Vascular Malformations and Hemangiomas
We at Vascular Anomalies Clinic of Jerusalem (Israel) offer comprehensive treatment options for vascular malformations and hemangiomas.
We provide the most effective and least invasive techniques to treat these conditions in most patients providing excellent results with minimal recovery times.
We are committed to delivering the highest quality of individualized treatment and compassion. We make every effort to ensure comfort and to control pain. Our patients receive frequent follow up phone calls after discharge to answer questions and provide guidance when needed.
While treatment is tailored to each individual, there are some guiding principles. Overall treatment is aimed not at cure, which is usually unattainable and unrealistic. It is aimed at improving our patients’ symptoms and preventing potentially serious complications (such as blood clots) in the future.
Traditionally, the only treatment option for vascular malformations was open surgery. We now know, that open surgery in most (but not all) cases, may actually worsen the malformation and cause physcial disfigurement. The current, state-of-the-art treatment of vascular malformations involves minimally-invasive, non-surgical therapies termed “endovascular” therapy. These include embolization (blocking off blood vessels with special liquid or tiny metallic coils), and sclerotherapy (injecting a liquid or foamy substance into the malformation to cause it to shrink).
With “endovascular” therapy, most patients will go home the same day of their procedure, recover quickly,and return to normal activities much quicker than with surgery. Most patients will require only local anesthesia and moderate sedation (‘partial’ anesthesia where patients feel relaxed and calm) to remain comfortable during the procedure. Some, especially young children, may require deep sedation (relaxed and very sleepy) or general anesthesia. Procedures usually take between half an hour and 2 hours in duration.
Our Vascular Malformations Philosophy
Vascular malformations (VM’s) represent a wide spectrum of disorders related to abnormal development of blood vessels in a certain part of the body. These are congenital (people are born with them) lesions, and are usually diagnosed early in childhood, though some people are not diagnosed until adulthood, when symptoms related to their vascular malformation prompt them to seek medical attention.
Vascular malformations are named based on the type of blood vessel involved. There are capillary, arteriovenous, venous, and lymphatic malformations. Sometimes, vascular malformations occur as combined lesions, such as in Klippel-Trenaunay Syndrome.
The good news about vascular malformations is that nearly all of them are benign (non-cancerous) and they are rarely life-threatening. Depending on their type, size, and location, however, they may cause significant symptoms such as pain, swelling, limitiation of mobility, or physical deformity. While treatment is often effective at minimizing the symptoms related to vascular malformations and preventing complications, it is important to realize that vascular malformations may recur and rarely completely go away. Many will require multiple treatments over an extended period of time.
Treatment of vascular malformations requires special knowledge and expertise due to the complex and rare nature of these disorders. Often, a multidisciplinary approach including specialists in radiology, surgery, dermatology, orthopedic surgery, vascular surgery, and ear nose and throat surgery, is required. Patients are best served in centers with experience and expertise in diagnosis and treatment of complex vascular malformations.
We recognize that vascular malformations comprise a wide spectrum of rare blood vessel disorders, that require unique knowledge, expertise and cutting-edge treatment options. We believe that we are the premier center in Israel to provide such care.
While we believe that treatments for vascular malformations are usually effective in reducing patient’s symptoms and preventing complications in the future, we recognize the limitations of treatment. Vascular malformations are rarely cured, and may require multiple treatment sessions over an extended period of time. We believe that our patients should be made aware of this in an honest and open fashion.
We believe that each vascular malformations patient is unique, and that each child or adult with a vascular malformations may suffer from physical as well as emotional symptoms related to their malformation. We believe in accompanying each patient through the treatment process with compassion and patience, and will do everything in our power to guide you and assist with any concerns you have during, before, and after treatment.
Types of Vascular Malformations
Venous malformations (sometimes incorrectly called ‘cavernous hemangiomas’) may affect the skin, muscle, internal organs, and bone. They often appear as soft, easily compressible masses that have a bluish color. They often enlarge when placed in a dependent position or when the child cries. As the child grows, the malformation grows with them. Venous malformations may swell and cause pain intermittently due to small blood clots forming within the malformation.
Arteriovenous malformations may appear as red or purple discoloration the skin. Often warmth and vibrations can be felt from the high blood flow. AVM’s can cause pain, bleeding, and ulceration. AVM’s are complex anatomic lesions and are usually the most challenging type of vascular malformation to treat.
Lymphatic malformations used to be called ‘lymphangiomas’ or ‘cystic hygromas.’ They often involve the underlying muscle and may cause swelling and bony overgrowth. Sometimes, clusters of very small fluid-filled vesicles may develop on top of the skin or lining of the mouth/tongue, and may cause minor bleeding or fluid discharge. The size of lymphatic malformations may change with infection or trauma that results in bleeding into the malformation, and increased lymph flow through the region.
Capillary malformations, in the past, called port-wine stains, appear as pink or red stains on the skin. They are present at birth and typically remain throughout life unless they are treated. Pulsed-dye-laser therapy often is effective at removing or lightening the discoloration.
Klippel-Trenaunay-Syndrome, also called CLVM (Capillary Lymphatic Venous Malformation) is a condition where patients have combinations of differents vascular malformations. These include capillary, lymphatic, and venous malformations and also is often associated with overgrowth, or enlargement of one or more limbs. One limb may also be longer than the other, which may lead to difficulties in walking or use of the arms. KTS patients may experience severe symptoms due to blood clots, varicose veins, limb swelling, and chronic pain. They require an intense multi-disciplinary effort between multiple trained specialists to help manage their condition.
KTS patients may also have a potentially life-threatening system of ‘extra’ veins in their limb that may predispose them to blood clots which can travel to the lungs. We believe in aggressive treatment of these veins in order to prevent blood clots travelling to the lungs (pulmonary embolus).
Hemangiomas are the most common birthmark seen in infants, and are seen in about 10 percent of children. They are usually seen at about 2 weeks of life. Typically, they appear as a pink to light red area on the skin. The lesion typically grows rapidly and becomes red and raised until about one year of age, when it begins to shrink. Most hemangiomas fade in color and shrink significantly by age 7, without any treatment. Hemangiomas that are large, ulcerated, distort facial structures, or threaten the airway, are often treated with a medication. Rarely, surgery is needed to remove a hemangioma, and sometimes, pre-surgery embolization (closing off) of the blood vessels involved is necessary to ensure the safety of surgery.
We would be happy to discuss vascular malformations and hemangiomas at our vascular anomalies clinic in Jerusalem (Israel) and take all the time you need, to answer your questions/concerns.
The procedure is covered by some of the kuppot and insurance companies. We typically appeal to the kuppot/insurance companies on an individual basis, and will make every effort to assist in obtaining a hitchayvut for the procedure.