Vol. 14 No. 2 (2022): Arch Pub Health
Clinical Science

Treatment of venous malformations in pediatric population – three- year experience

Roza Sokolova
University Clinic of Pediatric Surgery, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Republic of North Macedonia;
Shaban Memeti
University Clinic of Pediatric Surgery, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Republic of North Macedonia;
Toni Risteski
University Clinic of Pediatric Surgery, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Republic of North Macedonia;
Biljana Andonovska
University Clinic of Pediatric Surgery, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Republic of North Macedonia;
Njomza Lumani-Bakiji
University Clinic of Pediatric Surgery, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Republic of North Macedonia;
Aleksandar Stepanovski
University Clinic of Pediatric Surgery, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Republic of North Macedonia;
Borche Kocevski
Surgical department, Clinical Hospital Tetovo, Republic of North Macedonia

Published 2022-12-30


  • congenital vascular malformations,
  • pediatric venous malformations,
  • sclerotherapy,
  • bleomycin,
  • phleboliths

How to Cite

Sokolova R, Memeti S, Risteski T, Andonovska B, Lumani-Bakiji N, Stepanovski A, Kocevski B. Treatment of venous malformations in pediatric population – three- year experience. Arch Pub Health [Internet]. 2022 Dec. 30 [cited 2024 Apr. 16];14(2):90-100. Available from: https://id-press.eu/aph/article/view/6052


Venous malformations (VMs) are a type of vascular malformations that result in abnormal development of veins that become extensible over time due to an error in vascular morphogenesis. They usually appear in newborns or in early adulthood as a bluish, soft, swollen and eventually painful skin formation. Treatment includes conservative therapy, sclerotherapy and surgical excision. Aim of the paper is to evaluate the therapeutic effect of scleraotherapy in pediatric patients with venous malformations. Material and methods: In a three-year period, from 2019 to 2021, venous malformation was found in 33 patients aged 4 to 14 years (average age: 8 years). Pain as a symptom occurred in 8 patients. Two patients had lesions measuring up to 5 cm and 5 cm respectively, while in the remaining subjects the lesion was over 5 cm. Ultrasound was performed routinely in all subjects, and MRI in two patients. Conservative treatment was instituted in 13 patients with venous malformations of the extremities, surgical excision with local reconstruction was performed in 11 patients, and sclerotherapy with bleomycin under general anesthesia was performed in 8 patients. Combined treatment was used in one patient that presented with venous malformation of the upper arm that underwent partial sclerotherapy with subsequent operative excision due to a phlebolith. Follow-up examinations revealed regression of the change not only from functional but from aesthetic aspect as well. Conclusion: Sclerotherapy is the established golden standard, first-line treatment for venous malformations. Excellent results were achieved as the reduction of the lesions was below 50% of the initial size. However, the modality of treatment should be individualized to each patient as it can sometimes require a combination of more than one treatment option. Venous malformations are best treated early, but they usually recur over time. Treatment helps relieve symptoms and control the growth of vascular malformations.


