Hemangiomas and Vascular Malformations

Abstract

Pediatric vascular anomalies consist predominantly of hemangiomas or vascular malformations. Hemangiomas appear early in infancy and proliferate for 6 to 12 months before undergoing slow regression. They are the most common benign tumor of infancy, and historically pediatricians have advised conservative observation since the vast majority slowly involute over an average of 5 years. Propranolol has replaced steroids as first-line treatment for problematic hemangiomas. Residual deformity, which can be severe, is treated by surgical debulking. Lasers may be useful for very early hemangiomas, ulcerated hemangiomas, or for persistent vascular pigmentation in regressed hemangiomas. Vascular malformations are composed of abnormal capillaries (port wine stain), veins, lymphatics, arteries, or combinations of abnormal vessels such as arteriovenous malformations and venolymphatic malformations. Klippel-Trenaunay syndrome is a dermal capillary vascular malformation, an underlying venolymphatic malformation and hypertrophy of the involved area of the body. Unlike hemangiomas, vascular malformations tend to grow proportionately with the child and do not undergo involution. Treatment options include cutaneous and endovascular laser photocoagulation, sclerotherapy, embolization, and surgical debulking.