Algorithm of diagnosis and treatment of vascular anomalies

Abstract

Vascular anomalies (VA) are characterized by a wide range of diseases, occurring at different frequencies and significantly different from each other, which presents great difficulties in their diagnosis and treatment. Since 2001, more than 5000 children and adults with VA have been treated. The work was based on the classification of VA adopted by the ISSVA. Methods that evaluated local hemodynamics (LHD), such as ultrasound with color Doppler mapping, thermal imaging, spectrophotometry, were of significant importance in the differential diagnosis of VA, in determining the stage of development of infant hemangioma (IH), in choosing a method of treatment and monitoring its effectiveness. Methods of managing patients with VA included in IH: observation, treatment with propranolol systemically and locally, laser thermotherapy, non-contact and interstitial; with vascular malformations: sclerotherapy with picibanyl and bleomycin, laser thermotherapy without contact and interstitial, IPL-therapy, excision. The main goal of treatment of VA was to obtain the best cosmetic result while maintaining the functions of the affected area. In children with IH, three variants of LHD - intensive, moderately elevated and normal, were observed. 45% of children with IH with normal or moderately elevated LHD were simply observed. Laser thermotherapy was performed in 10% of children with intensive LHD (in parallel with treatment with propranolol) and in the presence of ulceration of IH. The rest of the children were treated with propranolol systemically or according to the original technology locally. In the treatment of venous or arteriovenous malformations, thermal therapy with laser radiation with a wavelength of 1.56 μm was effective, especially in combination with a wavelength of 1.94 μm. With lymphatic malformation, large cysts were sclerized with picibanyl or bleomycin (efficacy greater than 75%). Small and microcamps were heated by laser radiation with a wavelength of 1.94 microns. In general, the algorithm developed allowed to significantly increase the efficiency of diagnosis and treatment of this difficult and very diverse pathology.