Treatment Process

Many of the same modalities that are used for hemangiomas are used in vascular malformation treatment. There are some important differences however.

Malformations are true developmental abnormalities of the involved structures. So, any part of the malformation that is left behind after treatment has the potential for growing. This, of course, is not the case with hemangiomas. It is very important that the goals of the treatment are clearly established.

Alternative Vascular Malformation Treatment to Surgery

Propranolol has replaced steroids as the first line medical treatment for infantile hemangiomas. Propranolol is a beta-receptor blocker – it’s effects in general are to decrease heart rate, decrease blood pressure, relieve anxiety and various other uses. However, for infantile hemangiomas it has been found to decrease the rate of proliferation and increase the rate of involution. The doses at which propranolol is used for hemangiomas is much lower than for other conditions – therefore the side effects are extremely rare. Propranolol is also available as Hemangeol (made by Pierre-Fabre Pharmaceuticals). It is the only FDA approved version of propranolol for the treatment of infants with infantile hemangioma. It is formulated specifically for this use.

Sometimes it is not possible to remove the entire malformation surgically without causing harm to normal structures so a more conservative approach may be chosen knowing that multiple treatments may be necessary or that another treatment tool, such as embolization or sclerotherapy, may be needed.

Embolization and sclerotherapy are procedures done by an Interventional Radiologist and are useful to close down the blood supply of a malformation (venous or arterio-venous malformations, for example) prior to surgery or as the primary treatment option.

Special medicines can be used as well as different coils, sponges and other materials. The purpose of these treatments may also be to scar down the malformation (such as with lymphatic malformations). The interventional radiologist is also very helpful in doing studies prior to surgery to help map out the malformation.

The most common malformation for which lasers are used is the port wine stain. For these, the pulsed dye laser (PDL) with a dynamic cooling device is the currently the best treatment. Early treatment of port wine stains is advocated to try to close off the abnormal vessels. Even after this malformation clears, touch up treatments may be needed in the future.

Remember, any vessel that is left behind has the potential for growing. There is no current way to completely get rid of a port wine stain permanently. However, it is definitely worth treating in order to avoid complications such as ‘peppercorns’ or ‘cobblestones’. Once these areas of thickening occur they are more difficult to treat.

The Nd:YAG and resurfacing lasers are useful in these instances as well. Likewise, we try to prevent the overgrowth of tissues by using the laser early on. Surgery is useful for port wine stains to reduce the size of structures that have thickened such as the lips, eyelids and nose.

Steroids are typically used only occasionally in the treatment of malformations to reduce swelling during flare-ups. These powerful medicines have been replaced by propranolol as the mainstay of medical therapy. They are still used for life-threatening lesions and those that do not respond to propranolol.

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