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89th Annual Meeting Abstracts

Venous Malformation: Natural Progression and Recurrence after Treatment
Aladdin H. Hassanein, MD, John B. Mulliken, MD, Steven J. Fishman, MD, Arin K. Greene, MD, MMSC.
Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.

PURPOSE: Venous malformations (VM) can cause significant morbidity, particularly because they enlarge over time and recur after treatment. The purpose of this study was to determine VM progression and recurrence after therapeutic intervention.
METHODS: Our Vascular Anomalies Center database was reviewed for patients with cutaneous and soft-tissue VM; combined or visceral lesions were excluded. Predictor variables included: gender, age, location, size (localized, diffuse) and pregnancy. Outcome variables were: progression (enlargement/worsening symptoms) and recurrence (expansion/increasing symptoms after sclerotherapy or resection).
RESULTS: The study included 614 patients (60.9% female, 39.1 % male). VM involved the extremities (50.1%), head/neck (32.9%), trunk (9.8%), or multiple sites (7.2%). Patients had a 27.7 % risk of progression prior to adolescence, 77.8 % before adulthood, and 88.4% through adulthood. Progression was more likely in adolescence (59.4%) compared to childhood (23.0%); the relative risk was 2.6 [95% CI; 2.1-3.2] (p<0.001). The average age of progression was 12.2 + 8.8 years. Diffuse VM were more likely to progress than localized lesions (p=0.001); gender did not influence expansion (p=0.19). Progression during pregnancy was no different than in non-pregnant women (p=0.21). No difference in time to recurrence was noted between sclerotherapy (29.9% <1 year) or resection (35.8% <1 year) (p= 0.39). Recurrence following treatment was more likely in adolescence versus childhood; the relative risk was 1.6 [95% CI; 1.3-1.8] (p<0.001).
CONCLUSION: VM is more likely to expand and recur in adolescence, compared to childhood. Physiologic factors, such as increased levels of circulating hormones, may contribute to VM expansion during adolescence.


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