Vascular anomalies are abnormal formations or growths of the components of the vascular system: capillaries, venules, arteries, veins, and lymphatics. These anomalies can be broadly categorized as hemangiomas and vascular malformations.
Do vascular anomalies cause my baby any pain?
Most of the time, these anomalies are not painful. However, in some cases they can be painful, for example if they grow to a large size or if the overlying skin becomes ulcerated. Pain is more often associated with vascular malformations than hemangiomas.
What are the different types of vascular anomalies?
As noted above, vascualar anomalies are broadly categorized as hemangiomas or vascular malformations.
Hemangiomas are classically bright red and tense while they are growing, although the color may be more bluish if the hemangioma is in the deeper tissues rather than right beneath the skin. As they gradually regress, their color changes to a gray-purple, and they become softer. Hemangiomas may disappear completely, or leave behind some excess skin and fibrofatty tissue after they have resolved. Approximately 80% of hemangiomas are solitary lesions, while in 20% of cases there is more than one hemangioma present.
Vascular malformations may have a variety of appearances depending on the exact composition of the malformation (capillary, arterial, venous, lymphatic, or combined). There is a great variety of vascular malformations. Some only involve the skin, while others are very extensive and may involve deep structures and even the internal organs and bones.
Who gets vascular anomalies?
- Hemangiomas occur in 2.6% of newborns and in 12% of Caucasian children by one year of age; they are more common in very small premature babies. Girls are affected three times more often than boys. Hemangiomas are more common in Caucasians than in other racial or ethnic groups.
- Vascular malformations occur equally in boys and girls, and there seems to be no racial predilection.
- Hemangiomas and vascular malformations are not inherited or “genetic” conditions.
What causes vascular anomalies?
A great deal of research is being done to determine why hemangiomas and vascular malformations occur. However, currently, no clearly-defined causes of these lesions have been determined.
What are the main issues related to vascular anomalies?
Most hemangiomas cause no problems at all. However, some patients with hemangiomas will have problems such as very rapid growth with ulceration of the skin and damage to surrounding tissues; in addition, hemangiomas in the head and neck region can grow large enough to obstruct or interfere with vision, hearing, breathing, or feeding. In rare cases, very large or multiple hemangiomas may be associated with bleeding problems or with cardiac and circulatory problems.
Vascular malformations are so varied that it is difficult to generalize about them. Many of these lesions do not cause any problems. However, depending on the type of lesion, its size, location, and composition, there may be various problems such as pain, limitation of function (for example if the malformation is in the hand), distortion of surrounding tissues including bones, bleeding, and circulatory problems.
Are there other problems that occur commonly with vascular anomalies?
Usually, hemangiomas are solitary lesions that are not associated with any other problems. Vascular malformations may occur as isolated problems or as part of a number of different syndromes with many different types of associated abnormalities. Your surgeon will tell you if he thinks that your child may have one of these syndromes and explain it in detail.
What is the treatment for babies with vascular anomalies?
The vast majority of hemangiomas are not treated in any way. Occasionally, after they have regressed, a minor surgical procedure may be done to remove any excess skin or fibro-fatty tissue left behind. In some cases, when the hemangioma is growing very rapidly, steroids may be given to slow the growth. Surgical removal of a hemangioma is only rarely necessary.
Most vascular malformations can be treated just with observation or with the use of compression garments to prevent swelling. Several different treatment options are available for the different types of vascular malformations. These options include laser treatment, sclerotherapy (injection of a chemical substance directly into the malformation to shrink it), embolization (blocking off the supply of blood to the malformation), and surgery. Surgery may be to just reduce the size of the malformation or, in some cases, to remove the malformation altogether if possible. Because there is such a variety of vascular malformations, the treatment is really customized for each individual patient.
What is done after my baby is born?
You will often meet with your surgeon soon after your baby is born. Your surgeon will examine your baby and may order xrays or other images of the affected part of the body. Your baby will be examined at regular intervals in the clinic. The treatment plan and the details of the surgical procedures, if any, will be carefully explained to you by your surgeon. Sometimes compressive garments may be prescribed to keep pressure on areas that are swollen. If necessary, your surgeon may refer you to see other specialists as well (see below).
What sorts of specialists will be involved in my baby’s care?
Your child will be treated by the plastic surgeon. In some cases, other specialists, such as dermatologists, interventional radiologists, ophthalmologists, otolaryngologists (ENT), and general surgeons may be involved depending upon the specific details of the case.
Will we get to know our surgeon?
Ideally, you will meet your surgeon soon after your baby is born. Your surgeon will see your child regularly in the clinic as he or she grows over a period of months or years. During this process, you will have ample opportunity to ask questions and to get to know your surgeon quite well./p>