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Facial plastic and REconstructive surgery Wong > Chapter 16: Vascular Anomalies > Flashcards

Chapter 16: Vascular Anomalies Flashcards

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1
Q

What is the ISSVA classification system?

A

A dichotomous classification system adopted in 1996 that divides vascular anomalies into vascular tumors and vascular malformations

Vascular tumors are true neoplasms with endothelial proliferation, while vascular malformations consist of dysmorphic vessels with normal endothelial turnover.

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2
Q

What are the two main groups of vascular anomalies according to the ISSVA classification?

A
  • Vascular tumors
  • Vascular malformations
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3
Q

What is a key characteristic of vascular tumors?

A

Endothelial cell proliferation

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4
Q

How do vascular malformations differ from vascular tumors?

A

They are composed of dysmorphic vessels with normal endothelial turnover and are present at birth.

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5
Q

What percentage of vascular anomalies can be classified correctly through medical history and physical examination?

A

Over 90%

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6
Q

What is the most common benign tumor of infancy?

A

Infantile hemangioma (IH)

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7
Q

What risk factors are associated with infantile hemangiomas?

A
  • Fair skin
  • Female gender (3:1 ratio)
  • Premature birth
  • Low birth weight
  • Advanced maternal age
  • Multiple gestation pregnancies
  • Certain placental abnormalities
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8
Q

What are the six phases of the life cycle of an infantile hemangioma?

A
  • Nascent
  • Early proliferative
  • Late proliferative
  • Plateau
  • Involution
  • Abortive
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9
Q

What classification by depth is used for infantile hemangiomas?

A
  • Superficial
  • Deep
  • Mixed/compound
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10
Q

What are segmental infantile hemangiomas associated with?

A

Other anomalies and have a higher risk of complications

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11
Q

What syndrome is associated with facial segmental infantile hemangiomas?

A

PHACE syndrome

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12
Q

What is the most common complication of infantile hemangiomas?

A

Ulceration

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13
Q

What is GLUT-1 staining used for in infantile hemangiomas?

A

It is a unique positive marker that distinguishes IH from other vascular anomalies.

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14
Q

What is the primary method for diagnosing infantile hemangiomas?

A

Clinical diagnosis based on appearance and growth pattern

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15
Q

What is the first-line medical therapy for problematic infantile hemangiomas?

A

Propranolol

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16
Q

What are the potential side effects of propranolol?

A
  • Bradycardia
  • Hypotension
  • Hypoglycemia
  • Bronchoconstriction
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17
Q

What laser is the treatment of choice for ulcerated lesions in infantile hemangiomas?

A

Pulsed-Dye Laser (PDL)

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18
Q

What are congenital hemangiomas?

A

Rare vascular tumors that are fully formed at birth and do not have a postnatal proliferative phase.

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19
Q

What are the two types of congenital hemangiomas?

Study These Flashcards
A
  • Rapidly Involuting Congenital Hemangioma (RICH)
  • Noninvoluting Congenital Hemangioma (NICH)
20
Q

What is the treatment approach for rapidly involuting congenital hemangiomas?

21
Q

What is the treatment for noninvoluting congenital hemangiomas?

Study These Flashcards
A

Surgical excision

22
Q

What are pyogenic granulomas?

Study These Flashcards
A

Erythematous papules that bleed easily, often on mucosal surfaces.

23
Q

What is Kasabach-Merritt syndrome?

Study These Flashcards
A

A life-threatening consumptive coagulopathy with profound thrombocytopenia associated with Tufted Angiomas and Kaposiform Hemangioendotheliomas.

24
Q

What is the management approach for Tufted Angiomas and Kaposiform Hemangioendotheliomas?

Study These Flashcards
A

Involves a pediatric hematologist and may include high-dose steroids, vincristine, or other agents, along with surgical resection when possible.

25
What are the characteristics of vascular tumors?
Firm, infiltrative, plaque-like lesions that may be associated with Kasabach-Merritt syndrome
26
What is Kasabach-Merritt syndrome?
A life-threatening consumptive coagulopathy with profound thrombocytopenia, associated with KHE and TA, but not with IH
27
What should be evaluated in any infant with a rapidly growing vascular tumor and thrombocytopenia?
KHE/TA, not IH
28
How are vascular malformations classified?
By vessel type (capillary, venous, lymphatic, arterial) and flow characteristics (slow-flow vs. high-flow)
29
When are vascular malformations present?
Always present at birth and grow proportionally with the child, never involuting
30
What are capillary malformations (CMs) commonly known as?
Port-wine stains
31
What distinguishes medial lesions from lateral lesions in capillary malformations?
Medial lesions typically fade over time; lateral lesions do not fade and follow dermatomal distributions
32
What is Sturge-Weber Syndrome (SWS) associated with?
A CM in the V1 dermatome distribution, leading to seizures, developmental delay, and glaucoma
33
What is the mainstay treatment for capillary malformations?
Pulsed-dye laser (PDL)
34
What are the characteristics of venous malformations (VMs)?
Soft, compressible, bluish masses that enlarge with dependency or Valsalva
35
What is a key association with venous malformations?
Localized intravascular coagulation (LIC) with elevated D-dimer levels
36
What is the treatment approach for venous malformations?
Multimodal: compression, laser, sclerotherapy, and surgical excision
37
How are lymphatic malformations (LMs) categorized?
Macrocystic (>2 cm²) or microcystic (<2 cm²)
38
What can cause sudden enlargement of lymphatic malformations?
Infection or trauma
39
What is the treatment for macrocystic lymphatic lesions?
Sclerotherapy
40
What is a challenge in treating microcystic lymphatic lesions?
They are infiltrative and often require surgical excision
41
What defines arteriovenous malformations (AVMs)?
High-flow lesions with a direct connection between arterial and venous systems via a nidus
42
How are arteriovenous malformations staged?
By the Schobinger system (I-IV, from quiescent to cardiac failure)
43
What is contraindicated in the treatment of AVMs?
Ligation of a feeding artery
44
What is the recommended treatment for AVMs?
Preoperative superselective embolization of the nidus followed by wide surgical excision
45
What is a key difference between vascular tumors and vascular malformations?
Vascular tumors have a proliferative phase and often involute, while vascular malformations are present at birth and grow with the patient
46
What is essential for the management of vascular anomalies?
Accurate diagnosis based on history and physical exam, following the ISSVA classification system
47
True or False: Vascular malformations can involute over time.
False

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