Venous malformations: Clinical course and management of vascular birthmark clinic cases

Abstract

BACKGROUND/OBJECTIVES: Venous malformations (VM) are an uncommon vascular malformation with an estimated incidence of 1-2 per 10 000 births. The aim was to define the clinical characteristics and management of children with VM and develop a database for future research. METHODS: A retrospective chart review of all children presenting to the Vascular Birth Mark clinic with VM from 2000 to 2011. RESULTS: In total 128 patients were included, of whom 59.4% were female, 78.1% were Caucasian and 56.3% resided in a metropolitan area. Most lesions were noted at birth (64.1%) with an average age when VM was first noticed of 17.1 months. The average age of definitive diagnosis was 65.9 months. Locations most frequently involved were the lower limb (41.4%), face (21.1%), trunk (17.2%) and upper limb (15.6%). The most commonly associated conditions were capillary malformation (28.9%) and lymphatic malformation (28.1%). Magnetic resonance imaging was used in the majority of patients (86.7%) to assess tissue distribution of the lesions. Skin and subcutaneous tissue (61.3%), muscle (49.5%) and joints (11.7%) were most commonly involved. Complications of VM resulted in morbidity in 68.8% of cases, most commonly pain (52.3%), thrombophlebitis (17.2%), bleeding (13.3%) and limb length discrepancy (13.3%). Intervention was employed in 68.0%, most often with sclerotherapy (61.8%), compression garments (43.0%), and endovascular laser (17.2%) and surgical management (13.3%). CONCLUSIONS: Given the frequent association of VM with other vascular lesions, considerable morbidity, and specialised treatment, a multidisciplinary approach to their management in childhood is important and should include dermatology, diagnostic and interventional radiology, haematology, paediatric surgery, physiotherapy and social services.