Staged endovascular and surgical treatment of slow-flow vulvar venous malformations
ABSTRACT OBJECTIVE: To report our experience in a rare series of treated symptomatic slow-flow vulvar venous malformations (VVM) using a staged, multidisciplinary approach. STUDY DESIGN: Consecutive patients with symptomatic lesions treated over a 7-year period (2005-2012) were followed for technical success, resolution of symptoms, aesthetic outcomes, and complications. Direct endovenous sclerotherpy (DEVS) using sodium tetradecyl sulfate (STS) foam was performed in all patients under ultrasound (US) and contrast-enhanced fluoroscopic guidance. Surgical excision and layered primary closure was performed within 24 hours after the last DEVS session. RESULTS: Eleven patients (Mean age 25; Range 4-43) were treated. Presenting symptoms included pain (11), soft tissue swelling (11), local heaviness (11), dyspareunia (2), and dysmenorrhea (2). Most were isolated lesions (8). There were 2 cases of Klippel-Trénaunay (KTS) and 1 case of Maffucci Syndrome. The latter required Nd:YAG laser photocoagulation prior to sclerotherapy. On average, approximately 3 DEVS sessions were required prior to surgical excision (range 1-6). Mean estimated surgical blood loss was 130 mL (range 20-400). Mean follow-up was 23 months (Range: 3-55). Elimination of pain and soft tissue redundancy was achieved in all patients with satisfactory aesthetic outcomes. All patients experienced minor pain and swelling post-DEVS. Following surgical excision, there was 1 case of hematoma and wound dehiscence requiring surgical evacuation. No other reinterventions - endovascular or surgical - were required. CONCLUSIONS: VVMs require increased awareness and appropriate pre-operative evaluation for proper identification and treatment. A multi-disciplinary approach can provide improvement in clinical signs and symptoms with satisfactory cosmesis and minimal complications.
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