Qualitative Assessment of the Patient-Reported Outcome Measure for Vascular Malformation (PROVAM) Questionnaire in Patients with Low-Flow Vascular Malformations: A Prospective Cohort Study

Tushar Garg; Rebecca Choi; Natalie Y Ring; Ryan W England; Anna J Gong; Clifford R Weiss

doi:10.1007/s00270-025-04217-1

Qualitative Assessment of the Patient-Reported Outcome Measure for Vascular Malformation (PROVAM) Questionnaire in Patients with Low-Flow Vascular Malformations: A Prospective Cohort Study

Cardiovasc Intervent Radiol. 2025 Dec;48(12):1861-1868. doi: 10.1007/s00270-025-04217-1. Epub 2025 Oct 15.

Authors

Tushar Garg^{1

2}, Rebecca Choi¹, Natalie Y Ring¹, Ryan W England¹, Anna J Gong¹, Clifford R Weiss³

Affiliations

¹ The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 7203 Sheikh Zayed Tower, Ste 7, 1800 Orleans St., Baltimore, MD, 21287, USA.
² Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
³ The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 7203 Sheikh Zayed Tower, Ste 7, 1800 Orleans St., Baltimore, MD, 21287, USA. cweiss@jhmi.edu.

PMID: 41094085
DOI: 10.1007/s00270-025-04217-1

Abstract

Purpose: This study analyzed factors influencing pain, bothersome symptoms, and unmet concerns in low-flow vascular malformations (LFVM) using qualitative insights from Patient-Reported Outcome Measure for Vascular Malformation (PROVAM) questionnaires.

Materials and methods: Between July 2019 and February 2022, 327 patients with LFVM at a vascular anomalies clinic completed 439 PROVAM questionnaires. The 30-item instrument includes four free-text questions on factors that affect pain, bothersome symptoms, and issues not captured elsewhere. All responses were analyzed by a directed content-analysis approach within three domains: physical (PD), emotional/social well-being (ESD), and functional (FD) regarding LFVMs in the head and neck (H&N), upper extremity (UE), lower extremity (LE), and trunk.

Results: Of 439 questionnaires, 319 (72.7%) reported factors affecting pain. Increased activity (159/319, 49.8%) and physical pressure on the LFVM (110/319, 34.5%) worsened pain. Out of 323 responses (73.6%), the most bothersome symptoms related to the PD (261/323, 80.8%), followed by ESD (52/323, 16.1%) and FD (H&N: 15/323, 4.6%; UE, LE, trunk: 46/323, 14.2%). The most common themes were pain or discomfort (192/323, 59.4%) in the PD, appearance (28/323, 8.7%) in the ESD, effect on eating/drinking (9/323, 2.8%) in the FD (H&N), and effect on walking, standing, sitting, or lying down (21/323, 6.5%) in the FD (UE, LE, trunk).

Conclusion: Qualitative analysis of PROVAM responses revealed diverse factors affecting the quality of life for LFVM patients, including symptom triggers, most bothersome symptoms, and issues not covered in the quantitative survey. These insights highlight the importance of the qualitative survey in understanding this heterogeneous disease.

Keywords: PROVAM; low-flow vascular malformation; lymphatic malformation; quality of life; vascular malformation; venous malformation.

MeSH terms

Adolescent
Adult
Female
Humans
Male
Middle Aged
Pain / etiology
Patient Reported Outcome Measures*
Prospective Studies
Quality of Life
Surveys and Questionnaires
Vascular Malformations* / complications
Vascular Malformations* / physiopathology
Vascular Malformations* / psychology
Young Adult