciplinary approach is required to obtain both a correct classification and treatment of the vascular malformations. The relevant literature is discussed.