Vascular anomalies are characterized by abnormal overgrowth of cells or tissues that make up the peripheral vascular (blood vessels) system. There are two main types of vascular anomalies: hemangiomas and vascular malformations.
While hemangiomas don’t always need to be treated, vascular malformations do. Treatment of complicated lymphatic, arterial and venous malformations typically requires an interdisciplinary approach, including dermatologists, radiologists, interventional radiologists and surgeons.
Wake Forest Baptist Health brings together a team of specialists to treat all types of vascular anomalies.
A hemangioma is a benign overgrowth of endothelial cells, which are the cells which make the lining of blood vessels. Hemangiomas can occur within organs, but most commonly occur on or just beneath the skin. They can be found anywhere on the body, although 70 percent occur within the head and neck region. When occurring on or under the skin, they typically have a crimson red color and may have a dimpled surface, resembling a strawberry.
Hemangiomas most commonly appear just after birth, and grow rapidly in the ensuing months until around one year of age. After that, they gradually become smaller and fade, a process known as “involution.” By age 10 they are typically completely involuted, however they may leave a slightly irregular appearance of the skin.
Because they normally involute without causing problems, surgery or medical therapy to treat them isn’t always necessary.
There are two main reasons to treat hemangiomas at a young age. They can ulcerate and bleed, or they become infected. Hemangiomas which are rapidly growing, superficially located within the skin, or are located on prominent areas or pressure points are more likely to bleed. Treatment may also be necessary if the hemangioma interferes with important functions. This can include:
- Hemangiomas near the eyes which may obscure the vision
- Hemangiomas in the mouth, nose or throat that may interfere with breathing or eating
- Multiple hemangiomas, which put pressure on the heart due to increased cardiac output
Treatment of hemangiomas historically included the use of long-term steroids. However, due to negative side effects, this is generally no longer recommended. More recently, propranolol, a common blood pressure drug, has been found to be effective in stopping the growth or causing regression of growing hemangiomas in many patients. We commonly refer families to our colleagues in pediatric hematology/oncology to discuss whether this medicine will be appropriate for their child.
For patients whose hemangiomas don’t respond to propranolol, or that are problematic due to the structural concerns listed above, we offer surgery. Surgery may include:
- Simple excision and closure with sutures
- Laser therapy, which may require multiple sessions
- A combination of the two
Our pediatric plastic surgeons provide individualized recommendations for each child.
Vascular malformations, unlike hemangiomas, are present at birth and do not have phases of independent growth or involution. Rather, they grow in proportion to a child. They are classified according to the dominant vessel-type they contain.
The main vascular malformations are:
- Capillary malformations: Also known as port wine stains (PWS). These are benign areas of skin discoloration which contain dilated capillaries within deep layers of the skin. These sometimes grow darker and may become more uneven in adulthood. Laser therapy is the accepted way to treat PWS, but it typically requires many treatments.
- Lymphatic malformations: These malformations involve the lymph system, which normally helps drain fluid from the periphery of the body. Lymphatic malformations have a wide range of severity, from small blister-like marks on the skin, to large and sometimes disfiguring swelling of the limbs, face or neck. Treatment varies upon severity, but may include sclerotherapy (direct injection into the swelling) and/or surgery.
- Arteriovenous malformations: Also known as AVMs, and caused by an overgrowth of veins, arteries or both. These are rare, and may be associated with pulsatile swelling of the extremities or head and neck area. Enlargement of AVMs may be triggered by trauma or puberty. Treatment is highly variable based upon their location and involvement of deeper structures, but generally includes embolization (performed by an interventional radiologist to clog the affected vessels) and surgery.