Original Research

Peculiarities of diagnosis and surgical treatment of the venous forms of congenital vascular malformations of the lower limbs

L.M. Chernukha, A.A. Gooch, M.O. Artemenko, G.G. Vlaikov, I.V. Homoliako, T.D. Zadorozhna, O.I. Parnytska, A.V. Todosiev

National Institute of Surgery and Transplantology after O.O. Shalimov of NAMS of Ukraine, Kyiv, Ukraine

      Venous forms of congenital vascular malformations of the lower limbs are the most common type (up to 79 %) of congenital vascular malformations (CVM), making this the contemporary problem. Our goal was to achieve better results in surgical treatment of patients with venous forms of CVM of the lower limbs with the help of differentiated pathogenetic treatment approach using surgery, laser methods and sclerotherapy. We reviewed clinical characteristics and treatment results in 98 patients with venous forms of CVM of the lower limbs, mostly female – 67.35 %, more than a half patients were in age from 15 to 25 years. Examination methods included duplex ultrasound imaging, radiopaque phlebography, and computer-aided tomography of the lower limbs on indications. Proliferation activity of malformations’ cells and near-lying tissues was studied using pathomorphological and immunohistochemical methods. Patients were divided into four groups: patients with truncular malformations and superficial vein system lesion – 59 (60.20 %); patients with truncular malformations and deep vein system lesion – 27 (27.56 %); patients with extruncular malformations – 7 (7.14 %), and patients with combined malformations – 5 (5.10 %). Proliferation activity was found in 18 (18.37 %) cases using pathomorphological and in 27 (28.57 %) cases using immunohistochemical methods. Combination of surgery, sclerotherapy and laser treatment brought satisfactory results in 73 cases (74.49 %), including forms with deep vein system lesions and combined forms.

Key words: congenital vascular malformation, vascular endothelial growth factor, endovasal laser vein coagulation, venous form, ultrasound controlled sclerotherapy.