Abstract
Anomalies affecting the capillary and venous channels form the bulk of the spectrum of vascular anomalies. As per International Society for the Study of Vascular Anomalies (ISSVA) classification, these are referred to as hemangiomas and venous malformations respectively. The present article is a descriptive note of their management and outcomes. Retrospective records of patients over 17 y (January 2000 through December 2016) were reviewed for presentation, management and outcomes. Outcomes were graded into 3 subgroups based on subjective assessment of clinical images: Group A = near-total response (>90%); Group B = 50–90% and Group C = <50% reduction. Among 90 cases of hemangioma, majority were located in head and neck (86.7%). Outcomes recorded in children who received steroids (n = 36) were: Group A = 61.1%, B = 25% and C = 13.9%; steroids and beta-blockers (n = 8): Group A = 62.5%, B = 25% and C = 12.5%; only beta-blockers (n = 4): Group A = 75% and B = 25%; intralesional sclerotherapy (n = 32): Group A = 55.2% and B = 44.8%; steroids followed by sclerotherapy (n = 7): Group A = 28.6% and B = 71.4%; excision (n = 3): Group A = 100%. Among 171 cases of venous malformation, majority were located in head and neck (49.6%). Outcomes recorded in children who received sclerotherapy (n = 165) were Group A = 20.7%, B = 51% and C = 28.3%; steroids (n = 3): Group A = 100%; beta-blockers (n = 1): Group C = 100%; excision (n = 2): Group A = 100%. Better outcome was noted in smaller-sized lesions and those who required lesser volume of sodium tetradecyl sulfate (STS) injection. Thus, to conclude, the decision regarding the choice and timing of each therapeutic modality should be individualized based on location, size and type of the lesion. The goal of management in these lesions should be to improve the quality of life rather than elimination of the lesion.
Similar content being viewed by others
References
Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg. 1982;69:412–22.
Dasgupta R, Fishman SJ. ISSVA classification. Semin Pediatr Surg. 2014;23:158–61.
Chang LC, Haggstrom AN, Drolet BA, et al; Hemangioma Investigator Group. Growth characteristics of infantile hemangiomas: implications for management. Pediatrics. 2008;122:360–7.
Sasaki GH, Pang CY, Wittliff JL. Pathogenesis and treatment of infant skin strawberry hemangiomas: clinical and in vitro studies of hormonal effects. Plast Reconstr Surg. 1984;73:359–70.
Léauté-Labrèze C. Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taïeb A. Propranolol for severe hemangiomas of infancy. N Engl J Med. 2008;358:2649–51.
Love JN, Sikka N. Are 1-2 tablets dangerous? Beta-blocker exposure in toddlers. J Emerg Med. 2004;26:309–14.
Zimmermann AP, Wiegand S, Werner JA, Eivazi B. Propranolol therapy for infantile haemangiomas: review of the literature. Int J Pediatr Otorhinolaryngol. 2010;74:338–42.
Price CJ, Lattouf C, Baum B, et al. Propranolol vs corticosteroids for infantile hemangiomas: a multicenter retrospective analysis. Arch Dermatol. 2011;147:1371–6.
Talaat AA, Elbasiouny MS, Elgendy DS, Elwakil TF. Propranolol treatment of infantile hemangioma: clinical and radiologic evaluations. J Pediatr Surg. 2012;47:707–14.
Lou Y, Peng WJ, Cao Y, Cao DS, Xie J, Li HH. The effectiveness of propranolol in treating infantile haemangiomas: a meta-analysis including 35 studies. Br J Clin Pharmacol. 2014;78:44–57.
Mulliken JB, Fishman SJ, Burrows PE. Vascular anomalies. Curr Probl Surg. 2000;37:517–84.
Bennett ML, Fleischer AB Jr, Chamlin SL, Frieden IJ. Oral corticosteroid use is effective for cutaneous hemangiomas: an evidence-based evaluation. Arch Dermatol. 2001;137:1208–13.
Malik MA, Menon P, Rao KL, Samujh R. Effect of propranolol vs prednisolone vs propranolol with prednisolone in the management of infantile hemangioma: a randomized controlled study. J Pediatr Surg. 2013;48:2453–9.
Brouillard P, Vikkula M. Genetic causes of vascular malformations. Hum Mol Genet. 2007;16:R140–9.
Burrows PE, Mason KP. Percutaneous treatment of low flow vascular malformations. J Vasc Interv Radiol. 2004;15:431–45.
Qiu Y, Chen H, Lin X, Hu X, Jin Y, Ma G. Outcomes and complications of sclerotherapy for venous malformations. Vasc Endovasc Surg. 2013;47:454–61.
Acknowledgements
The authors would like to acknowledge the contribution of each and every patient whose data was included for this article.
Contributions
AG: Acquisition of data and drafting of manuscript; AV: Acquisition of data; AD: Analysis of data and critical revision; VB: Study conception, design and critical revision. VB will act as guarantor for the paper.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
None.
Source of Funding
None.
Rights and permissions
About this article
Cite this article
Gupta, A., Verma, A., Dhua, A. et al. Vascular Anomalies: A Pediatric Surgeon’s Perspective. Indian J Pediatr 84, 612–617 (2017). https://doi.org/10.1007/s12098-017-2355-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-017-2355-8