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Purpose: Venous malformation (VM) has variable presentations. This study stratifies VM by its topographic distribution, types of tissues involved, proportion of affected patients undergoing active treatment and the types of treatment(s) administered within a closed population. Methods: Consecutive VM patients were identified from the prospectively maintained vascular anomalies database 1996–2015 at our national Vascular Anomalies Centre. Demographic data of the patients and the characteristics of their VM were obtained from the database and supplemented by review of medical records. Results: Among 1907 vascular anomalies patients, 316 (16.6%) had VM including 191 females and 125 males, aged 2–93 (mean, 34) years. Twelve (3.8%) patients had multiple VMs with four (1.3%) patients having a family history of VM. The lesion(s) was located in the head and neck (n = 152), lower limb (n = 80), upper limb (n = 61), trunk (n = 13), lower limb girdle (n = 11), perineal (n = 10), upper limb girdle (n = 6) and pelvic (n = 1) regions. Two anatomic sites were affected in 10 patients, and 3 sites in 6 patients. The lesion(s) affected the cutaneous/subcutaneous tissue (n = 211), muscle (n = 103), mucosa (n = 79), orbit (n = 14), parotid gland (n = 11), joint (n = 6), bone (n = 5), and intracranial vessels (n = 3). The management included observation (n = 133), surgery (n = 101), ethanol sclerotherapy (ES, n = 79) and low-dose aspirin (n = 32). Fifteen patients received both surgery and ES. Conclusions: VM affects different anatomic regions and tissues. Management of VM should be individualised for each patient who may require more than one treatment modality.

BackgroundTo review our management of common venous malformation (VM) affecting the orbit and/or periorbital area.MethodsConsecutive patients with orbital and/or periorbital VM were identified from our vascular anomalies database. Demographic details of the patients, anatomic site(s) affected, symptoms and signs, presence of a family history of VM, and types of treatment(s) were collected, supplemented by chart review.ResultsA total of 24 patients’ age 1–68 (mean, 30) years with orbital and/or periorbital VM presented with cosmetic concerns (n = 17, 71%), distensibility (n = 15, 63%), pain (n = 9, 38%), diplopia (n = 4, 17%), and spontaneous thrombosis (n = 1, 8%). The VM caused globe dystopia (n = 13, 54%), enophthalmos (n = 6, 25%), proptosis (n = 3, 12%), exotropia (n = 3, 12%), and pseudoptosis with visual obstruction (n = 3, 13%). A total of 11 (46%) patients were managed conservatively. 13 (54%) patients underwent active treatment. Ethanol sclerotherapy (ES) was performed in six patients with extensive facial VM associated with orbital/periorbital involvement, resulting in symptomatic improvement in five patients, one of whom developed skin necrosis and another patient developed reduced infraorbital nerve sensation. Surgery was performed for localized lesion (n = 3, 23%), for extensive lesions (n = 4, 31%) and as an adjunct to ES (n = 6, 46%) resulting in symptomatic improvement in all patients. One patient required correction of lower lid ectropion.ConclusionOrbital and/or periorbital VMs are heterogeneous, and management needs to be individualized. Surgery is used for localized lesions aiming for complete excision, as a debulking procedure for extensive orbital/periorbital VM when ES was not possible, or following ES for extensive facial VM with orbital and/or periorbital involvement.