Classification of lower extremity venous malformations and risk of knee involvement: A retrospective cohort study - 28/02/21

Doi : 10.1016/j.jaad.2020.12.054

Krystal M. Jones, MD ^a, Kristen C. Corey, MD ^a, Anna Cristina Garza-Mayers, MD, PhD ^a, Samantha A. Spencer, MD ^b, John B. Mulliken, MD ^c, Rush H. Chewning, MD ^d, Marilyn G. Liang, MD ^a,^⁎
^a Dermatology Program, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
^b Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
^c Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
^d Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts

^∗Correspondence to: Marilyn Liang, MD, 300 Longwood Ave, Boston, MA 02115.300 Longwood AveBostonMA02115

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Abstract

Background

Venous malformation (VM) is the most common vascular anomaly in the lower extremity. VMs can be classified as focal, multifocal, or diffuse types. Intraarticular VM (IA-VM) of the knee portends morbidity. Association of the lower extremity VM type with IA-VM is not well defined.

Objective

To classify a large cohort of lower extremity, nonsyndromic VMs by type and determine associations with IA-VM.

Methods

Retrospective cohort study.

Results

We assessed 156 patients with nonsyndromic, lower extremity VM; 71 (46%) were focal and 85 (54%) were diffuse type VM, and 97 (62%) were IA-VM. Of diffuse VMs, 26 (31%) were Bockenheimer and 59 (69%) were localized subtypes. Pure VM had a significantly elevated risk of IA-VM (relative risk [RR], 2.34; 95% confidence interval [CI], 1.42-3.89). IA-VM was more common in diffuse (73%) versus focal (49%) types. Risk of IA-VM in diffuse type VM was significantly elevated (RR, 1.48; 95% CI, 1.13-1.94). One hundred percent of diffuse Bockenheimer type VM had IA-VM, and this subtype had the highest risk (RR, 1.83; 95% CI, 1.56-2.14) of IA-VM.

Limitations

Retrospective, single-institution study.

Conclusions

Intraarticular involvement of the knee should be considered in all lower extremity VMs. Pure VM and the Bockenheimer diffuse VM subtype had the highest risk of IA-VM.

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Key words : articular, Bockenheimer, intraarticular, joint, knee, vascular anomaly, vascular malformation, venous, venous malformation

Abbreviations used : BRBNS, CI, CLVM, CMVM, CVM, IA-VM, KTS, MRI, RR, VLM, VM