Venous malformations in children: controversies of the diagnosis and treatment
Background. The characteristics of venous malformations are the progressive course, high risk of complications and unstable results of treatment. The purpose of the study is to determine the informative diagnostic methods and effective and safe methods for the treatment of venous malformations in children. Materials and methods. The study included 27 children with venous malformations aged 2 months to 17.5 years. The main method of visualization was magnetic resonance imaging. For the diagnosis of coagulation disorders, the level of fibrinogen, D-dimer s in the blood plasma was determined. Sclerotherapy was carried out under real-time ultrasound guidance using Tessari method. The statistical analysis was performed using the SPSS Statistics program. Results. Coagulation disorders are diagnosed in 55.56 % of patients, with increased levels of D-dimers in all cases and a decrease in the fibrinogen content in 11.12 % of children. The study found that the increase of D-dimers correlates with the presence of phleboliths and the size of the lesion. Sclerotherapy alone and in combination with surgical resection was performed in 74.07 % of patients; the number of sessions was from 1 to 12. We didn’t observe any complication after sclerotherapy, however, recanalization was diagnosed in 80 % of children in the period from 8 months to 2 years. In order to correct coagulopathy, low molecular weight heparin was used in a daily dose of 100 U/kg body weight for 5–14 days before and after main treatment. A comparison between the level of D-dimers before and after the treatment was performed using a Wilcoxon test, indicating a significant decrease in the level of D-dimers. The result of venous malformations treatment in children is the disappearance or reduction of pain (73.07 %), increase in daily activity (26.92 %), bleeding stop (11.54 %), improvement of cosmetic outcome (19.23 %), no changes (3.84 %), deterioration due to increased edema after removal (3.84 %). Conclusions. Sclerotherapy is an effective and safe method for treating venous malformations in children, but its disadvantage is potential recanalization.
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