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Abstract Perfect understanding of the biological behavior of vascular anomalies, expressed as correct terminology, is the backbone of proper management. 2- Infantile hemangiomas can be managed expectantly “active nonintervention”. Propranolol is on its way to revolutionize its treatment, both reducing the need to surgery and making it safer if needed. It also opened the gate for the study of other beta-blockers with fewer side effects as well as topical beta blockers. 3- Kaposiform hemangioendotheliomas should not be given heparin or platelets. Both were found to stimulate tumor growth. Platelets are given only in case a surgical procedure, such as biopsy, is being planned. 4- The target of an AVM embolization or surgery is the nidus of the lesion. Interruption of the feeders of an AVM by any means is more dangerous than the lesion itself. It results in recruitment of huge collaterals that are more difficult to control later on. 5- Sclerotherapy has become the standard of venous malformation therapy. Surgery is reserved for a residual “devascularized” mass that is posing a cosmetic or functional concern. Laser is reserved for lesions with high surgery-related morbidity as well as the risk of catastrophic embolization from sclerotherapy, eg to the eye. 6- Though the results are still far from ideal, being limited by the depth of penetration, pulsed dye laser is still the standard remedy for capillary malformations. Surgery is indicated in selected cases with disfiguring exophytic growth. 7- Sclerotherapy is a minimally invasive, repeatable option with excellent results for macrocystic LMs. Surgery should be reserved only for failure of sclerotherapy of macrocystic LMs and for microcystic LMs. The surgical morbidity and the risk of recurrence, especially with microcystic LMs should be weighed against the expected benefit. Laser, though not so promising, can be a repeatable step in advance of surgery. 8- Patients with vascular anomalies should be treated in interdisciplinary centers provided with the due personnel and equipment; more than one-half of patients, on the average, have an incorrect referral diagnosis and consequently therapy. 9- Although a cure may not be possible, relief of symptoms can be achieved in the majority of patients. 10- Percutaneous therapy is technically straightforward, but requires perfect planning.sup |