Classification of venous malformations in children and implications for sclerotherapy.
OBJECTIVE
The purpose of this work is to present a simple and descriptive classification system for venous malformations (VMs) that may serve as a basis for interventional therapy, and to test its usefulness in a sample of consecutively referred paediatric patients.


METHODS
The classification system we developed includes four types: type I, isolated malformation without peripheral drainage; type II, malformation that drains into normal veins; type III, malformation that drains into dilated veins; and type IV, malformation that represents dysplastic venous ectasia. The system was prospectively tested using phlebography in a sample of 43 children and adolescents with VMs who were referred for treatment during a 10-month period. Our hypothesis was that the type of VM would determine whether low-risk sclerotherapy was indicated.


RESULTS
Thirteen (30%) patients had a type-I VM, 16 (37%) had a type-II, 9 (21%) had a type-III, and 5 (12%) had a type-IV malformation. In more than 90% of patients with a type-I or type-II lesion, sclerotherapy could be performed without any problems. In one third of patients with a type-III VM, sclerotherapy had to be withheld and one of nine (11%) developed a severe complication after therapy. Of the five patients with type-IV lesions, three (60%) had to be excluded from sclerotherapy.


CONCLUSIONS
Our initial results indicate that sclerotherapeutic intervention in patients with type-III and type-IV VMs must be carefully considered, while it can be safely performed in low-risk patients with type-I and type-II lesions.
Puig
Stefan
S
Department of Radiology, University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. stefan.puig@univie.ac.at
Aref
Hussein
H
Chigot
Valerie
V
Bonin
Beatrice
B
Brunelle
Francis
F
D000293:Adolescent; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000145:classification* / Q000453:epidemiology / Q000628:therapy*; D003973:Diatrizoate / Q000627:therapeutic use; D004338:Drug Combinations; D000431:Ethanol / Q000627:therapeutic use; D005227:Fatty Acids / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D008297:Male; D010690:Phlebography; D011237:Predictive Value of Tests; D011409:Propylene Glycols / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy; D016896:Treatment Outcome; D014680:Veins / Q000002:abnormalities*; D015028:Zein / Q000627:therapeutic use
D004338:Drug Combinations; D005227:Fatty Acids; D011409:Propylene Glycols; D012597:Sclerosing Solutions; D003973:Diatrizoate; D000431:Ethanol; D015028:Zein; C020481:alcoholic prolamine solution