Kashyrova O. Optimization of methods of diagnostics and treatment of arteriovenous forms of congenital vascular malformations of extremities

Work is based on data of complex clinical research and surgical treatment of 155 patients with the arteriovenous forms of congenital vascular malformation (CAVM) of extremities. The analysis of clinical material is viewed depending on the clinical-anatomical forms of congenital vascular malformation, which were subdividing into 11 groups on the basis of "working" classification «VASC +T». In the preoperative period, patients with congenital vascular malformation revealed an imbalance in the hemostasis system (predominantly from groups I-IV), manifested by a significant activation of the coagulation system (chronic syndrome of disseminated intravascular coagulation): 9 (39 %) patients had significantly increased plasma fibrinogen content (from 3,7 to 7,2 g/l), 10 (43,5 %) – soluble fibrin (from 3,6 to 50 μg/ml), in 7 (30,4 %) – D-dimer (from 119,3 to 1608,3 ng/ml); the activity of protein C in 95 % of patients corresponded to the norm (85-100 %). Pathomorphological (66, 45,8 %) and immunohistochemical studies (10, 7 %) revealed the presence of proliferative activity of angiomatous tissues and degenerative changes in the walls of the angiodysplastic vessels both due to developmental defects and pathological disorders of hemodynamics, while the source of progression of the congenital vascular malformation there are vessels of the microvasculature (capillaries) and microfustulas, proceeding from the level of VEGF and Ki-67.