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Objectives: Among vascular malformations, the predominantly venous malformations represent the majority of cases. They form a clinical entity and therefore need clear concepts concerning diagnosis and treatment. This paper presents an overview of contemporary classification as well as tactics and techniques of treatment. According to the Hamburg Classification, predominantly venous malformations are categorized into truncular and extratruncular forms, with truncular forms distinguished as obstructions and dilations, and extratruncular forms as limited or infiltrating. Methods: The tactics of treatment represent surgical and non-surgical methods or combined techniques. Surgical approaches utilize different tactics and techniques that are adopted based on the pathologic form and type of the malformation: (I) operation to reduce the haemodynamic activity of the malformation; (II) operation to eliminate the malformation; and (III) reconstructive operation. As for (I), a type of a tactic is the operation to derive the venous flow. In (II), the total or partial removal of the venous malformation is demonstrated subdivided into three different techniques. In this way, the infiltrating as well as the limited forms can be treated. An additional technique is dedicated to the treatment of a marginal vein. Approach (III) involves the treatment of venous aneurysms, where a variety of techniques have been successful. Results: Long-term follow-up demonstrates positive results in 91% of the cases. Conclusion: Congenital predominantly venous malformations should be treated according to the principles developed during the past decades in vascular surgery, interventional treatment and multidisciplinary treatment. The days of predominantly conservative treatment should be relegated to the past. Special skills and experiences are necessary to carry out appropriate surgical strategy, and the required operative techniques should be dictated by the location and type of malformation and associated findings. [ABSTRACT FROM AUTHOR]

Discusses the controversial issues in contemporary diagnosis and management of congenital vascular malformation (CVM). Acceptance of primary lymphedema as CVM; Limitation of traditional arteriography in diagnosis of CVM; Use of venography for the management of venous malformation.

Evolution of contemporary concept for the advanced management of congenital vascular malformation (CVM) took a long and difficult path through decades, in spite of tremendous efforts by many scholars and surgeons throughout the world. The enormous progress particularly for the last decade would not have been possible but for the guidance of the late Professor Stefan Belov of Bulgaria. A few surgeons, mostly of the European camp, led by Belov and his disciples, were able to continue to wage war against the CVM with scaled-down surgery and more logical and broad based approach; containing the complication and morbidity within acceptable as well as affordable range.