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FAQs—VASCULAR MALFORMATIONS and SCLEROTHERAPY

  1. What is a venous malformation?

    Venous malformations (VMs) are one of the most common vascular anomalies. A VM is an abnormal formation of tangled, dilated veins somewhere within the body. These abnormal veins often lack smooth muscle along the vessel wall, causing them to enlarge and rupture easily. The center of the tangled veins is called the nidus. Venous malformations are usually congenital, meaning they occur during fetal development but may not be noticed for months to years. VMs can occur in isolation or as part of another disease. Most people with VMs do not have any symptoms and they grow in proportion with the person. Some become more disproportionately enlarged over time. Episodic clotting of the malformation, trauma, puberty, and pregnancy can all enlarge the VM.

  2. How do you treat VMs?

There are a few options for treating VMs depending on the size, location, and type of symptoms the person is having. Usually, VMs are not treated unless there is a perceived risk, like possible rupture, or if the person is symptomatic. The two most common methods of treatment are surgery and sclerotherapy. Surgery is the gold standard. Complete removal of the VMs’ nidus is required to achieve an effective cure. Depending on the mass’ size and location, this can be very challenging if not nearly impossible by surgery alone. Sclerotherapy uses a chemical solution to cause destruction of the blood vessel walls and rapid thrombosis, or clotting of the nidus. Typically, sclerotherapy involves a simple injection through a small needle into the mass but it takes several treatments before it is effective.

  1. How successful is sclerotherapy for the treatment of VMs?

Each VM is unique, with different characteristics including its location, the rate of blood flow through the nidus, the symptoms it’s causing, the current size and if it’s growing or maintaining its size. With so many variables, the cure rate has to be discussed on an individual basis.

  1. What are the benefits to sclerotherapy versus surgery?

    Outpatient setting, typically back home within a few hours and back to your normal routine if not immediately within 24 hours

    No general anesthesia

    No scars

    Minimal risks of complications

  2. Will I still need surgery?

Possibly. Treating VMs is a team approach often involving many different specialties including a plastic surgeon and an interventional radiologist. Sometimes, it is best for the person to go directly to surgery. Some people are not good surgical candidates, so sclerotherapy is a better option. Some patients do best by initial sclerotherapy treatments to shrink the mass and then surgery to completely remove the remaining nidus.

  1. What are potential risks/side effects of sclerotherapy?

Risks/side effects are very minimal in sclerotherapy because of the simple approach to the procedure. These are discussed on an individual basis depending on the VM. With this procedure, there is a small chance of damage to healthy tissues surrounding the mass.

  1. How many treatments of sclerotherapy will I need?

This is determined on an individual basis depending on the venous malformation