Peripheral venous malformations: Post-millennium Cappadocia experience

Background. Venous malformations (VMs) are present at birth and low-pressure, low-flow vascularmalformations showing thin-walled dilated sponge-like channels varying in size from capillary tocavernous dimensions. VMs, which commonly confused with deep growing hemangioma in children or withKlippel-Trénaunay syndrome when they involve a full limb, are best evaluated using T2-weighted MRI. Theother diagnostic tools are plain films which can reveal a soft tissue mass with phlebolith, Dopplerultrasound, 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 bystagnation within large VMs. Prior to initiating therapy of extensive limb VMs, LIC should be corrected withLMWH and elastic stockings. Sclerotherapy with ethanol, STS, Ethibloc, or polidocanol is commonly usedfor therapy of VMs. Anti-inflammatory agents such as NSAIDs should be given to minimize postsclerotherapicinflammatory symptoms. Surgical resection is required for functionality, cosmesis or thetreatment of post-sclerotherapic residual lesions. Laser therapy can be useful in very superficial VMs andin oro-mucosal lesions.Patients and Method. After Millennium, 47 patients (n=27, female) with VM were reviewed; their medianage was 19 (range, 1-32 years). They accounted for 42 percent of the patients with all congenital vascularmalformations (CVMs) managed during the same period (Figures 1-3). The most of VMs was localizedlimbs (upper, n=18, lower, n=29); a patient also had truncal involvement. Three patients with cephalicVM (lip, tongue and palate, and chins) were not included to this study. The patients were advised to avoiddirect traumas. Prophylactic low-dose aspirin and compression stocking were given in patients withextensive VMs.Results. A coagulation abnormality was not found in our patients with bulky VMs. In our study, thetreatment 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 VMrequired repeated sclerotherapy.Conclusion. Compression, sclerotherapy and resection were therapeutic modalities of VMs. Because themost of VMs is asymptomatic, discomfort of a localized lesion can answer to a simple compression