Congenital Vascular Anomalies/Sclerotherapy
What are congenital vascular anomalies?
The congenital vascular anomalies can essentially be divided into two groups: tumors and malformations. Tumors are characterized by cellular growth and these lesions can grow at a rapid pace. The malformations however do not grow, per se, but grow in conjunction with the growth of the child.
- Hemangiomas are the most common benign tumor of infancy and occur in up to 4% and 10% of Caucasian infants and are 3-5 times more common in females.
- The majority of hemangiomas occur in the head and neck area. Less than 25% occur in the trunk and 15% occur in the arm or legs. Hemangiomas while most commonly grow on the skin, can grow on any internal organ such as the liver, gastrointestinal tract, lung and even the brain.
- Hemangiomas are usually first noticed shortly after birth. Rarely, they can be present at birth.
- Hemangiomas have a classic rapid period of growth (proliferative phase) followed by a period of regression (involution phase). Large hemangiomas and hemangiomas that have not regressed should be treated
What do hemangiomas look like?
Hemangiomas vary from small raised reddish lesions to large firm masses.
Common types of Malformations:
- Lymphatic Malformation
- Venous Vascular Malformations
- Arteriovenous Malformations
Vascular malformations are benign lesions of the lymphatics, arteries and veins. All vascular malformations are present at birth although they may not be visible. Vascular malformations, unlike hemangiomas, do not have a rapid period of growth but grow slowly throughout life, growing in conjunction with the growth of the child. The most common types of vascular malformations are:
- Capillary malformations or port wine stains.
- Venous malformations: these are soft bluish lesions that are commonly seen on the lips, tongue and cheek.
- Lymphatic malformations: these are a collection of abnormal channels and cystic spaces that contain clear fluid. They are also known as “cystic hygromas”
- Arteriovenous malformations are abnormal connections between arteries and veins resulting in high flow pulsating masses.
How are hemangiomas and vascular malformations different?
All vascular malformations are present at birth while most hemangiomas appear shortly after birth. Hemangiomas have a period of rapid growth (over months) and then regress (over years), while vascular malformations grow slowly and never disappear. Vascular malformations can experience periods of rapid growth during times of infection and hormonal change (puberty and pregnancy).
How are Hemangiomas and vascular anomalies treated?
The majority of small hemangiomas disappear on their own; most small hemangiomas can be treated conservatively, that is with careful observation.
Large hemangiomas or hemangiomas in cosmetically sensitive locations that are disfiguring or those that hinder important functions such as vision or breathing should be evaluated by a vascular anomalies specialist. Treatment may consist of medical therapy with propranolol, surgery, embolization or sclerotherapy.
Treatment of the vascular anomalies depends on the type. Laser therapy can be used to treat capillary malformations. Arteriovenous malformations are treated with embolization while lymphatic malformations and venous malformations can be treated with sclerotherapy.
What is sclerotherapy?
Sclerotherapy is a minimally invasive, image guided treatment used to treat certain types of vascular anomalies. It involves injecting a special material, called a sclerosant, directly into a vascular anomaly in order to bring about scarring
Who treats hemangiomas and congenital vascular anomalies?
Hemangiomas are can be treated by pediatricians, pediatric ENT, dermatologists, plastic surgery and radiology. A collaborative group of physicians within MUSC work together to treat these patients.