Venous malformations (VMs) are the most common type of vascular malformation. Recurrence after treatment remains a significant challenge in clinical management.
Methods
A multi-center retrospective cohort study was conducted on consecutive patients who received surgical or endovascular VM treatment from 2005 to 2020. The study aimed to compare treatment efficacy between surgical and non-surgical endovascular approaches. Post-treatment size, symptoms, and recurrence were evaluated more than 1 year after treatment.
Results
Ninety-eight patients with 288 VM treatment cases were included. The mean follow-up duration was 60.7 ± 42.4 months. Both surgical and non-surgical treatments showed size improvement and symptom improvement in more than 90% and 75% of the cohort, respectively. Regarding recurrence, patients who underwent total resection (26.5%; p < .001) and primary closure (44.6%; p = .04) had significantly lower recurrence rates among the whole cohort.
Conclusion
Where feasible, total resection is the ideal treatment modality. Sclerotherapy has a higher long-term recurrence rate but is a less invasive procedure that can be performed repeatedly.
DuboisJSoulezGOlivaVL, et al.Soft-tissue venous malformations in adult patients: imaging and therapeutic issues. Radiographics2001; 21: 1519–1531. DOI: 10.1148/radiographics.21.6.g01nv031519.
5.
BehrGGJohnsonCM. Vascular anomalies: hemangiomas and beyond--part 2, Slow-flow lesions. AJR Am J Roentgenol2013; 200: 423–436. DOI: 10.2214/AJR.11.7853.
6.
HuLChenHYangX, et al.Risk factors associated with pain in patients with venous malformations of the extremities. Vasc Med2019; 24: 56–62. DOI: 10.1177/1358863X18802007.
7.
PessanhaIDelgado-MiguelCAlvesH, et al.Venous malformations: what do phleboliths tell us in the pediatric population?Pediatr Surg Int2022; 38: 1501–1506. DOI: 10.1007/s00383-022-05181-4.
8.
LeeADriscollDGloviczkiP, et al.Evaluation and management of pain in patients with Klippel-Trenaunay syndrome: a review. Pediatrics2005; 115: 744–749. DOI: 10.1542/peds.2004-0446.
9.
MazoyerEEnjolrasOBisdorffA, et al.Coagulation disorders in patients with venous malformation of the limbs and trunk: a case series of 118 patients. Arch Dermatol2008; 144: 861–867.
10.
DompmartinAAcherAThibonP, et al.Association of localized intravascular coagulopathy with venous malformations. Arch Dermatol2008; 144: 873–877.
BehraveshSYakesWGuptaN, et al.Venous malformations: clinical diagnosis and treatment. Cardiovasc Diagn Ther2016; 6: 557–569. DOI: 10.21037/cdt.2016.11.10.
13.
SuhJSShinKHNaJB, et al.Venous malformations: sclerotherapy with a mixture of ethanol and lipiodol. Cardiovasc Interv Radiol1997; 20: 268–273.
14.
GuzelbeyTCingozMErdimC, et al.Effectiveness of polidocanol sclerotherapy in alleviating symptoms in patients with venous malformations. J Vasc Surg Venous Lymphat Disord2024; 12: 101698. DOI: 10.1016/j.jvsv.2023.101698.
15.
LeeBBBaumgartnerIBerlienHP, et al.Consensus document of the international union of angiology (IUA)-2013. Current concept on the management of arterio-venous management. Int Angiol2013; 32: 9–36.
16.
BerenguerBBurrowsPEZurakowskiD, et al.Sclerotherapy of craniofacial venous malformations: complications and results. Plast Reconstr Surg1999; 104: 1–15.
17.
AliSWeissCRSinhaA, et al.The treatment of venous malformations with percutaneous sclerotherapy at a single academic medical center. Phlebology2016; 31: 603–609. DOI: 10.1177/0268355516633380.
18.
VogelzangRLAtassiRVoucheM, et al.Ethanol embolotherapy of vascular malformations: clinical outcomes at a single center. J Vasc Intervent Radiol2014; 25: 206–214.
19.
van der VleutenCJKaterAWijnenMH, et al.Effectiveness of sclerotherapy, surgery, and laser therapy in patients with venous malformations: a systematic review. Cardiovasc Interv Radiol2014; 37: 977–989. DOI: 10.1007/s00270-013-0764-2.
20.
HoqueSDasBK. Treatment of venous malformations with ethanolamine oleate: a descriptive study of 83 cases. Pediatr Surg Int2011; 27: 527–531. DOI: 10.1007/s00383-010-2824-x.
21.
Marrocco-TrischittaMMGuerriniPAbeniD, et al.Reversible cardiac arrest after polidocanol sclerotherapy of peripheral venous malformation. Dermatol Surg2002; 28: 153–155. DOI: 10.1046/j.1524-4725.2002.00344.x.
22.
