Characteristics, clinical presentation and treatment outcomes of venous malformation in the extremities.

Abstract

OBJECTIVES\nThe clinical presentation of venous malformations (VMs) is variable and not well documented. This study was designed to determine the clinical characteristics and outcomes in association with the type and extent of VM in the extremities.\n\n\nMETHODS\nPatients diagnosed by ultrasound, CT or MRI were included. VM extent and tissue involvement, signs and symptoms were retrospectively collected. Those with arteriovenous malformations, Klippel -Trenaunay syndrome, lymphedema and symptoms from other unrelated diseases were excluded. VMs were classified as extensive or localized based on whether different tissues or the entire compartment was involved. Clinical outcomes and imaging were obtained on both treated patients and those whose chose to have no interventions.\n\n\nRESULTS\nThere were 72 patients with a median age of 30 years of whom 26 were males. VM extended into the subfascial space in 40 (55.6%). Patients with VM distributed on their leg had mostly pain being more evident during physical activity (N=40, 80.0%) and swelling worsening with prolonged standing (N=35, 70.0%) while in the upper extremities the most prominent complaints were venous enlargement (N=10, 45.5%), pain (N=9, 40.9%), and swelling (N=11, 50.0%). Symptoms were related to the extent of the lesion (odds ratio=7.664; 95% CI, 2.006-29.291; p=003). Treatment was decided by the extent and the depth of lesions. Excision was performed in 15 (20.8%) patients, sclerotherapy in 12 (16.7%), sclerotherapy with phlebectomy or coil embolization in 8 (11.1%), and stripping in 2 (2.8%). An excellent result was achieved for treating localized malformations where in the extensive cases symptoms intensity was reduced or controlled with multiple treatments.\n\n\nCONCLUSIONS\nVM of the extremities affected patients quality of life significantly by their appearance and pain. VM extent is associated with symptom severity. Clinical outcomes are excellent for localized VM but extensive cases require multiple treatments to reduce symptom intensity.