Percutaneous endovenous treatment of congenital extratruncular venous malformations with an ultrasound-guided and 810-nm diode laser

Background: Venous malformations (VMs) are the commonest vascular anomalies. Treatment of extratruncular venous malformations (EVMs) is difficult. Surgery has been the mainstay therapy for EVMs but can be hazardous, leading to major blood loss and incomplete resection. Recurrence and cosmetic problems are also common after resection. Endovenous laser ablation (EVLA) has been found to be safe and effective for endovenous ablation of incompetent saphenous veins. We report our experience of diode laser ablation in percutaneous ultrasound (US)-guided treatment of congenital EVMs with respect to effectiveness and safety. Methods: A consecutive series of patients (16 males and 22 females; age, 13-46 years) were treated by US-guided EVLA for EVMs at our institution. A questionnaire was used to assess preoperative and postoperative symptoms. Effectiveness was assessed by procedural success and clinical success. Subjective improvement of symptoms was further assessed simultaneously with objective evidence of improved clinical signs. This included reduction of lesion size, general swelling, or improved range of motion of the joint. Duplex US imaging was used to assess blood flow within lesions. Safety was assessed by morbidity and mortality, including laser-related adverse events, postoperative deep vein thrombosis, pulmonary embolism, and hematoma. Results: All patients tolerated the procedure and recovered uneventfully. Fifty-six procedures were undertaken in 38 patients. All procedures were successful. Thirty-three patients had resolution of presenting pain symptoms after laser treatment; the remaining patients were able to significantly reduce the number of pain medications from that used before treatment. For complaints related to swelling and cosmetic effect, clinical success was 70% and 67%, respectively. No patients returned with recurrent symptoms after initial successful treatment at a mean follow-up of 12.7 months. Thirty-six (64%) treated lesions areas were classified as excellent, 18 (32%) were good, and 2 (4%) were fair using duplex US imaging at final follow-up. Better results were obtained with localized types of VMs, in which palliation was achieved after only one treatment. Complications were minor and improved quickly. Conclusions:Treatment of congenital EVMs with endovenous laser ablation under US guidance achieved palliation in most symptomatic patients; it was safe, with minimal morbidity during short-term follow-up. (J Vasc Surg 2011; 54:139-45.)