D-dimer level correlation with treatment response in children with venous malformations

Area of Science:

• Vascular Surgery
• Pediatric Surgery
• Interventional Radiology

Background:

• Localized intravascular coagulopathy is a known complication in children with venous malformations (VMs).
• Elevated D-dimer levels are indicative of coagulopathy, but their changes following sclerotherapy and correlation with outcomes are not well-studied.

Purpose of the Study:

• To investigate the changes in D-dimer levels in children with VMs undergoing alcohol sclerotherapy.
• To correlate D-dimer level changes with treatment outcomes and complications.

Main Methods:

• Prospective cohort study of children (<18 years) with VMs treated with alcohol sclerotherapy from 2014-2016.
• Perioperative D-dimer levels were measured at baseline and on postoperative days 1, 2, 5, and 14.
• Treatment outcome was assessed by lesional size at 6 months and long-term recurrence.

Main Results:

• Eighteen children (10 female, 8 male) were included with a median follow-up of 21 months.
• 15 patients (83%) had a satisfactory outcome; 8 patients (44%) had high baseline D-dimer.
• Postoperative D-dimer elevation occurred in 12 patients, peaking on day 1 in 92%. Elevated D-dimer correlated with satisfactory outcomes and no long-term recurrence. No complications were observed.

Conclusions:

• Perioperative D-dimer level changes may predict early treatment response and long-term recurrence in children with VMs after alcohol sclerotherapy.
• Alcohol sclerotherapy, when performed with a standardized protocol, is a safe and effective treatment for VMs in children, associated with minimal complications.