Congenital Vascular Anomalies
According to the International Society for the Study of Vascular Anomalies (ISSVA) congenital vascular anomalies are classified into two categories: vascular tumors or vascular malformations.
| Vascular Tumors | Vascular Malformations |
|---|---|
| Infantile hemangioma | slow flow |
| Congenital hemangioma (RICH, NICH, PICH) | high flow |
| ,Tufted angioma’* | Complex-combined |
| Kaposiform hemangioendothelioma* | |
| Spindle-cell hemangioma | |
| Other hemangioma | |
| Angiosarcoma | |
| Slow flow malformation: | |
| Capillary malformation | |
| Venous malformation (sporadic form or within a genetic syndrome, e.g. Bean Syndrom, Maffucci Syndrom) | |
| Lymphatic malformation | |
| High flow malformation: | |
| Arteriovenous fistula | |
| Arterial malformation e.g. (Coarctatio) | |
| *risk of Kasabach Merrit phenomenon | Complex-combined malformation |
Treatment approaches for vascular tumors and vascular malformations are entirely different so the appropriate diagnostic classification is essential. Hemangiomas (tumors) usually regress spontaneously in the first years of life. In the case of incomplete regression or rapid growth, both pharmaceutical and surgical treatment may be required (e.g. open surgery, laser therapy, combined approaches). Vascular malformations, however, persist for the life and regression or involution never occur. Malformations are present at birth and, though frequently not recognized at that time, can present with a large variety of symptoms.
The hemodynamics of vascular anomalies lead to sub classification of malformations into slow flow, fast flow and complex-combined categories. In most cases vascular malformations can be treated with a minimally invasive catheter using either ultrasound or fluoroscopy guidance (interventional sclerotherapy/embolization) in repetitive therapy sessions.