Protocol for the treatment of haemangiomas and/or vascular malformations

Abstract

When facing any vascular lesion present in the first moments of life, it is necessary to determine whether one is dealing with a tumour or a vascular malformation, given the different evolution of both processes and, hence, the different treatments they require. Diagnosis is basically clinical, based on a correct anamnesis and a detailed physical exploration. The first thing is to establish whether the lesion was present at birth and has changed size significantly, which would lead one to think of a haemangioma or, on the contrary, whether it is congenital and of very slow growth, such as vascular malformations. Facing dubious lesions, it is recommendable to carry out a biopsy with immunohistochemistry for the GLUT-1 antibody, specific to haemangiomas. Amongst the image tests, the first choice is usually ecography-Doppler, which makes it possible to determine whether the lesion is of high or low flow and to distinguish whether one is dealing with a haemangioma or a vascular malformation. Depending on the type of lesion, its localisation and degree of affectation it might be necessary to carry out radiography, magnetic resonance, phlebography, angio-resonance, arteriography or lymphoscintigraphy to complete the study. In more particular cases, such as multiple haemangiomatosis, it is necessary to carry out an hepatic echography, blood concealed in faeces, gastroscopy and colonoscopy, as well a determination of thyroid hormones; and in venous or combined extensive malformations, a haemogram and coagulation tests. On the other hand, the possible repercussions on other organs make a multidisciplinary approach essential, with the participation of different specialists. Due to the wide spectrum covered by vascular anomalies, treatment must be individualised.