Prevalence of deep venous anomalies in congenital vascular malformations of venous predominance

Purpose: The overall incidence of congenital vascular malformations in the general population is 1.5%. Approximately two thirds of them are malformati ons of venous predominance Abnormalities of the deep venous trunks have bee n observed in association with large superficial compensatory varices in th ese type of malformations. Knowledge of the integrity of the deep venous sy stem is important in their management because excision of the enlarged supe rficial veins may be deleterious if there is aplasia or hypoplasia of the d eep venous trunks. The objective was to investigate the prevalence and natu re of deep venous anomalies that occur in patients with congenital vascular malformations of venous predominance both in our series and in the series from the medical literature. Methods: From the last 35 years of medical literature, we reviewed seven se ries of congenital vascular malformations that provided pertinent informati on an the subject of our study. We also reviewed our own series of 392 pati ents with congenital vascular malformations studied at Children's Hospital of Mexico City (1963-1983; n = 223 children) and at Walter Reed A-my and Na tional Naval Medical Centers (1984-1998; n = 169 children). Of 392 patients , 257 (65.5%) had malformations of venous predominance; these were the subj ect of our analysis. Prevalence of the following deep venous anomalies was recorded: phlebectasia, aplasia or hypoplasia of venous trunks, aneurysms, and avalvulia, Diagnosis was made by one or more of the following methods: Doppler scanning, duplex scanning, plethysmography; computerized tomography , magnetic resonance imaging, and angiography. Results: At least one anomaly of the deep venous system was present in 47% of the congenital vascular malformations of venous predominance reviewed. P hlebectasia was recorded in 36% of the cases, and aplasia or hypoplasia of deep venous trunks was observed in 8% of the cases. Venous aneurysms also w ere present in 8% of the cases; avalvulia was recorded in 7% of the cases. Conclusion: Anomalies of the deep venous system occur in almost one half of congenital vascular malformations of venous predominance. The most common is the relatively innocuous phlebectasias that occur in over one third of c ases. Aplasia/hypoplasia, venous aneurysms, and avalvulia were less frequen t, each less than 10%; but: failure to detect the latter three anomalies ma y lead to serious therapeutic errors.