The decision process about the best treatment in congenital vascular malformations (CVM) should consider several factors: symptoms, possible complications of treatment, hemodynamic correction expected, invasivity of the procedure and others (see Chap. 24 for more details about clinical conditions and treatment). In other words, a balance between risks and advantage of the treatment is mandatory, as in any therapy. However, that decision may be much more difficult in CVM, due to the great variability of the disease. Several techniques are available, and often, best result is obtained by a combination of those procedures and also by a correct timing.

Truncular vascular dysplasia of veins and arteries is mainly treated by conventional vascular techniques, like revascularization surgery or reflux control surgical techniques in venous truncular dysplasia. Specific reconstructive techniques are available for some cases of truncular lymphatic defects (see Chap. 51). In arteriovenous truncular fistulas, complex devascularization techniques or, sometimes, endovascular procedures can be used.

Extratruncular forms are much more frequent and variable and have a tendency to recur because they are composed by a remnant of embryonic cells. To prevent recurrence, the ideal treatment should be a radical surgical removal, rather than a simple occlusion, that close the lumen of the dysplastic vessels but let the abnormal cells in site. Limited forms can be treated by surgery or by occlusion. In extensive infiltrations of organs, surgical resection is performed according to general surgical techniques. Occlusion techniques, by catheter or percutaneous, are available as an alternative or a combination with surgery.