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Video

Voiceover:
41-year-old Sarah met Dr Dawn, embarrassed by the painful marking on her thighs.

Dr Dawn:
It’s an abnormality of the blood vessels, almost like a great network of varicose veins on the buttock and the thigh.

Voiceover:
She was referred to Dr Peter Rowlands, a consultant interventional radiologist at the Royal Liverpool NHS Hospital.

Dr Rowlands:
So these lumps here, do they become tender?

Sarah:
Yeah. Yeah, they’re sore.

Dr Rowlands:
And do they get hard?

Sarah:
Sometimes, yeah. When it gets really hot, they get harder, almost.

Dr Rowlands:
Yeah.

Sarah:
And it almost goes quite solid.

Dr Rowlands:
So what that is, is, is that you get little clots in those. I mean, there are some veins here, and you get little clots forming in those, and you get little areas of the, um, the skin that clot, and that’s what gets really really painful.

Voiceover:
Before Dr Rowlands can decide on treatment, he needs to investigate how deep the birthmark malformation goes. He uses ultrasound to check the outer layer of the malformation.

Dr Rowlands:
This is an ultrasound scanner, and the top centimetre or so is skin, and then this area here is subcutaneous fat, and then below the subcutaneous fat is the muscle. And the veins in your situation are in the skin, and at the junction of the skin and the subcutaneous fat. Now, that’s actually good news for you, because if it’s localised to those areas, it usually responds better than if it is deep or it’s involving the muscle. So, you’ve got, you know, a favourable version of it, really.

Voiceover:
And also an MRI to check how deep it goes.

Dr Rowlands:
Another five or six minutes yet, Sarah, so as long as you’re comfortable, we’ll carry on.

Dr Rowlands:
On this right-hand screen here, anything that’s white on this scan is a blood vessel. So, this is your buttock, it’s very extensive there, it goes right round from your side, most of the problems you’re having are from the ones in the skin here.

Voiceover:
The MRI scan confirms Dr Rowlands’ diagnosis that she has a venous malformation. A venous malformation is a rare type of birthmark. It grows with age and causes pain in the affected areas. It can be successfully treated with sclerotherapy, a treatment where chemicals are injected into the veins to close them off. Once the scans are complete, he can begin the sclerotherapy treatment. To see the veins clearly, he injects a contrast dye into the large bumps, which under X-ray reveal a spider web of veins. The next step is to use a sclerosant to kill the veins.

Dr Rowlands:
The sclerosant is a detergent, and it causes blood to clot within the, um, within the vein, and it also causes a kind of chemical damage to the vein, so the vein, having clotted, then doesn’t come back. So I fill the syringe over there, I fill this syringe over there, and then I’m going to agitate this backwards and forwards, and you can see now it’s forming a detergent foam in the syringes. And that’s what the foam’s like as it injects, just like shaving foam, really.

Dr Rowlands:
You may feel a bit of stinging here, or you may feel nothing much at all. Again, these are very tiny needles that I used for the procedure. Okay, you’ll feel another scratch now. And you see that in the right place, you get blood coming back down the, down the line there, so we know it’s, it’s within the right place. And we can see this is a much bigger area. When I’ve injected the dye there, it’s filled an area that’s probably the size of the palm of my hand, because all of the veins are interconnected here. That means that I don’t have to make multiple injections, so that’s very good for, uh, for the procedure.

Voiceover:
Dr Rowlands also injects the larger area with the sclerosant.

Dr Rowlands:
Having done that, I now just can take the needles out, put gentle pressure on there because I don’t want to squeeze the foam out of the veins, and that’s the procedure done.

Voiceover:
After two injections, the first treatment is over.

Sarah:
Yeah, it was painful. It was painful, it’s still throbbing and burning now, but um, he’s assured me that that will only last a few days, and then hopefully it should start to get better from then on.

Voiceover:
Sarah will need one to two further treatments, and there’s a good chance the pain will disappear. The darker marks should also fade, but this will take time.

Read the video transcript

Sarah was next into the clinic to see Dr Dawn about an embarrassing birthmark on her leg. Having doubled in size over ten years and causing her considerable pain, Dr Dawn was baffled by Sarah’s symptoms until she was able to examine the birthmark herself and diagnosed a vascular abnormality of the blood vessels which explained the pain Sarah had been experiencing. Dr Dawn referred her to Dr Peter Rollins who conducted various scans to see how deep the condition went and firmly diagnosed a venous malformation. Treatment consisted of two injections of a detergent into the veins which made up the birthmark.

Patient Name: Sarah Wilkins
Condition: Venous Malformation
Specialist: Dr Peter Rowlands, Consultant Interventional Radiologist
Hospital: NHS, Royal Liverpool Hospital
Length of procedure: Approx 20 minutes

“Watch 12 year old Michael find a treatment for his sebaceous naevus birthmark on Embarrassing Bodies: Kids website.:^http://embarrassingbodieskids.channel4.com/video/clinic-consultations/clinic-consultation-birthmark/

For more information about birthmarks, read our guide for parents on Embarrassing Bodies: Kids website.

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I was also born with a venous malformation that affects one side of my face, when i was younger it hurt so as a result i went to John Radcliffe Hospital, Oxford and got a sclerosant injection. It has taken away the pain but when I get stressed, tired, take part in sports or experience change in hormones it gets more aggravated and sometimes painful again. I am reluctant to repeat the sclerosis because it was a traumatic time if I'm honest as it was on my face and was very noticeable. Since I have noticed that any form of hormonal change affects it quite a bit, I'm now starting to consider anything that can possibly help or prevent the pain as I'm considering things I want to do in the future and pregnancy. If anyone could recommend a specialist or a second opinion please let me know.





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hi i have an artrovenous malformation in my right buttock,i had the same thing 9yrs ago and had it removed by surgery now it has come back but a lot worse than before with serve pan in my leg , they tell me that i might have to have radiothearpy but im alittle concerned on that and what affect if any it will have as i am wantin children





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i have the same problem on my face on my chin is all down side of my neck and my ear, i hate going out into public to people what they think, Im having treatment at queens elizabeth hospital and after the treatment it seems to be getting worse..





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i was born with a venous malformation in my whole left leg form foot 2 hip up untill the show i had never seen any1 other than myself with this condition i have been in and out of hospital my whole life i am in sever pain constantly i have had a few treaments of what dr p rowlands had giving sarah but i don't think it helped me in anyway.Is there any1 else who has the same condition as me and was born with it like me?





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I was amazed to see someone else with this as my daughter has been troublesd with this since that age of two, her dad and most of his siblings have at least one spot but my daughter got more than her share , her arm is now so unsightly with huge blue lumps and very painful especialy in hot weather. All she has been offered is surgery with skin grafts taken from her hip but as her legs are the only areas not affected she does not want to spoil the only normal part of her body.

My 6 year old daughter has been diagnosed with this condition - it is predominantley on the back of her leg & vulva - at present it isn't causing her any pain - is this something i should be looking out for

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