Skip to main content
SpringerLink
Log in

Venous malformations: what do phleboliths tell us in the pediatric population?

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

Phleboliths are often observed within Venous malformations (VM) and frequently indicated as cause of morbidity. The aim of this study is to investigate independent risk factors for phleboliths in a pediatric population and to determine if its presence influences clinical management.

Methods

We retrospectively review data from patients diagnosed with VM in a vascular anomalies center during a 5-year period. Associations between phleboliths and potential risk factors were assessed. A multivariable analysis, was performed to assess the influence of phleboliths in the need for surgery.

Results

We included 88 patients with a mean age of 10 years. Phleboliths were found in 33.0%. In univariate analysis, there were no significant differences between the two groups regarding age or gender, location, dimension or depth of the VM, pain and laboratory parameters. Multivariable analysis could not detect any independent risk factor for phleboliths. In contrast, multivariable logistic analysis revealed that when phleboliths were present, the need for surgical extirpation was more likely (p = 0.031).

Conclusions

This study showed that patients who have phleboliths within their VM seem to require surgery more frequently. This constitutes an entirely innovative thought that could raise awareness to a lower threshold for surgery in this group of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

BMI:

Body mass index

BSA:

Body surface area

DVT:

Deep vein thrombosis

ISSVA:

International society for the study of vascular anomalies

IQR:

Interquartile ranges

LIC:

Localized intravascular coagulopathy

MRI:

Magnetic resonance imaging

NLR:

Neutrophil-to-lymphocyte ratio

SD:

Standard deviation

VM:

Venous malformations

References

  1. ISSVA classification for vascular anomalies. ISSVA. 2018:Available from: https://www.issva.org/UserFiles/file/ISSVA-Classification-2018.pdf

  2. Cooke-Barber J, Kreimer S, Patel M, Dasgupta R, Jeng M (2020) Venous malformations. Semin Pediatr Surg 29(5):150976

    Article  Google Scholar 

  3. Dompmartin A, Acher A, Thibon P, Tourbach S, Hermans C, Deneys V et al (2008) Association of localized intravascular coagulopathy with venous malformations. Arch Dermatol 144(7):873–877

    Article  Google Scholar 

  4. Hu L, Chen H, Yang X, Wang Y, Gu H, Liu M et al (2019) Risk factors associated with pain in patients with venous malformations of the extremities. Vasc Med 24(1):56–62

    Article  Google Scholar 

  5. Ernemann U, Kramer U, Miller S, Bisdas S, Rebmann H, Breuninger H et al (2010) Current concepts in the classification, diagnosis and treatment of vascular anomalies. Eur J Radiol 75(1):2–11

    Article  Google Scholar 

  6. Hammer S, Zeman F, Fellner C, Wohlgemuth WA, Uller W (2018) Venous malformations: phleboliths correlate with the presence of arteriovenous microshunts. AJR Am J Roentgenol 211(6):1390–1396

    Article  Google Scholar 

  7. Mendonca DA, McCafferty I, Nishikawa H, Lester R (2010) Venous malformations of the limbs: the Birmingham experience, comparisons and classification in children. J Plast Reconstr Aesthet Surg 63(3):383–389

    Article  Google Scholar 

  8. Ricci KW, Brandao LR (2020) Coagulation issues in vascular anomalies. Semin Pediatr Surg 29(5):150966

    Article  Google Scholar 

  9. Hung JW, Leung MW, Liu CS, Fung DH, Poon WL, Yam FS et al (2017) Venous malformation and localized intravascular coagulopathy in children. Eur J Pediatr Surg 27(2):181–184

    PubMed  Google Scholar 

  10. Eivazi B, Fasunla AJ, Guldner C, Masberg P, Werner JA, Teymoortash A (2013) Phleboliths from venous malformations of the head and neck. Phlebology 28(2):86–92

    Article  CAS  Google Scholar 

  11. Wieck MM, Nowicki D, Schall KA, Zeinati C, Howell LK, Anselmo DM (2017) Management of pediatric intramuscular venous malformations. J Pediatr Surg 52(4):598–601

    Article  Google Scholar 

  12. Aronniemi J, Castren E, Lappalainen K, Vuola P, Salminen P, Pitkaranta A et al (2016) Sclerotherapy complications of peripheral venous malformations. Phlebology 31(10):712–722

    Article  Google Scholar 

  13. Ierardi AM, Mangini M, Vaghi M, Cazzulani A, Carrafiello G, Mattassi R (2010) Sclerotherapy of peripheral venous malformations: a new technique to prevent serious complications. Vasc Endovascular Surg 44(4):282–288

    Article  Google Scholar 

  14. Leung YC, Leung MW, Yam SD, Hung JW, Liu CS, Chung LY et al (2018) D-dimer level correlation with treatment response in children with venous malformations. J Pediatr Surg 53(2):289–292

    Article  Google Scholar 

  15. Delgado-Miguel C, Munoz-Serrano AJ, Barrena Delfa S, Nunez Cerezo V, Estefania K, Velayos M et al (2019) Neutrophil-to-lymphocyte ratio as a predictor of peritonitis in acute appendicitis in children. Cir Pediatr 32(4):185–189

    CAS  PubMed  Google Scholar 

  16. Acarturk G, Acay A, Demir K, Ulu MS, Ahsen A, Yuksel S (2015) Neutrophil-to-lymphocyte ratio in inflammatory bowel disease—as a new predictor of disease severity. Bratisl Lek Listy 116(4):213–217

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to express their deep gratitude to Hospital Universitario La Paz for their support to this study and to all of the patients, for their contribution to this investigation. They also thank to the language editor José Pedro Lopes for his critical reading.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Paediatric Surgery, Paediatric Hospital, Centro Hospitalar E Universitário de Coimbra, R. Dr. Afonso Romão, 3000-602, Coimbra, Portugal

    Inês Pessanha

  2. Department of Pediatric Surgery, Hospital Universitario la Paz, Madrid, Spain

    Carlos Delgado-Miguel

  3. Department of Biomedicine, Unit of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal

    Hélio Alves

  4. Department of Plastic Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain

    Paloma Triana & Juan Carlos Lopéz-Gutierrez

Authors
  1. Inês Pessanha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlos Delgado-Miguel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hélio Alves
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paloma Triana
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juan Carlos Lopéz-Gutierrez
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design: IP, JCLG Data acquisition: IP, CDM Analysis and data interpretation: IP, HA, CDM, PT, JCLG Drafting of the manuscript: IP Critical revision: IP, HA, CDM, PT, JCLG.

Corresponding author

Correspondence to Inês Pessanha.

Ethics declarations

Conflict of interest

All of the authors declare that they have no conflicts of interest or financial ties to disclose

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pessanha, I., Delgado-Miguel, C., Alves, H. et al. Venous malformations: what do phleboliths tell us in the pediatric population?. Pediatr Surg Int 38, 1501–1506 (2022). https://doi.org/10.1007/s00383-022-05181-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-022-05181-4

Keywords

Search

Navigation