D‐Dimer as a Biomarker for Painful Non‐Extremity Venous Malformations: A Retrospective Analysis of 68 Surgical Patients

Venous malformations are the most common type of congenital vascular malformations, with an estimated prevalence of 1% in the general population. Pain is one of the most significant clinical manifestations of venous malformations, with more than 50% of patients reporting discomfort, although the underlying pathophysiology remains incompletely understood. Coagulation abnormalities, particularly localized intravascular coagulopathy, have been documented in patients with venous malformations, with elevated D-dimer levels reported in approximately 42%-58% of venous malformation patients. This single-center retrospective cohort study included 68 patients with venous malformations who underwent surgical resection between April 2022 and December 2024. Demographic data and preoperative coagulation parameters, including prothrombin time, activated partial thromboplastin time, D-dimer level, and fibrinogen level, were collected and analyzed. The most common locations of venous malformations were in the head and neck (47.1%) and extremities (44.1%), and 55.9% of participants reported pain. Pain prevalence was significantly higher in extremity venous malformations (76.5%) compared to non-extremity venous malformations (35.3%) (p < 0.001). In non-extremity venous malformations, D-dimer levels were significantly elevated in the pain-positive group compared to the pain-negative group (3.25 ± 4.04 μg/mL vs. 0.63 ± 0.27 μg/mL, p = 0.046), whereas no such correlation was observed in extremity venous malformations or other coagulation parameters. These findings suggest that pain mechanisms differ depending on the anatomical location of the venous malformations. Localized intravascular coagulopathy may play a more significant role in pain generation in non-extremity lesions, while mechanical factors may predominate in extremity lesions. Preoperative D-dimer levels may serve as a biomarker for symptomatic non-extremity venous malformations to guide perioperative management. Further prospective studies with larger sample sizes and comprehensive coagulation profiling are warranted to verify these observations and elucidate the mechanisms underlying the relationship between coagulopathy and pain at different anatomical locations.