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Vascular Anomalies Center

Since 2010, CHOC has offered the only pediatric program in Orange County for treating vascular anomalies. Our Vascular Anomalies Center comprises a team of specialists who work together to assess and treat all forms of vascular anomalies, no matter how complicated or rare. Our specialists include experts in hematology, otolaryngology (head and neck surgery), plastic surgery, laser surgery, cardiology, wound care, and vascular, diagnostic and interventional radiology. The center is coordinated by a dedicated RN who oversees appointments and follow-up care for every patient. We are committed to not only treating the malformation but always keeping in mind the needs of the whole child—physically and emotionally—both now and in the future.

What We Treat

Vascular anomalies are tumors or malformations caused by a defect in the vascular system, including arteries, veins, lymphatics and capillaries. They are very different for each child. Some children may only have one vascular anomaly, while others may have a combination of two or more. Some vascular anomalies are on the surface of the skin, while others reside below the skin and involve blood vessels and other organs. Some are cosmetic concerns, while other anomalies affect a function of the body like vision, breathing, eating or speaking. Most vascular anomalies are benign, while there is a risk of some being cancerous. The good news is that CHOC Vascular Anomalies Center has the expertise and experience necessary to treat all kinds of vascular anomalies, including:

Vascular Tumors

Hemangiomas (congenital and infantile)
Kaposiform hemangioendothelioma (KHE)
PHACE syndrome.

Vascular Malformations

Venous malformations
Lymphatic malformations
Capillary malformations —Port-wine stains —Klippel-Trenaunay syndrome —Sturge-Weber syndrome
Arteriovenous malformations.

The Right Diagnosis at the Right Time

Vascular anomalies can evolve or quickly become worse, leading to bigger problems including vision impairment, infection, bleeding or difficulty breathing (airway obstruction). It’s important to get a prompt, proper diagnosis early on—while the anomaly is still growing—in order to begin effective treatment and prevent other issues. Our team has multiple sources of expertise and uses comprehensive testing to understand every aspect of your child’s anomaly. We use state-of-the-art diagnostics, including 3 Tesla MRI, ultrasound, electrocardiograms (ECG/EKG), echocardiograms, blood tests and genetic testing. As a member of the American Society of Pediatric Hematology/Oncology Special Interest Group for Vascular Anomalies and the International Society for the Study of Vascular Anomalies, we are also part of a network of specialists worldwide who review complex cases together, to ensure that we find the answers your family needs.

Patient and Family Education

A Full Range of the Latest Treatment Options

Medication

Medication is an effective treatment for many vascular anomalies. The sooner medication is started, the greater the likelihood that we can prevent the anomaly from growing to a point that requires surgery or more invasive treatment. The most common oral medication is a beta blocker called propranolol, a recent advancement in the treatment of hemangiomas. We also prescribe sirolimus for treatment of lymphatic malformations. We also use a topical beta blocker preparation called timolol. Other medications include corticosteroids and chemotherapy. Some medications may require a hospital stay at first to ensure a child does not experience side effects.

Surgery

Our pediatric surgeons specialize in plastic surgery and head and neck surgery, and perform excision and resection to remove vascular anomalies. Surgery is done at CHOC’s state-of-the-art Tidwell Procedure Center where our ORs are equipped with the latest in technology and safety. We also offer pediatric anesthesiologists who are trained in using the safest dosages of anesthesia for children.

Pulsed Dye Laser Therapy

We offer a pulsed dye laser (PDL), a non-invasive treatment for hemangiomas, port-wine stains, bleeding anomalies, and post-surgical scarring anywhere on the body. The laser delivers very quick pulses of energy at a specific wavelength that is absorbed into the skin, destroying the abnormal blood vessels just below the surface. CHOC uses the latest PDL model—the Vbeam Perfecta—because of its level of precision, which is especially important when lasering sensitive areas like near the eye. Patients are sent home the same day and side effects are very minimal, including slight pain or bruising. Most patients require three to five treatments depending on the severity of the anomaly. Learn more about pulsed dye laser therapy at CHOC.

