Servier – Phlebolymphology

Characteristics and monitoring of venous malformations in children.
C. Boulard, Y. Surlemont, E. Clavier et al

The study is focused on the characteristics and the way of monitoring venous malformations in children. These malformations are general vascular congenital anomalies with a slow flow developing in parallel with the child’s growth.

The study presents the results of an observational retrospective analysis developed at the CHU-Hospital of Rouen, in consultations covering several medical areas over the year 2000. There were 23 girls and 22 boys with venous malformations included, with the average age of 7 (3 months to 18 years old), who were under medical investigation for an average of 4.5 years (2 months to 12 years). The clinical, evolutional, and therapeutic characteristics of the studied venous malformations were very diverse. Regarding the localization: 35.5% were on the legs; 22% were on the arms; 16% were on the face; and 6.5% were on the body.

The venous malformation dimension was greater than 15 cm3 in 28% of the cases, and 91% of the venous malformations were symptomatic: functional discomfort (23 patients), inequality of legs and arms (2 patients), and pain in 50% of the cases. Pain was more frequent in cases of associated muscular touch, extended venous malformations, puberty, or venous malformations associated with phleboliths. In six cases, venous malformations developed into complications of relapsing venous thrombosis, treated with low-molecular-weight heparin (LMWH) in curative doses for about 15 days.

The therapeutic behavior was different: elastic compression was used in 17/26 children with venous malformations of the legs (good tolerance in 73% of the cases); curative sclerotherapy was used in 3 cases of venous malformations of the face; sclerotherapy in an antalgic scope was used in 3 cases of venous malformations of the arms and legs (50% relapse rate in 5 years); and surgical treatment was used and showed improvement in 6 cases of venous malformations of the face. The authors consider that it is the first study demonstrating that, although congenital, venous malformations are diagnosed late in about 51% of the cases.

Painful venous malformations are associated with muscular touch, extended venous malformations, and the existence of phleboliths. This study confirms the results of two other prospective studies sustaining that there is localized intravascular coagulation in venous malformations. The pain in venous malformations associated with the increase in D-dimers can be treated with LMWH, even if it does not have market authorization for children, but the degree of relapses when stopping the treatment is large.

The conclusion of the authors is that monitoring children with venous malformations is difficult because of its evolution in parallel with their growth and when suggesting a therapy, the benefits and the risks must be considered.