Management of congenital venous malformations of the vulva

OBJECTIVE: To discuss the differential diagnosis and the management of veno us malformations of the vulva. METHODS: Five symptomatic patients were treated. The degree of pain and dis comfort was self-assessed by using a horizontal visual analog scale before and after treatment. Preoperative evaluation included Doppler ultrasound sc anning in all patients and magnetic resonance imaging (AW in one. All patie nts had direct-injection venography and sclerotherapy during the same sessi on. Ethanol was used in two cases and polidocanol in three. Patients were f ollowed-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 hemo globinuria 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 exper ienced complete relief from symptoms and currently have normal vulvar sensa tion. Four patients had complete ablation of die treated lesion. In one pat ient the procedure resulted in a significant, albeit incomplete, occlusion of the lesion, and no further treatment was deemed necessary. From a cosmet ic standpoint, both patients and physicians considered the results successf ul. CONCLUSION: Vulvar venous malformations should be distinguished from vulvar varicosities, hematomas, soft-tissue neoplasms, and other vascular anomali es. Doppler ultrasound, MRI, and direct-injection venography are the most a ccurate diagnostic modalities. Sclerotherapy can successfully treat this co ndition. The procedure should be monitored with an imaging modality, prefer ably direct-injection venography with digital subtraction serial imaging. ( Obstet Gynecol 2001;98:789-93. (C) 2001 by the American College of Obstetri cians and Gynecologists).