Embolization and Sclerotherapy

Through our partnership with St. Joseph Hospital, we work with vascular and interventional radiologists to treat vascular anomalies using embolization (injection near the anomaly to block blood flow to it) and sclerotherapy (direct injection of a medication that causes clotting of the channels).

Wound Care

Some vascular anomalies ulcerate, which means the skin becomes red and swollen, and may produce fluid or bleed, and may lead to infection. We have expert wound care staff who are trained to care for even the most severe ulcerations.

Research and Training

Vascular anomalies and hemangiomas are a part of the core curriculum of the CHOC Hematology/Oncology Fellowship Program. Our Vascular Anomalies Center offers residents and fellows the opportunity to participate in a wide variety of cases, from the mild to the highest complexity. Our clinicians are also leaders in research, with publications including:

Treatment Strategies for Airway Hemangiomas. Geetha Puthenveetil, Jill Stites. Abstract presented at the annual meeting of the American Society of Pediatric Hematology and Oncology in May 2015.
Parotid Hemangiomas Require Longer Courses of Treatment with Propranolol. Robin Huffer, Jill Stites, Geetha Puthenveetil. Abstract presented at the annual meeting of the American Society of Pediatric Hematology and Oncology in May 2013.
New Approach in Treating Pediatric Hemangiomas. Jill Stites FNP, Geetha Puthenveetil MD, CHOC. Abstract accepted for a poster presentation at the annual meeting of the American Society of Pediatric Hematology/Oncology in April 2010.
Durr ML. Huoh KC. Meyer AK. Rosbe KW. Airway Hemangiomas in PHACE Syndrome. Laryngoscope 2012 Oct;122(10):2323-9.
Huoh KC. Rosbe KW. Infantile Hemangiomas of the Head and Neck. Pediatric Clinics of North America: Pediatric Otolaryngology. 2013 Aug;60(4):937-49.

Related Features

The Facts about Vascular Anomalies
Dr. Kevin Huoh explains the facts about vascular anomalies and their common treatments.

When Vascular Anomalies Are More Than a Blemish
Dr. Dan Jaffurs discusses when a pediatrician should refer a patient to a vascular anomalies specialist.

Infantile Hemangiomas
Infantile hemangiomas are benign tumors in children, and most often occur in the head or neck area.

Spotlight: Dr. Kevin Huoh
Dr. Huoh was inspired to be a doctor after he was treated for a lymphatic malformation as a child.

New Laser Treats Vascular Anomalies in Children

Many babies are born with small blemishes—a little patch of redness here, a birthmark there. These typically aren’t cause for concern, and most go away on their own. But what if they don’t? A new laser treatment at CHOC is helping children like Casey, who was born with an infantile hemangioma that quickly became a problem.

Frequently Asked Questions about Vascular Anomalies

What is a vascular anomaly?

A vascular anomaly is a type of growth made up of arteries, veins, capillaries or lymphatic vessels. There are two categories of vascular anomalies: vascular tumors and vascular malformations. Vascular malformations are named according to which type of blood vessel is predominantly affected and may also be known as lymphangioma, arteriovenous malformation and vascular gigantism. Sometimes vascular anomalies are referred to as birthmarks, but many birthmarks do not require medical treatment.

How are vascular anomalies treated?

Treatment for vascular anomalies depends on the type of anomaly. Medication is most effective for hemangiomas, and some lymphatic malformations. Laser therapy is usually effective for capillary malformations or port-wine stains, which tend to be flat, violet or red patches on the face. Arterial malformations are often treated by embolization. Venous malformations are usually treated by sclerotherapy. Most often, a combination of these various treatments is used for effective management of the lesion.

What should I do if my child has a vascular anomaly?

If a vascular anomaly is large, growing, bleeding or is affecting body functions like breathing, it should be evaluated by a specialist. Vascular anomalies should also be evaluated by a specialist if they are on the face, near the ear, near the armpit or near the genital/buttocks areas. Talk to your child’s pediatrician about getting a referral to our Vascular Anomalies Center or call us at 714-509-3313 for more information.

If your child is experiencing severe breathing problems or the anomaly is infected or bleeding uncontrollably, call 911 or take your child to the nearest emergency department.