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Vascular
Anomalies
Complex vascular anomalies are seen at a monthly multidisciplinary
clinic at Hutt Hospital. Referrals are received from throughout
the country. The team is lead by Mr Swee Tan who has completed his
PhD studying the molecular basis of haemangioma.
During my fellowships I have studied with the Vascular Anomaly
teams at Boston and Brussels who also receive referrals throughout
the USA, Belgium and beyond.
Dr John Mulliken from Boston has classified vascular anomalies
into vascular tumours and vascular malformations.
| Haemangioma
A haemangioma is a benign tumour of endothelial cells
lining blood vessels.
Typically they grow very rapidly in the first few months
of life and then start involuting about age one. Involution
occurs over several years and may leave a fibro fatty residuum
which sometimes requires excision for cosmetic reasons.
Early treatment with steroids or surgery is instigated if
the haemangioma obscures vision or is likely to distort an
anatomical region that would be difficult to reconstruct later. |
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| Capillary Malformation
There are many types of capillary malformation including
the “port wine stain” shown here. Sturge-Weber
syndrome is a variant with intracranial involvement and cutis
meromata telangiectasia congenita (CMTC) is a variant that
gives the skin a marbled appearance. Pulsed dye laser is useful
to fade the pigment. Treatment is more likely to be successful
with lighter lesions. |
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| Venous malformation
Venous malformations may be multiple and may run in families.
The Brussels team have recently identified the only three
genes known to cause VMs.
Aspirin is useful to prevent microthrombi in extensive lesions.
Lesions may be sclerosed (for example with absolute alcohol)
or may be surgically removed. |
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| Lymphatic Malformation
Lymphatic malformations in the neck were previously called
cystic hygroma.
The lesion shown here in a tongue causes deformation of the
growing mandible. Variants with large cysts (macrocystic)
may be sclerosed however those with small cysts (microcystic)
require surgical excision.
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Arteriovenous malformation
AVMs are a high flow lesion and may bleed rapidly. Those that
are quiescent or slowly growing may not require treatment.
Treatment is commenced once they cause pain or ulceration.
The main feeder vessels are embolized by an interventional
radiologist (Dr Trevor Fitzjohn in Wellington) and surgical
excision performed in the following days before vessels reform.
AVMs of the ear as shown here usually also involve the scalp. |
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Klippel-Trenaunay syndrome
KTS is a mixed malformation of capillaries, lymphatics and
veins.
Treatment is difficult. If overgrowth of a limb is occurring
then the growth plates can be fused. Pressure garments help
control generalized swelling.
It is very important to check for an adequate deep venous
system before removing superficial varicose veins.
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