Peripheral venous malformations: Post-millennium Cappadocia experience


AKÇALI Y. F.

8th International Congress of Update in Cardiology and Cardiovascular Surgery, Turkey, 1 - 04 December 2008, vol.31, pp.44

  • Publication Type: Conference Paper / Summary Text
  • Volume: 31
  • Country: Turkey
  • Page Numbers: pp.44

Abstract

Background. Venous malformations (VMs) are present at birth and low-pressure, low-flow vascular malformations showing thin-walled dilated sponge-like channels varying in size from capillary to cavernous dimensions. VMs, which commonly confused with deep growing hemangioma in children or with Klippel-Trénaunay syndrome when they involve a full limb, are best evaluated using T2-weighted MRI. The other diagnostic tools are plain films which can reveal a soft tissue mass with phlebolith, Doppler ultrasound, CT demonstrating the extent of a VM, and/or direct percutaneous phlebography. Thrombosis, swelling, and pain are common in VMs. Localized intravascular coagulopathy (LIC) could be caused by stagnation within large VMs. Prior to initiating therapy of extensive limb VMs, LIC should be corrected with LMWH and elastic stockings. Sclerotherapy with ethanol, STS, Ethibloc, or polidocanol is commonly used for therapy of VMs. Anti-inflammatory agents such as NSAIDs should be given to minimize postsclerotherapic inflammatory symptoms. Surgical resection is required for functionality, cosmesis or the treatment of post-sclerotherapic residual lesions. Laser therapy can be useful in very superficial VMs and in oro-mucosal lesions. Patients and Method. After Millennium, 47 patients (n=27, female) with VM were reviewed; their median age was 19 (range, 1-32 years). They accounted for 42 percent of the patients with all congenital vascular malformations (CVMs) managed during the same period (Figures 1-3). The most of VMs was localized limbs (upper, n=18, lower, n=29); a patient also had truncal involvement. Three patients with cephalic VM (lip, tongue and palate, and chins) were not included to this study. The patients were advised to avoid direct traumas. Prophylactic low-dose aspirin and compression stocking were given in patients with extensive VMs. Results. A coagulation abnormality was not found in our patients with bulky VMs. In our study, the treatment modalities included surgical excision (n=21) (Figure 4), sclerotherapy (n=6) (Figure 5 & 6), and/or compression therapy. Surgical results are excellent (90.5%) (Figure 7 & 8). A patient with foot VM required repeated sclerotherapy. Conclusion. Compression, sclerotherapy and resection were therapeutic modalities of VMs. Because the most of VMs is asymptomatic, discomfort of a localized lesion can answer to a simple compression.