FeiedCFJacksonJJBrenTS, et al.Allergic reactions to polidocanol for vein sclerosis. Two case reports. J Dermatol Surg Oncol1994; 20: 466–468. DOI: 10.1111/j.1524-4725.1994.tb03218.x.
23.
PascarellaLBerganJJYamadaC, et al.Venous angiomata: treatment with sclerosant foam. Ann Vasc Surg2005; 19: 457–464. DOI: 10.1007/s10016-005-4656-z.
24.
ShiraishiMNarushimaMBandaCH, et al.Treatment effectiveness and recurrence of extracranial arteriovenous malformations following surgical operations: a 15-year retrospective cohort study. Ann Plast Surg2024; 92: 688–693. DOI: 10.1097/SAP.0000000000003924.
25.
HorbachSELokhorstMMSaeedP, et al.Sclerotherapy for low-flow vascular malformations of the head and neck: a systematic review of sclerosing agents. J Plast Reconstr Aesthetic Surg2016; 69: 295–304. DOI: 10.1016/j.bjps.2015.10.045.
26.
GladeRSRichterGTJamesCA, et al.Diagnosis and management of pediatric cervicofacial venous malformations: retrospective review from a vascular anomalies center. Laryngoscope2010; 120: 229–235. DOI: 10.1002/lary.20715.
27.
KajiNHariiK. Establishment of embolosclerotherapy for vascular malformations of the head and neck; evaluation of the response rate based on MRI. J Kyorin Med Soc2006; 37: 43–54 (in Japanese).
28.
OzakiMKuritaMKajiN, et al.Efficacy and evaluation of safety of sclerosants for intramuscular venous malformations: clinical and experimental studies. Scand J Plast ReConstr Surg Hand Surg2010; 44: 75–87. DOI: 10.3109/02844310903569725.
29.
RibeiroMCde Mattos Camargo GrossmannSdo AmaralMBF, et al.Effectiveness and safety of foam sclerotherapy with 5% ethanolamine oleate in the treatment of low-flow venous malformations in the head and neck region: a case series. Int J Oral Maxillofac Surg2018; 47: 900–907. DOI: 10.1016/j.ijom.2017.12.004.
30.
KatoMWatanabeSIidaT, et al.Flow pattern classification in lymphatic malformations by indocyanine green lymphography. Plast Reconstr Surg2019; 143: 558e–564e.
ParsiKExnerTConnorDE, et al.The lytic effects of detergent sclerosants on erythrocytes, platelets, endothelial cells and microparticles are attenuated by albumin and other plasma components in vitro. Eur J Vasc Endovasc Surg2008; 36: 216–223. DOI: 10.1016/j.ejvs.2008.03.001.
33.
RaoJGoldmanMP. Stability of foam in sclerotherapy: differences between sodium tetradecyl sulfate and polidocanol and the type of connector used in the double-syringe system technique. Dermatol Surg2005; 31: 19–22. DOI: 10.1111/j.1524-4725.2005.31008.
34.
MimuraHKanazawaSYasuiK, et al.Percutaneous sclerotherapy for venous malformations using polidocanol under fluoroscopy. Acta Med Okayama2003; 57: 227–234. DOI: 10.18926/AMO/51909.
35.
MimuraHFujiwaraHHirakiT, et al.Polidocanol sclerotherapy for painful venous malformations: evaluation of safety and efficacy in pain relief. Eur Radiol2009; 19: 2474–2480. DOI: 10.1007/s00330-009-1442-2.
36.
HouFChenJXiaM, et al.Percutaneous sclerotherapy with polidocanol under the guidance of ultrasound for venous malformations in children - a retrospective cohort study from a single tertiary medical center. Medicine (Baltim)2020; 99: e18839. DOI: 10.1097/MD.0000000000018839.
37.
Al-QattanMM. Acquired localized subcutaneous cavernous vascular malformations of the hand. J Hand Surg Br2004; 29: 139–143. DOI: 10.1016/j.jhsb.2003.11.002.
38.
MendoncaDAMcCaffertyINishikawaH, et al.Venous malformations of the limbs: the Birmingham experience, comparisons and classification in children. J Plast Reconstr Aesthetic Surg2010; 63: 383–389.
39.
BuckmillerLMRichterGTSuenJY. Diagnosis and management of hemangiomas and vascular malformations of the head and neck. Oral Dis2010; 16: 405–418.
40.
DuboisJGarelL. Imaging and therapeutic approach of hemangiomas and vascular malformations in the pediatric age group. Pediatr Radiol1999; 29: 879–893.
41.
ZhengJWMaiHMZhangL, et al.Guidelines for the treatment of head and neck venous malformations. Int J Clin Exp Med2013; 6: 377–389.
42.
De MariaLDe SanctisPBalakrishnanK, et al.Sclerotherapy for venous malformations of head and neck: systematic review and meta-analysis. Neurointervention2020; 15: 4–17.
43.
KatoTKatayamaYFukuharaS, et al.Efficacy of foam sclerotherapy with polidocanol for the management of oral venous malformations. Med Int2024; 4: 24.
