[Obliteration techniques for treatment of patients with venous malformations: a single-center experience].

Abstract

Background: Venous malformations (VMs) constitute the largest group among patients with congenital vascular malformations. Recently, in the treatment of this category of patients, modern minimally invasive methods of obliteration of venous caverns and dysplastic veins have been widely used.

Objective: The purpose of this study was to compare the results of treatment of patients with VM using sclerobliteration (SO), laser coagulation (LC) and radiofrequency ablation (RFA).

Patients and methods: Our retrospective study with a prospective component included (a total of) 156 patients with VM. Of these, 111 were women aged 18 to 42 years (mean age 38.5) and 45 men aged 18 to 56 years (mean age 30.2). Depending on the surgical intervention performed, all patients were divided into 3 groups: SO (n=48), LC (n=56), and RFA (n=54). Establishment of the diagnosis of VM, clarification of the localization, depth, and extent of the lesion were carried out based on the findings of duplex scanning (DS) of vessels and soft tissues. The dimensions of the venous cavities ranged from 5 to 42 mm. LC and RFA were not used with a lesion depth of less than 10 mm. The effectiveness of treatment was evaluated by the results of DS at 12 months, taking into account obliteration of cavities in the intervention zone, the presence of residual cavities and their sizes. Pain was assessed by means of a visual analogue scale.

Results: In the RFA group, complete obliteration of venous caverns in the area of intervention at 12 months of follow-up was achieved in 50 (92.6%) patients. At the same time, occlusion of rather large caverns (more than 30 mm in diameter) was noted. Three (5.5%) patients were found to have partial occlusion of the venous caverns, which was associated with a diffuse lesion. Complete obliteration of cavities in the LC group was achieved in 43 (76.8%) patients. The best result was recorded for cavities smaller than 30 mm. In the presence of partial obliteration, according to the DS findings, the blood flow continued to be registered. In the SO group, positive results were obtained in 44 patients (91.7%). The technical success of the performed procedure in this case can be explained by the presence of single limited cavities of small and medium diameter (less than 30 mm). In the RFA group, there were fewer complications than in other groups (pRFA,LC=0.0038, pRSA,SO=0.004). There was no significant difference between the results of obliteration in all groups, but there was a trend towards slightly worse results for obliteration in the LC group (p>0.05).

Conclusion: The effectiveness of obliteration techniques in treatment of patients with VM directly depends on the depth, extent of the lesion and the diameter of the vascular formation. These methods make it possible to alleviate the course of the disease and reduce the recovery time after surgery. This is especially important, given the relapsing nature of the disease. Despite the fact that all these operations are palliative, their goal is to reduce primary complaints and improve quality of life of patients.