Venous Malformations Treatment & Management

  • Author: Silvio Podda, MD; Chief Editor: Gregory Caputy, MD, PhD, FICS   more...
 
Updated: Nov 21, 2011
 

Medical Therapy

Sclerotherapy is the primary form of nonsurgical intervention for venous malformations.[11] 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.[12]

In a retrospective analysis of facial paralysis causwe 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.[13]

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.[14] This approach seems more appropriate for smaller lesions.

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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] In general, surgery or sclerotherapy is more successful when dealing with pure venous malformations than when dealing with combined malformations.

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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.[15] 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.[15]

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.[15]

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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, and 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 for Reconstructive Microsurgery, American Society of Plastic Surgeons, Plastic Surgery Research Council, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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 and American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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 Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Gregory Caputy, MD, PhD, FICS  Chief Surgeon, Aesthetica Plastic and Laser Surgery Center, Inc

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

Disclosure: Syneron Corporation Salary Speaking and teaching

References

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

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

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

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  13. 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. Nov 2011;33(11):1616-21. [Medline].

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  17. Enjolras O, Mulliken JB. Vascular tumors and vascular malformations (new issues). Adv Dermatol. 1997;13:375-423. [Medline].

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  22. 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. Jul 2005;116(1):200-4. [Medline].

 
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