Venous Malformations in Pediatric Patients: Clinical Manifestations, Diagnostic Methods, and Treatment Strategies

Introduction: Venous malformations (VMs) are a prevalent type of congenital vascular disorder, affecting nearly 1% of the population. These low-flow vascular anomalies often lead to chronic swelling, pain, and mobility challenges, often interfering with a child's daily life. Their development is mostly caused by genetic abnormalities in the TIE2/TEK and PIK3CA pathways, which cause poor venous remodeling and vascular proliferation. This study aims to assess the clinical manifestations, diagnostic methods, and therapeutic alternatives for pediatric venous malformations, emphasizing the effectiveness of different treatment modalities. Recognizing clinical presentations and understanding treatment outcomes are essential for improving early diagnosis and optimizing patient-centered care strategies. Materials and methods: Between 2019 and 2023, the Clinic for Pediatric Surgery in Skopje treated 38 pediatric patients with venous abnormalities. Patient demographics, lesion characteristics, and treatment options (including conservative management, sclerotherapy, and surgical intervention) were examined. Results: The majority of patients (39.5%) received conservative treatment, whereas 23.7% underwent sclerotherapy and 34.2% needed surgical intervention. Sclerotherapy results were evaluated according to lesion size. Treatment was effective for smaller lesions (<5 cm), while bigger or recurring cases required multiple treatment sessions. Conclusion: The results highlight the importance of early identification and individualized treatment strategies for pediatric venous malformations. Sclerotherapy is the primary therapeutic option for minor to moderate lesions, whereas surgical intervention is designated for symptomatic or refractory patients. A multidisciplinary approach is crucial for enhancing patient outcomes, and future research should focus on the advancement of minimally invasive therapeutic techniques and the exploration of targeted genetic medicines.