Vascular anomalies

Vascular anomalies are vascular lesions that are present from childhood. They are classified into tumours and malformations based on clinical and histological features. Infantile haemangiomas, the most common vascular tumour, are benign and have a predictable self-limiting course. Management is conservative, with active treatment reserved for presence of functional or cosmetic complications (ulceration, obstruction and distortion of vital structures). Oral propranolol is useful for troublesome lesions. Rarer tumours exist and some may cause platelet consumption. Vascular malformations are structural anomalies of vascular morphogenesis present at birth without cellular proliferation that, in general, grow with the patient. They are sub-classified by vessel type as low-flow (capillary, lymphatic and venous) and high-flow (arteriovenous) or lesions with a combination of vessel type. They become problematic under certain circumstances, usually puberty and also pregnancy. The most troublesome are extensive lesions, especially venous and arteriovenous. Their effects may be cosmetic, or those of a space-occupying lesion: infection, bleeding, pain or coagulopathy. Venous lesions cause consumptive coagulopathy, sometimes with life threatening risks. Treatment options include laser (capillary), percutaneous sclerotherapy and surgery (venous and lymphatic), and embolization and surgery (arteriovenous). Such patients with complex lesions, are best managed by a multidisciplinary team.