Vascular anomalies: special considerations in children
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CVIR Endovascular
REVIEW ARTICLE
Open Access
Vascular anomalies: special considerations in children Craig R. Gibson1 and Alex M. Barnacle2*
Abstract The diagnosis and treatment of vascular anomalies are a large part of the caseload for paediatric interventional radiologists. Although many of the principles of sclerotherapy and embolisation are the same in adult and paediatric practice, there are some key differences in the approach for children, including some longer term thinking about managing these chronic diseases and their impact on a growing child. Vascular tumours are not often seen in adult IR practice and the rarest can be life threatening; knowledge of the commonest types and the role IR can play in their management can be instrumental in ensuring that children get appropriate treatment in a timely manner. Vascular anomalies also encompass some conditions associated with complex overgrowth, a subject that often causes confusion and uncertainty for interventional radiologists. This paper presents a simplified and practical approach to this spectrum of disease. Keywords: Vascular malformation, Haemangioma, Paediatric, Fibroadipose vascular anomaly, Venous malformation, Lymphatic malformation, Sclerotherapy, Embolisation
Background The term vascular anomalies incorporates a diverse range of pathologies which are best understood when classified as either vascular tumours or vascular malformations. The 2018 guidelines published by The International Society for the Study of Vascular Anomalies (ISSVA 2018) breaks this down into significantly more detailed categories although several pathologies have considerable overlapping clinical and imaging characteristics (ISSVA 2018; Dasgupta and Fishman 2014). Although vascular anomalies are relatively common, their correct diagnosis and management is notoriously poorly understood, which is a source of frustration for patients and risk for their clinicians (Patel and Barnacle 2017). This is particularly the case for children, where parental anxieties are often heightened. Vascular anomalies in children warrant special consideration for a multitude of reasons. Families will often have seen many other teams and been given a variety of * Correspondence: [email protected] 2 Department of Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK Full list of author information is available at the end of the article
diagnostic labels and misleading advice. Parents or care givers will have questions over the correct diagnosis and what it means for their child over the course of their childhood. They often have pre-formed views on whether their child should be treated or not and many will initially push for a surgical ‘cure’. Their opinions are often strongly influenced by concerns over the physical appearance of their child, worries over genetic implications and guilt over a delayed diagnosis. Explaining a complex condition and suggesting a treatment which rarely has defined outcome measures is a challenge. How do we determine the most appropriate t
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