Do you suffer from a vascular malformation or hemangioma?
Vascular Malformations and Hemangiomas involve abnormalities of blood vessels that cause swelling and pain. The Jerusalem Vascular team comprises a dedicated team of specialists devoted to best helping you.
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Are You Suffering From Swelling or Pain Related to a Vascular Malformation or Hemangioma?
The terms ‘Vascular Anomalies’ is used to describe both vascular malformations and hemangiomas. Vascular malformations are benign disorders of abnormal blood vessel development. They often cause pain and swelling, and can be treated with minimally-invasive, non-surgical therapies. Hemangiomas are benign growths that often go away on their own; some will require surgical treatment.
- Blood Vessels
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, limitation 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, hematology, oral 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 (AVM)
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.
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Dr. Adam Farkas
We believe in partnering with you, in order to alleviate your suffering. Our patients’ concerns are our concerns, and we take pride not only in providing excellent outcomes to our patients, but in seeing a smile on their faces.
National referral center for complex vascular disorders
with 3000 annual procedures performed
Please call 02-564-5634 and ask for an appointment in Dr. Farkas’s private clinic in Jerusalem. If you have undergone any imaging studies (MRI, Ultrasound, CT, XRAY), please bring an original (from the place where the study was performed) disc of the imaging study to your visit. It is helpful if you can have your discs scanned into our computer system on the day of your visit (2nd floor, radiology department).
Once you are seen in Dr. Farkas’s clinic and are determined to be a candidate for a minimally-invasive procedure, the procedure will be scheduled with our scheduling coordinator. Typically an appointment can be given within a few weeks time. The embolization procedure is generally covered by your kuppat cholim. You will have the option of doing the procedure via “sharap” which allows you to guarantee that Dr. Farkas (and not another physician in the department) performs your procedure. Doing the procedure via “sharap” is generally covered by private insurance and involves a co-payment if done via kuppat cholim. Our scheduling coordinator at 02-655-5014 will be happy to explain the details.
You can expect to have your procedure performed in the morning of your appointed date. The procedure typically takes 1-2 hours, during which you will be partially sedated (partially asleep) or sometimes completely asleep (general anesthesia). Some patients will have their procedure performed under ‘regional anesthesia’ (a local injection causing the limb to become numb for several hours) and will be able to avoid general anesthesia. You will then go home several hours after the procedure, typically in the late afternoon/evening time. You can expect to require 1-3 days of oral pain medications at home and you should be able to return to your normal activities within 1-2 days.
You will be asked to follow up in Dr. Farkas’s clinic several weeks after your procedure. After treatment for vascular malformations, the treated area will often be quite swollen for 1-2 weeks. Improvement from baseline swelling and pain typically takes about 6-8 weeks. Many patients will need more than one procedure for their vascular malformation and this will determined at their follow up clinic visit.
The vast majority of vascular anomalies are not cancer, and they are not life-threatening. Treatment is aimed at improving quality of life related to pain and swelling. While the majority of vascular anomalies are not life-threatening, there are situations where the blood vessel anatomy poses a risk of blood clots that can travel to the lungs, a potentially dangerous situation. In this case, we will likely recommend closing off (‘embolization’) of these potentially dangerous blood vessels.
Most likely yes! Most vascular anomalies are congenital, meaning you are born with it, even if you don’t know you have it until later in life.
Many vascular anomalies respond to hormonal changes in the body. They may get worse especially during pregnancy, but also during the monthly period, or during puberty.
It is important to know that most vascular anomalies cannot be cured completely. On the one hand, they are benign (non-cancerous) conditions for the most part, but on the other hand, complete cure is usually not possible. Most patients, however, can experience significant improvement in their symptoms with appropriate treatment.
While specific genes have been identified for many vascular anomalies, most are NOT heritable, meaning most patients will not pass on the genes to their children. There are some rare exceptions, and these patients will likely be referred to a genetics specialist in order to better understand how their condition may be passed on to their children.
There is much confusion (even among doctors) about the difference between hemangiomas and vascular malformations. Many physicians inadvertently use incorrect terminology such as calling a Venous Malformation by an old term, ‘Cavernous Hemangioma.’ Hemangiomas do, in fact, go away on their own in the majority of children. Vascular malformations, however, practically never resolve on their own, and usually require treatment.
Vascular Birthmark Institute of New York
Boston Vascular Anomalies Center
National Organization for Rare Disorders
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