Pharmaceutical Treatment
In the last few years, there has been a large growth of knowledge about what drives the formation of vascular tumors and malformations at the level of the cells.  Scientists have found that these anomalies use the same pathways that some cancers use to cause cell growth.  This important discovery has allowed specialists to study and use medications that were originally developed to fight cancer to treat patients who suffer from a range of vascular anomalies.  These are known as “targeted therapies” because they affect the cells that drive the growth of the vascular anomalies and not the normal cells, so their side effects are usually more manageable.  Medications are now being considered and used by many patients with vascular anomalies along with Surgery and Interventional Radiology procedures.

Kaposiform Hemangioendothelioma (KHE) is a painful malformation that can lead to serious bleeding.  Medications that target the malformation are very important and include corticosteroids and immunosuppressants, like mTOR inhibitors (Sirolimus).  As with any medicine, side effects may occur.  In the case of Sirolimus, it can include effects on the immune system and a mild increase in risk of infection, elevated triglycerides, which are managed.  

Pharmaceutical Treatment
In the last few years, there has been a large growth of knowledge about what drives the formation of vascular tumors and malformations at the level of the cells.  Scientists have found that these anomalies use the same pathways that some cancers use to cause cell growth.  This important discovery has allowed specialists to study and use medications that were originally developed to fight cancer to treat patients who suffer from a range of vascular anomalies.  These are known as “targeted therapies” because they affect the cells that drive the growth of the vascular anomalies and not the normal cells, so their side effects are usually more manageable.  Medications are now being considered and used by many patients with vascular anomalies along with Surgery and Interventional Radiology procedures.

Fibro-adipose vascular anomaly (FAVA) is a painful condition, for which treatment may include medication that targets PI3KCA (Alpelisib), a change in the genetic make-up (mutation) in the cells of the affected tissues.   As with any medicine, side effects may occur, which include elevated blood sugar levels and growth delay with Alpelisib, although they tend to be self-limited with close monitoring and supportive care.  

Cryoablation
This involves the use of extremely low temperatures to destroy abnormal tissue. Using imaging guidance a needle is advanced within the diseased tissue. Through the tip of the needle, an extremely cold gas is released into the targeted abnormal tissue.  It is a promising treatment for Fibroadipose vascular Anomaly(FAVA), a type of low flow vascular malformation.

Bleomycin Electrosclerotherapy (BEST)
Bleomycin electrosclerotherapy is the latest development in the treatment of vascular malformations. This new treatment modality is being used since 2019 in a few specialized vascular malformation centers. Our multidisciplinary group of clinicians was one of the first worldwide to apply electrosclerotherapy for the treatment of vascular malformations and has already treated a large number of patients with this modality.

Our clinical experience with BEST in FAVA patients has shown encouraging clinical results. The procedure is performed under general anesthesia. First, the sclerosing agent is administered either directly into the vascular malformation, or intravenously. Subsequently, thin needles are placed into the vascular malformation, usually under ultrasonographic and fluoroscopic guidance. These needles are connected to the electric pulse generator. By applying short electric pulses, the permeability of the cell membrane of the cells that form the wall of the vascular malformation is increased, resulting in a dramatic increase in the intracellular concentration of Bleomycin.

Endovascular Laser ablation of pathological veins

It is a minimally invasive procedure for closure of abnormal superficial embryonic veins usually found in patients with Klippel Trenaunay Syndrome(KTS) and other overgrowth syndromes. A small fiber is advanced into the abnormal vessel and laser energy is delivered which results in vein occlusion.