Pediatric Vascular Anomalies Program

Vascular anomalies are generally divided into two groups:

1. Vascular Tumor (Hemangioma)
   A vascular tumor, or hemangioma, is an abnormal growth of blood vessels, sometimes apparent at birth as a red “birthmark” or “strawberry”, while others develop soon after birth. About 4-5% of all infants have a benign hemangioma and many tend to grow quickly then go away slowly, although this is not always the case. Uncomplicated hemangiomas are managed by the patient’s pediatrician and often do not need treatment. However, more complex hemangiomas are managed by our dermatology colleagues through the Vascular Anomalies Program. 
   
   Learn more about hemangiomas.
   
   
2. Vascular Malformation
   A vascular malformation is a collection of disorganized vessels that are usually present at birth, although it may not become noticed until later in childhood, or less commonly in adulthood. These malformations can occur in any part of the body and can involve arteries, veins, capillaries or lymphatic vessels. Some types of malformation also involve other tissues such as nerve and fat tissue. Vascular malformations can range in severity from asymptomatic and harmless, to life threatening. There are 4 general types of vascular malformations:
   • Venous malformations
   • Arteriovenous malformations
   • Lymphatic malformations
   • Capillary malformations
   Learn more about vascular malformations. 

Treatment for vascular anomalies depends on the type, location, severity and potential impact on the patient’s health or quality of life. The approach often involves a combination of medical, interventional and surgical strategies tailored to patient needs.

Observation / Monitoring

• Many small or non-symptomatic anomalies (e.g., small hemangiomas) may resolve or stabilize without intervention.
• Periodic follow-up appointments are scheduled with your healthcare team to monitor changes in size, symptoms, or complications of the vascular anomaly.

Medical Management

• Anti-inflammatory medications: Reduces pain and swelling associated with vascular malformations
• Beta blockers: Commonly used for infantile hemangiomas to reduce size and prevent complications
• Corticosteroids: Sometimes used for refractory hemangiomas or inflammation-related complications
• mTOR pathway inhibitors (sirolimus, alpelisib) : Effective for treating lymphatic malformations, venous malformations, and complex combined anomalies

Interventional Treatment(s)

• Laser therapy: Used for superficial vascular anomalies to reduce skin discoloration (for example, port wine stains or small capillary malformations)
• Sclerotherapy: Injection of a sclerosant will shrink or close abnormal blood vessels (common for venous and lymphatic malformations)
• Embolization: Intentionally blocking blood vessels that supply vascular anomalies, typically high-flow arteriovenous malformations
• Ablation: Uses extreme temperatures to either freeze or burn abnormal tissues associated with vascular malformations to reduce the size and vascularity
  Interstitial bleomycin: These injections are performed around the vascular malformation to induce fibrosis, ultimately shrinking or eliminating the abnormal vessels

Surgery

• Excision: Complete or near-complete surgical removal of a focal vascular anomaly, which is a benign tumor or noncancerous growth of blood vessels
• Debulking surgery: Partial removal of large or complex anomalies to reduce symptoms/disfigurement
• Reconstructive surgery: After anomaly removal, some patients may be left with a defect that needs to be addressed

Supportive Therapies

• Physical and Occupational Therapy: Addresses mobility or functional impairments caused by anomalies
• Psychological support: Offered to our patients and families who are coping with pain and disfigurement caused by vascular anomalies