الفهرس 
Pathology, Pathogenesis & Clinical PictureOnly 14 pages are availabe for public view
 |  | from | 151 |  |  |
| | | from | 151 | | |
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