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Management of Congenital Venous Malformations of the Vulva

From the Department of Vascular Surgery and Pathology, Center for Vascular Anomalies, "Istituto Dermopatico dell’Immacolata," I.D.I.-IRCCS, Roma, Italy; and Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.

Address reprint requests to: Francesco Stillo, MD, Chairman, Department of Vascular Surgery and Pathology, "Istituto Dermopatico dell’Immacolata," I.D.I.-IRCCS, Via dei Monti di Creta, 104, 00167 Roma, Italy; E-mail: f.stillo{at}idi.it.

OBJECTIVE: To discuss the differential diagnosis and the management of venous malformations of the vulva.

METHODS: Five symptomatic patients were treated. The degree of pain and discomfort was self-assessed by using a horizontal visual analog scale before and after treatment. Preoperative evaluation included Doppler ultrasound scanning in all patients and magnetic resonance imaging (MRI) in one. All patients had direct-injection venography and sclerotherapy during the same session. Ethanol was used in two cases and polidocanol in three. Patients were followed-up by means of Doppler ultrasound scanning and office visits.

RESULTS: All patients experienced marked swelling after the injection, and one developed cutaneous necrosis that healed within 2 weeks. Transient hemoglobinuria was observed in two cases. No early or late major complications occurred. At a mean follow-up of 23 months (range 5–43), all patients experienced complete relief from symptoms and currently have normal vulvar sensation. Four patients had complete ablation of the treated lesion. In one patient the procedure resulted in a significant, albeit incomplete, occlusion of the lesion, and no further treatment was deemed necessary. From a cosmetic standpoint, both patients and physicians considered the results successful.

CONCLUSION: Vulvar venous malformations should be distinguished from vulvar varicosities, hematomas, soft-tissue neoplasms, and other vascular anomalies. Doppler ultrasound, MRI, and direct-injection venography are the most accurate diagnostic modalities. Sclerotherapy can successfully treat this condition. The procedure should be monitored with an imaging modality, preferably direct-injection venography with digital subtraction serial imaging.