Multidisciplinary Surgical Management of a Complex Thoracic Venous Malformation

Objective:Venous malformations are congenital low-flow vascular anomalies that may present significant therapeutic challenges when associated with extensive anatomical spread. This study presents the multidisciplinary surgical management of a complex thoracic venous malformation extending from the scapular region to the breast with pleural and retrosternal involvement following failed sclerotherapy.Materials and Methods:A 30-year-old female patient presented with a congenital left thoracic wall mass that progressively enlarged over time. The patient had previously undergone three unsuccessful sessions of sclerotherapy. Magnetic resonance imaging demonstrated a multicompartment vascular lesion involving the latissimus dorsi, serratus anterior, pectoralis major and minor muscles, with extension toward the retrosternal region. The lesion showed close association with the internal thoracic and thoracodorsal vascular structures. Surgical excision was performed through a multidisciplinary approach involving plastic and thoracic surgery teams.Results:Intraoperatively, the lesion was found to extend to the visceral pleura and pericardial surface. Thoracic access and pleural dissection were performed with the assistance of the thoracic surgery team to ensure safe resection. Complete excision was achieved after meticulous vascular control and dissection. No postoperative complications or recurrence were observed during follow-up.Conclusion:Multidisciplinary surgical management may represent a safe and effective treatment option in complex thoracic venous malformations with extensive anatomical involvement and resistance to sclerotherapy. Detailed preoperative imaging and careful surgical planning are essential for successful outcomes.Keywords: Venous malformation, thoracic wall, multidisciplinary surgery, sclerotherapy, vascular anomaly