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  1. Redondo P, Aguado L, Martínez-Cuesta A. Diagnosis and management of extensive vascular malformations of the lower limb: part II. Systemic repercussions, diagnosis, and treatment. Journal of the American Academy of Dermatology 2011; 65: 909-923. DOI: https://doi.org/10.1016/j.jaad.2011.03.009
  2. Lobo-Mueller E, Amaral JG, Babyn PS, Wang Q, John P. Complex combined vascular malformations and vascular malformation syndromes affecting the extremities in children. Semin Musculoskelet Radiol 2009; 13(3):255-276. DOI: https://doi.org/10.1055/s-0029-1237692
  3. Lee MS, Liang MG, & Mulliken JB. Diffuse capillary malformation with overgrowth: a clinical subtype of vascular anomalies with hypertrophy. Journal of the American Academy of Dermatology 2013; 69: 589-594. DOI: https://doi.org/10.1016/j.jaad.2013.05.030
  4. Mazoyer E, Enjolras O, Laurian C, Houdart E, & Drouet L. Coagulation abnormalities associated with extensive venous malformations of the limbs: differentiation from Kasabach–Merritt syndrome. Clinical & Laboratory Haematology 2002; 24: 243-251. DOI: https://doi.org/10.1046/j.1365-2257.2002.00447.x
  5. Enjolras O, Ciabrini D, Mazoyer E, Laurian C, Herbreteau D. Extensive pure venous malformations in the upper or lower limb: a review of 27 cases. Journal of the American Academy of Dermatology 1997; 36: 219-225. DOI: https://doi.org/10.1016/S0190-9622(97)70284-6
  6. ISSVA classification for vascular anomalies. (n.d.). Retrieved March 10, 2022, from https://www.issva.org/UserFiles/file/ISSVA-Classification-2018.pdf
  7. Ernemann U, Kramer U, Miller S, Bisdas S, Rebmann H, Breuninger H, et al. Current concepts in the classification, diagnosis and treatment of vascular anomalies. European journal of radiology 2010; 75: 2-11. DOI: https://doi.org/10.1016/j.ejrad.2010.04.009
  8. Hage A N, Chick J, Srinivasa R N, Bundy J J, Chauhan N R, Acord M, Gemmete JJ. Treatment of venous malformations: The data, where we are, and how it is done. Techniques in vascular and interventional radiology 2018; 21(2): 45–54. DOI: https://doi.org/10.1053/j.tvir.2018.03.001
  9. Glovkzki P, & Driscoll D (2007). Klippel–Trenaunay syndrome: current management. Phlebology 22: 291-298. DOI: https://doi.org/10.1177/026835550702200611
  10. Noel AA, Gloviczki P, Cherry Jr KJ, Rooke TW, Stanson AW, & Driscoll DJ (2000). Surgical treatment of venous malformations in Klippel-Trenaunay syndrome. Journal of vascular surgery 32: 840-847. DOI: https://doi.org/10.1067/mva.2000.110343
  11. Lee BB, Baumgartner I, Berlien P, et al. Diagnosis and Treatment of Venous Malformations. Consensus Document of the International Union of Phlebology (IUP): updated 2013. Int Angiol 2015
  12. Richter GT, Friedman AB. Hemangiomas and vascular malformations: current theory and management. Int J Pediatr 2012; 2012:645678. DOI: https://doi.org/10.1155/2012/645678
  13. Vikkula M, Boon LM, Mulliken JB. Molecular genetics of vascular malformations. Matrix Biol 2001;20:327-335. DOI: https://doi.org/10.1016/S0945-053X(01)00150-0
  14. van Rijswijk CS, van der Linden E, van der Woude HJ, et al. Value of dynamic contrast-enhanced MR imaging in diagnosing and classifying peripheral vascular malformations. AJR Am J Roentgenol 2002; 178(5):1181-1187. DOI: https://doi.org/10.2214/ajr.178.5.1781181
  15. Legiehn GM, Heran MK. Venous malformations: classification, development, diagnosis, and interventional radiologic management. Radiol Clin North Am 2008;46 (3):545-597. DOI: https://doi.org/10.1016/j.rcl.2008.02.008
  16. Horbach SE, Lokhorst MM, Saeed P, et al. Sclerotherapy for low-flow vascular malformations of the head and neck: A systematic review of sclerosing agents. J Plast Reconstr Aesthet Surg 2016; 69(3):295-304 DOI: https://doi.org/10.1016/j.bjps.2015.10.045
  17. Ahmad S, Akhtar FK. Percutaneous sclerotherapy of para-orbital and orbital venous malformation: A single center, case series. Phlebology 2019; 34(5), 355–361. DOI: https://doi.org/10.1177/0268355518805364
  18. Bai Y, Jia J, Huang XX, et al. Sclerotherapy of Microcystic Lymphatic Malformations in Oral and Facial Regions. J Oral Maxillofac Surg 2009; 67(2):251-256. DOI: https://doi.org/10.1016/j.joms.2008.06.046
  19. Hassan Y, Osman AK, Altyeb A. Noninvasive management of hemangioma and vascular malformation using intralesional bleomycin injection. Ann Plast Surg 2013; 70(1):70-73. DOI: https://doi.org/10.1097/SAP.0b013e31824e298d
  20. Yang Y, Sun M, Ma Q, et al. Bleomycin A5 sclerotherapy for cervicofacial lymphatic malformations. J Vasc Surg 2011; 53(1):150-155. DOI: https://doi.org/10.1016/j.jvs.2010.07.019
  21. Shigematsu T, Sorscher M, Dier E C and Berenstein A. Bleomycin sclerotherapy for eyelid venous malformations as an alternative to surgery or laser therapy. Journal of neurointerventional surgery 2019; 11(1), 57–61. DOI: https://doi.org/10.1136/neurintsurg-2018-013813
  22. Mohan A T, Adams S, Adams K, Hudson D A. Intralesional bleomycin injection in management of low flow vascular malformations in children. Journal of plastic surgery and hand surgery 2015; 49(2), 116 –120. DOI: https://doi.org/10.3109/2000656X.2014.951051
  23. Zhang J, Li HB, Zhou SY, Chen KS, Niu CQ, Tan XY, Jiang YZ, Lin QQ. Comparison between absolute ethanol and bleomycin for the treatment of venous malformation in children. Exp Ther Med 2013;6(2):305-309. DOI: https://doi.org/10.3892/etm.2013.1144
  24. Gregory S, Burrows P E, Ellinas H, Stadler M, Chun R H. Combined Nd:YAG laser and bleomycin sclerotherapy under the same anesthesia for cervicofacial venous malformations: A safe and effective treatment option. International journal of pediatric otorhinolaryngology 2018; 108: 30–34. DOI: https://doi.org/10.1016/j.ijporl.2018.02.005
  25. MacArthur CJ, Nesbit G. Simultaneous intra-operative sclerotherapy and surgical resection of cervicofacial venous malformations. International journal of pediatric otorhinolaryngology 2019; 118: 143 –146. DOI: https://doi.org/10.1016/j.ijporl.2018.12.017