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Venous Malformations Treatment & Management

  • Author: Silvio Podda, MD; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
 
Updated: Aug 27, 2015
 

Medical Therapy

Sclerotherapy is the primary form of nonsurgical intervention for venous malformations.[14, 15] Larger lesions usually are treated with 95% ethanol, while cutaneous and smaller lesions are treated with sodium tetradecyl sulfate (1%). Sclerotherapy is often performed by an interventional radiologist under general anesthesia. Multiple sclerotherapeutic sessions often are needed. Venous malformations have a propensity for recanalization and recurrence.

An alternative to standard sclerotherapy using sclerosant foam has recently been described.[16]  For example, a retrospective study by Park et al found sclerotherapy with sodium tetradecyl sulfate foam to be effective against venous malformations, reducing both pain and malformation size. According to the study, which involved 86 patients (91 venous malformations), positive responses with regard to pain and mass reduction were 49.5% and 52.7%, respectively.[17]

In a retrospective analysis of facial paralysis caused by ethanol sclerotherapy, Hu et al concuded that the zygomatic and temporal branches of the facial nerve were the most vulnerable to injury after ethanol sclerotherapy and suggested surgeons to pay close attention when performing ethanol sclerotherapy in those areas.[18]

Compression garments are a mainstay of treatment for extremity venous malformations, particularly the lower extremity. Venous malformations of the GI tract also have been managed by sclerotherapy or endoscopic banding.

Laser therapy has shown promise in selected situations. Argon and yttrium-aluminum-garnet (YAG) lasers have been used to treat intraoral lesions.[19] This approach seems more appropriate for smaller lesions.[20]

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Surgical Therapy

Surgery is indicated in isolated, symptomatic venous malformations or following sclerotherapy to improve form or function. Surgical results are a function of the size and location of the malformation. Recurrence following surgery is more common with diffuse malformations and when excision is incomplete.[9, 21] In general, surgery or sclerotherapy is more successful when dealing with pure venous malformations than when dealing with combined malformations.[20]

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Follow-up

Complicated or large venous malformations are best treated at a referral center staffed by a multidisciplinary team of diagnostic and interventional radiologists, plastic surgeons, and interested ablative surgeons (eg, neurosurgery).

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Complications

The type and severity of complications depend on the size and location of the malformation and type of intervention chosen. Greater complications are seen with more difficult resections that involve vital structures. Recurrence is a common complication of therapy.

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Outcome and Prognosis

The outcome and prognosis are most closely related to the size and location of the venous malformation. The likelihood of significant perioperative morbidity and recurrence increases with more diffuse malformations and with malformations intimately involving vital neurovascular structures.

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Future and Controversies

The future holds great promise for the diagnosis and treatment of all vascular malformations, including venous malformations. Advances in molecular genetics are adding to the understanding of vascular malformations and hopefully will elucidate the mechanism of origin of the developmental abnormalities associated with these anomalies.[22] Several inherited disorders have been identified and defective genes have been located.[5] Additional information is expected as work on the human genome continues. This new knowledge hopefully will elucidate the pathogenesis of vascular malformations and lead to fresh approaches to therapy.[22, 23]

The field of angiogenesis continues to mature, and new antiangiogenesis drugs are in clinical trials that may lead to fresh treatment modalities for these vascular anomalies.[22]

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Contributor Information and Disclosures
Author

Silvio Podda, MD Craniofacial and Plastic Surgeon, Department of Plastic and Reconstructive Surgery, St Joseph's Regional Medical Center and Children's Hospital

Silvio Podda, MD is a member of the following medical societies: American Medical Association, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Northeastern Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Frederick J Duffy, Jr, MD, FACS Clinical Assistant Professor, Department of Plastic Surgery, University of Texas Southwestern Medical School

Frederick J Duffy, Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, Plastic Surgery Research Council, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jorge I de la Torre, MD, FACS Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, Association for Academic Surgery, Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Chief Editor

Gregory Gary Caputy, MD, PhD, FICS Chief Surgeon, Aesthetica

Gregory Gary Caputy, MD, PhD, FICS is a member of the following medical societies: Wound Healing Society, American Society for Laser Medicine and Surgery, International College of Surgeons, International College of Surgeons US Section, Pan-Pacific Surgical Association

Disclosure: Receive salary from Advantage Wound Care for employment. for: On the speaker's bureau for Smith and Nephew for Santyl Ointment.

Additional Contributors

Shahin Javaheri, MD Chief, Department of Plastic Surgery, Martinez Veterans Affairs Outpatient Clinic; Consulting Staff, Advanced Aesthetic Plastic & Reconstructive Surgery

Shahin Javaheri, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

References
  1. Shaw WC. Folklore surrounding facial deformity and the origins of facial prejudice. Br J Plast Surg. 1981 Jul. 34(3):237-46. [Medline].

  2. Breugem CC, van Der Horst CM, Hennekam RC. Progress toward understanding vascular malformations. Plast Reconstr Surg. 2001 May. 107(6):1509-23. [Medline].

  3. Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg. 1982 Mar. 69(3):412-22. [Medline].

