title: Management of congenital venous malformations of the vulva.
abstract: OBJECTIVE
  To discuss the differential diagnosis and the management of venous malformations of the vulva.
  
  
  METHODS
  Five symptomatic patients were treated. The degree of pain and discomfort was self-assessed by using a horizontal visual analog scale before and after treatment. Preoperative evaluation included Doppler ultrasound scanning in all patients and magnetic resonance imaging (MRI) in one. All patients had direct-injection venography and sclerotherapy during the same session. Ethanol was used in two cases and polidocanol in three. Patients were followed-up by means of Doppler ultrasound scanning and office visits.
  
  
  RESULTS
  All patients experienced marked swelling after the injection, and one developed cutaneous necrosis that healed within 2 weeks. Transient hemoglobinuria was observed in two cases. No early or late major complications occurred. At a mean follow-up of 23 months (range 5-43), all patients experienced complete relief from symptoms and currently have normal vulvar sensation. Four patients had complete ablation of the treated lesion. In one patient the procedure resulted in a significant, albeit incomplete, occlusion of the lesion, and no further treatment was deemed necessary. From a cosmetic standpoint, both patients and physicians considered the results successful.
  
  
  CONCLUSIONS
  Vulvar venous malformations should be distinguished from vulvar varicosities, hematomas, soft-tissue neoplasms, and other vascular anomalies. Doppler ultrasound, MRI, and direct-injection venography are the most accurate diagnostic modalities. Sclerotherapy can successfully treat this condition. The procedure should be monitored with an imaging modality, preferably direct-injection venography with digital subtraction serial imaging.
authors.affiliation: Department of Vascular Surgery and Pathology, Center for Vascular Anomalies, Istituto Dermopatico dell'Immacolata, I.D.I.-IRCCS, Roma, Italy.
authors.forename: M M
authors.initials: MM
authors.lastname: Marrocco-Trischitta
authors.forename: E M
authors.initials: EM
authors.lastname: Nicodemi
authors.forename: C
authors.initials: C
authors.lastname: Nater
authors.forename: F
authors.initials: F
authors.lastname: Stillo
mesh_terms: D000328:Adult; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010147:Pain Measurement; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy; D013997:Time Factors; D014680:Veins / Q000002:abnormalities*; D014844:Vulva / Q000098:blood supply*
chemical_list: D012597:Sclerosing Solutions; D000077423:Polidocanol; D000431:Ethanol; D011092:Polyethylene Glycols