The effects of surgical treatment and sclerotherapy for intramuscular venous malformations: a comparative clinical study

Abstract

Background Venous malformations (VMs) are the most common type of vascular malformations. Intramuscular venous malformations (IMVMs) are lesions involving the muscles, excluding intramuscular hemangiomas. The purpose of this study was to compare clinical outcomes between patients with IMVMs who were treated with sclerotherapy and those who were treated with surgical excision.Methods Of 492 patients with VMs treated between July 2011 and August 2020 at a single medical center for vascular anomalies, 63 patients diagnosed with IMVM were retrospectively reviewed. Pain, movement limitations, swelling, and quality of life (QOL) were evaluated subjectively, while radiological outcomes were assessed by qualified radiologists at the center. Complication rates were also evaluated, and radiological and clinical examinations were used to determine which treatment group (sclerotherapy or surgical excision) exhibited greater improvement.Results Although there were no significant differences in pain (P=0.471), swelling (P=0.322), or the occurrence of complications (P=0.206) between the two treatment groups, the surgical treatment group exhibited significantly better outcomes with regard to movement limitations (P=0.010), QOL (P=0.013), and radiological outcomes (P=0.017). Moreover, both duplex ultrasonography and magnetic resonance imaging showed greater improvements in clinical outcomes in the surgical excision group than in the sclerotherapy group.Conclusions Although several studies have examined IMVM treatment methods, no clear guidelines for treatment selection have been developed. Based on the results of this study, surgical excision is strongly encouraged for the treatment of IMVMs.

An overview of interventional radiology techniques for the diagnosis and management of vascular anomalies: Part 1

“…For intramuscular VMs, surgery may have better outcomes than IR procedures, although the literature to date is mixed. Of 492 patients with intramuscular VMs treated with sclerotherapy versus surgical excision, the surgical treatment group exhibited significantly better outcomes with regard to movement limitations, quality of life, and radiological outcomes 25 . However, many surgically resected VMs recur more than 5 years after surgery, which was outside of the time frame of this study.…”

“…Of 492 patients with intramuscular VMs treated with sclerotherapy versus surgical excision, the surgical treatment group exhibited significantly better outcomes with regard to movement limitations, quality of life, and radiological outcomes. 25 However, many surgically resected VMs recur more than 5 years after surgery, which was outside of the time frame of this study. Additionally, in another study of 41 patients who underwent sclerotherapy of VMs with polidocanol, there was no statistically significant difference in quality of life, pain, or functional limitations between those with intramuscular lesions versus those with extramuscular lesions.…”

Successful Management of a Rare Manifestation of Intramuscular Venous Malformation in a Young Adult: A Case Report

“…An accurate diagnosis of the VMs though can be made with a Doppler ultrasound coupled with an MRI of the affected extremity [7]. Treatment of the condition includes observation and active surveillance of asymptomatic or mildly symptomatic lesions, sclerotherapy, or surgical resection of the VMs [4]. Sclerotherapy is a non-surgical intervention that may be considered for smaller lesions [8].…”

“…A congenital mixed vascular malformation syndrome known as Klippel-Trenaunay syndrome presents with capillary malformations, venous/lymphatic anomalies and bony/soft tissue hypertrophy [3]. Venous malformations (VM) are the most common type of vascular malformation affecting about 1-4% of individuals [4]. VMs in skin or subcutaneous tissue typically diagnosed at birth are benign and often regress during childhood.…”

Deep Learning for the Automatic Segmentation of Extracranial Venous Malformations of the Head and Neck from MR Images Using 3D U-Net

“…VMs in the head and neck region are known for being difficult to treat [ 3 , 16 ]. Their treatment includes sclerotherapy and excisional surgery, with sclerotherapy being more preferred due to the concentration of important structures, such as nerves and the orbits, in this anatomical region.…”