  4. Dubois J, Garel L. Imaging and therapeutic approach of hemangiomas and vascular malformations in the pediatric age group. Pediatr Radiol. 1999 Dec. 29(12):879-93. [Medline].

  5. Boon LM, Mulliken JB, Vikkula M, et al. Assignment of a locus for dominantly inherited venous malformations to chromosome 9p. Hum Mol Genet. 1994 Sep. 3(9):1583-7. [Medline].

  6. Vikkula M, Boon LM, Carraway KL, et al. Vascular dysmorphogenesis caused by an activating mutation in the receptor tyrosine kinase TIE2. Cell. 1996 Dec 27. 87(7):1181-90. [Medline].

  7. Hassanein AH, Mulliken JB, Fishman SJ, Alomari AI, Zurakowski D, Greene AK. Venous Malformation: Risk of Progression During Childhood and Adolescence. Ann Plast Surg. 2011 May 27. [Medline].

  8. Greene AK, Liu AS, Mulliken JB, Chalache K, Fishman SJ. Vascular anomalies in 5,621 patients: guidelines for referral. J Pediatr Surg. 2011 Sep. 46(9):1784-9. [Medline].

  9. Hill RA, Pho RW, Kumar VP. Resection of vascular malformations. J Hand Surg [Br]. 1993 Feb. 18(1):17-21. [Medline].

  10. Koo KS, Dowd CF, Mathes EF, et al. MRI phenotypes of localized intravascular coagulopathy in venous malformations. Pediatr Radiol. 2015 Jul 5. [Medline].

  11. Hein KD, Mulliken JB, Kozakewich HP, et al. Venous malformations of skeletal muscle. Plast Reconstr Surg. 2002 Dec. 110(7):1625-35. [Medline].

  12. Fraulin FO, Flannigan RK, Sharma VK, McPhalen DF, Harrop RA. The epidemiological profile of the Vascular Birthmark Clinic at the Alberta Children's Hospital. Can J Plast Surg. 2012 Summer. 20(2):67-70. [Medline]. [Full Text].

  13. Frischer JM, Göd S, Gruber A, Saringer W, Grabner G, Gatterbauer B, et al. Susceptibility-weighted imaging at 7 T: Improved diagnosis of cerebral cavernous malformations and associated developmental venous anomalies. Neuroimage Clin. 2012 Sep 14. 1(1):116-20. [Medline]. [Full Text].

  14. Pappas DC Jr, Persky MS, Berenstein A. Evaluation and treatment of head and neck venous vascular malformations. Ear Nose Throat J. 1998 Nov. 77(11):914-6, 918-22. [Medline].

  15. Castren E, Aronniemi J, Klockars T, et al. Complications of sclerotherapy for 75 head and neck venous malformations. Eur Arch Otorhinolaryngol. 2015 Mar 4. [Medline].

  16. Pascarella L, Bergan JJ, Yamada C, Mekenas L. Venous angiomata: treatment with sclerosant foam. Ann Vasc Surg. 2005 Jul. 19(4):457-64. [Medline].

  17. Park HS, Do YS, Park KB, et al. Clinical outcome and predictors of treatment response in foam sodium tetradecyl sulfate sclerotherapy of venous malformations. Eur Radiol. 2015 Aug 26. [Medline].

  18. Hu X, Chen D, Jiang C, Jin Y, Chen H, Ma G, et al. Retrospective analysis of facial paralysis caused by ethanol sclerotherapy for facial venous malformation. Head Neck. 2011 Nov. 33(11):1616-21. [Medline].

  19. Rebeiz E, April MM, Bohigian RK, Shapshay SM. Nd-YAG laser treatment of venous malformations of the head and neck: an update. Otolaryngol Head Neck Surg. 1991 Nov. 105(5):655-61. [Medline].

  20. van der Vleuten CJ, Kater A, Wijnen MH, Schultze Kool LJ, Rovers MM. Effectiveness of Sclerotherapy, Surgery, and Laser Therapy in Patients With Venous Malformations: A Systematic Review. Cardiovasc Intervent Radiol. 2013 Nov 7. [Medline].

  21. Waner M, O TM. The role of surgery in the management of congenital vascular anomalies. Tech Vasc Interv Radiol. 2013 Mar. 16(1):45-50. [Medline].

  22. Fishman SJ, Mulliken JB. Vascular anomalies. A primer for pediatricians. Pediatr Clin North Am. 1998 Dec. 45(6):1455-77. [Medline].

  23. Blei F. Medical and genetic aspects of vascular anomalies. Tech Vasc Interv Radiol. 2013 Mar. 16(1):2-11. [Medline].

  24. Berenguer B, Burrows PE, Zurakowski D, Mulliken JB. Sclerotherapy of craniofacial venous malformations: complications and results. Plast Reconstr Surg. 1999 Jul. 104(1):1-11; discussion 12-5. [Medline].

  25. Zhang L, Lin X, Wang W, et al. Circulating level of vascular endothelial growth factor in differentiating hemangioma from vascular malformation patients. Plast Reconstr Surg. 2005 Jul. 116(1):200-4. [Medline].

 
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