title: Staged endovascular and surgical treatment of slow-flow vulvar venous malformations.
abstract: OBJECTIVE
  The objective of the study was to report our experience in a rare series of treated symptomatic slow-flow vulvar venous malformations (VVMs) using a staged, multidisciplinary approach.
  
  
  METHODS
  Consecutive patients with symptomatic lesions treated over a 7 year period (2005-2012) were followed up for technical success, resolution of symptoms, aesthetic outcomes, and complications. Direct endovenous sclerotherapy (DEVS) using sodium tetradecyl sulfate (STS) foam was performed in all patients under ultrasound 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 years; range, 4-43 years) were treated. Presenting symptoms included pain (n = 11), soft tissue swelling (n = 11), local heaviness (n = 11), dyspareunia (n = 2), and dysmenorrhea (n = 2). Most were isolated lesions (n = 8). There were 2 cases of Klippel-Trénaunay syndrome 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 mL). Mean follow-up was 23 months (range, 3-55 months). Elimination of pain and soft tissue redundancy was achieved in all patients with satisfactory aesthetic outcomes. All patients experienced minor pain and swelling after 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 preoperative evaluation for proper identification and treatment. A multidisciplinary approach can provide improvement in clinical signs and symptoms with satisfactory cosmesis and minimal complications.
authors: Lenox Hill Heart and Vascular Institute of New York, Lenox Hill Hospital, North Shore Long Island Jewish Health System, New York, NY, USA. naiemn@gmail.com
authors: Naiem
authors: N
authors: Nassiri
authors: Teresa M J
authors: TM
authors: O
authors: Robert J
authors: RJ
authors: Rosen
authors: Jacques
authors: J
authors: Moritz
authors: Milton
authors: M
authors: Waner
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000379:methods*; D012981:Sodium Tetradecyl Sulfate / Q000627:therapeutic use*; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D014680:Veins / Q000002:abnormalities / Q000601:surgery; D014844:Vulva / Q000098:blood supply / Q000601:surgery*; D014845:Vulvar Diseases / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D055815:Young Adult
chemical_list: D012597:Sclerosing Solutions; D012981:Sodium Tetradecyl Sulfate