The most common type of vascular malformation is called a venous malformation and involves veins that develop abnormally and do not function as they should. Venous malformations are present at birth but may not become apparent until later in life. They typically grow larger over time and may grow especially large during times of hormonal changes, such as puberty, monthly period, and pregnancy. Small blood clots may form within the abnormal veins and this along with stretching of the veins, frequently causes swelling and pain.
Venous malformations vary in size and are found anywhere in the body with the majority involving the head and neck area. Venous malformations frequently affect the skin of the face, legs, or arms. Bones, joints, muscles, and mucous membranes are commonly inovolved as well.
Because venous malformations are comprised of a detailed network of veins, they typically appear as blue or purple in color. They are soft and easy to compress and may enlarge when a person cries or exerts pressure. For example, if the venous malformation is located on the face, it will typically become more swollen when the head is lowered. Blood flows slowly through venous malformations, making patients susceptible to forming blood clots.
Diagnosis
Venous malformations can often be diagnosed clinically based on their appearance. Ultrasound is a very useful tool in order to distinguish venous malformations from other vascular malformations and hemangiomas. At the Jerusalem Vascular Anomalies Clinic, we routinely perform ultrasound in the clinic as part of the physical exam. MRI is very often necessary in order to see the deeper tissues involved by venous malformations and when planning different treatment approaches.
Treatment
At the Jerusalem Vascular Anomalies Clinic, we will carefully evaluate the size and location of the venous malformation. If the venous malformation is not causing you any symptoms, we may recommend watching it without any active treatment. Most venous malformations due, however, cause symptoms or place patients at risk of potentially dangerous blood clots. The options for treatment will depend on the impairment that the venous malformation is causing, including pain, swelling, airway blockage, internal bleeding, or impaired speech or vision. Every patient’s care is individualized and may include the following:
Sclerotherapy + Embolization (‘Endovascular Therapy’)
Using ultrasound and x-ray technology as a guide, a special liquid is injected into the abnormal veins in order to cause them to shrink down. This helps with the swelling pain caused by the dilated veins. Multiple sclerotherapy sessions are usually required for the best outcome. Sclerotherapy is often combined with embolization (closing off) of veins that are associated with the venous malformation. This treatment is performed through several tiny pin holes in the skin without need for large incisions or scars.
Surgery
Some venous malformations are amenable to surgery, and surgery is often combined with endovascular therapy in order to make the surgery safer and more effective.
Our extraordinary team at The Jerusalem Vascular Anomalies Clinic is here to help you in any way we can. We will help walk you through every step of the way in navigating your venous malformation. For an appointment to Dr. Farkas’s clinic, please call 02-564-5634