Q: I am a 28 years old man suffering from arteriovenous malformation or haemangiomas of the right knee. The malformation has many feeder vessels and it has become impossible to block all of them without risking the blockage of the main blood vessels of the leg. How can it be treated?

A:The A-V malformations/haemangiomas are extremely difficult to treat. As you have correctly stated that all the feeders are difficult to block without risking the main blood supply the limb. I am of the opinion that a good digital subtraction angiography (DSA) with facility to do intra-arterial embolisation and direct puncture glue injection and in some cases to follow it up with surgery is sometimes the only way to ensure the malformation has been controlled. Vascular interventionist (Radiologist) should be careful not to over do the embolisation and if there is danger of the main artery getting involved then defer the embolisation for another day. The main feeder is the last to be closed.