The term vascular anomalies is a general term used to describe a group of malformations involving blood vessels and/or lymphatic channels. A vascular anomaly occurs when a group of blood vessels and/or lymphatic channels grow in an abnormal manner, usually resulting in a mass or visible abnormality of the skin or soft tissues. These are almost always benign, non-cancerous growths.
Types of vascular anomalies and nonmenclature:
Abnormal growth can occur in four basic types of tissue: capillaries, veins, arteries, and lymphatics. Most vascular anomalies consist of one of these tissue groups, but any combination of these four groups can be affected. The most common vascular malformations are capillary hemangiomas, venous malformations, arterio-venous malformations, and lymphatic malformations. However, other combinations such as capillary-lymphatic, veno-lymphatic, or capillary-veno-lymphatic malformations can also occur.
Hemangiomas are benign growths of capillary vessels that typically present as red, smooth or raised skin lesions. They can occur anywhere in the body.
The natural history of hemangiomas is that they usually continue to increase in size until 9 to 12 months of age, when they reach their peak. They will then spontaneously regress over the next 5 to 8 years and eventually will completely involute on their own without surgery. If hemangiomas do not go away on their own, they might require treatment with medication, laser ablation, or surgery.
Venous malformations are abnormal collections of veins that typically present as soft-tissue masses. Patients might or might not have symptoms of discomfort. Ultrasound and MRI can usually make the diagnosis non-invasively. However, if the diagnosis is unclear, an angiogram or biopsy of the mass might be necessary. Once the diagnosis is established, treatment is based on symptoms and location. Most venous malformations can be treated by percutaneous injection therapy, which helps obliterate blood flow through the abnormal venous blood vessels. Some might require surgical removal.
Arterio-venous or “AV” malformations are abnormal communications between groups of arteries and veins, usually presenting as soft-tissue masses. They typically require treatment with emolization techniques in which catheters are placed into the malformation, and material is injected into the blood vessels to decrease or eliminate blood flow through the malformation.
Commonly referred to as “cystic hygromas,” lymphatic malformations are collections of abnormally large lymphatic channels that usually present as subcutaneous mass lesions. The term lymphatic malformation is now preferred over cystic hygroma.
Lymphatic malformations can be localized to specific areas, often in the head, neck, or axilla. Surgical excision is the preferred method of treatment to prevent further growth of the lesions and to prevent local infection. Very often, lymphatic malformations will e much more extensive, involving very large areas of the body. In these instances, combinations of percutaneous injections (sclerotherapy) and surgery are often required. It is not uncommon for larger lesions to require multiple surgical procedures.
How is the diagnosis made?
A medical history and physical examination are the first steps in making the diagnosis. Very often, the lesion is beneath the skin and will require ultrasound and MRI to make the diagnosis. In some cases, angiograms through the artery or vein might be required. These tests involve the insertion of catheters directly into the blood vessels followed by an injection of contrast material to obtain detailed images of the lesions and the blood vessels that are involved.
Who will diagnose and treat these lesions?
A multi-discipliary team of specialists will work together to properly diagnose and treat these lesions. Because vascular malformations can occur anywhere in the body, specialists from all areas take part in the evaluation and treatment. Treatment might include laser therapy, surgical removal, percutaneous sclerotherapy, vascular embolization, or a combination of these techniques.
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