The Classification of Vascular Anomalies

There are 2 classifications of vascular anomalies, including vascular tumors and vascular malformations.

The most common type of vascular tumor is infantile hemangioma. Other types of vascular tumors include1:

  • Congenital hemangioma
  • Tufted angioma
  • Kaposiform hemangioendothelioma
  • Spindle cell hemangioendotheliomas
  • Epithelioid hemangioma
  • Hemangioendotheliomas
  • Others

Types of vascular malformations include1:

  • Simple
    • Capillary malformation (CM)
    • Venous malformation (VM)
    • Lymphatic malformation (LM)
    • Arteriovenous malformations
    • Arteriovenous fistula
  • Combined vascular formations
    • Capillary venous malformation (CVM)
    • Capillary lymphatic malformation (CLM)
    • Capillary-arteriovenous malformation (CAVM)
    • Lymphatic-venous malformation (LVM)
    • Capillary-lymphatic-venous malformation (CLVM)
    • Capillary-lymphatic-arteriovenous malformation (CLAVM)
    • Capillary-venous-arteriovenous malformation (CVAVM)
    • Capillary-lymphatic-venous-arteriovenous malformation (CLVAVM)

Anamalies of major named vessels:

  • Anomalies of
    • Origin
    • Course
    • Number
    • Length
    • Diameter
    • Communication (AVF)
    • Persistence (of embryonal vessels)
  • Associated with other anomalies
    • Klippel-Trenaunay sydrome
    • Parkes Weber sydrome
    • Servelle-Martorell sydrome
    • Sturge-Weber sydrome
    • Limb CM+ congenital non-progressive limb hypertrophy
    • Maffucci sydrome
    • Macrocephaly
    • CLOVES sydrome
    • Proteus sydrome
    • Banayan-Riley-Ruvalcaba sydrome

Vascular tumors grow mainly by endothelial cell hyperplasia whereas vascular malformations have a quiescent endothelium (inner lining) and are considered localized defects of vascular morphogenesis.2

While vascular tumors can regress or persist depending on their type, vascular malformations persist throughout a child’s life and never regress. Most vascular malformations have commensurate growth during childhood, and some worsen over time if left untreated.2

For help in differentiating vascular tumors from vascular malformations, you can refer to a specialist. A pediatric dermatologist can help determine a proper diagnosis and find the treatment that is right for your patient.



INDICATION
HEMANGEOLTM oral solution contains the beta-adrenergic blocker propranolol hydrochloride and is indicated for the treatment of proliferating infantile hemangioma requiring systemic therapy.

IMPORTANT SAFETY INFORMATION
HEMANGEOLTM is contraindicated in the following conditions:
  • Premature infants with corrected age <5 weeks
  • Infants weighing less than 2 kg
  • Known hypersensitivity to propranolol or any of the excipients
  • Asthma or history of bronchospasm
  • Heart rate <80 beats per minute, greater than first degree heart block, or decompensated heart failure
  • Blood pressure < 50/30 mmHg
  • Pheochromocytoma
HEMANGEOLTM prevents the response of endogenous catecholamines to correct hypoglycemia and masks the adrenergic warning signs of hypoglycemia, particularly tachycardia, palpitations and sweating.

HEMANGEOLTM can cause hypoglycemia in children, especially when they are not feeding regularly or are vomiting; withhold the dose under these conditions. Hypoglycemia may present in the form of seizures, lethargy, or coma. If a child has clinical signs of hypoglycemia, parents should discontinue HEMANGEOLTM and call their health care provider immediately or take the child to the emergency room.

Concomitant treatment with corticosteroids may increase the risks of hypoglycemia.

HEMANGEOLTM may cause or worsen bradycardia or hypotension. Monitor heart rate and blood pressure after treatment initiation or increase in dose. Discontinue treatment if severe (<80 beats per minute) or symptomatic bradycardia or hypotension (systolic blood pressure <50 mmHg) occurs.

HEMANGEOLTM can cause bronchospasm; do not use in patients with asthma or a history of bronchospasm. Interrupt treatment in the event of a lower respiratory tract infection associated with dyspnea and wheezing.

HEMANGEOLTM may worsen circulatory function in patients with congestive heart failure or increase the risk of stroke in PHACE syndrome patients with severe cerebrovascular anomalies. Investigate infants with large facial infantile hemangioma for potential arteriopathy associated with PHACE syndrome prior to HEMANGEOLTM therapy.

HEMANGEOLTM will interfere with epinephrine used to treat serious anaphylaxis.

The most frequently reported adverse reactions to HEMANGEOLTM (occurring ≥10% of patients) were sleep disorders, aggravated respiratory tract infections, diarrhea, and vomiting. Adverse reactions led to treatment discontinuation in fewer than 2% of treated patients.

The most common ( >3% more often on HEMANGEOLTM than on placebo) adverse reactions reported in the a total of 424 patients treated with HEMANGEOLTM 1.2 mg/kg/day or 3.4 mg/kg/day were sleep disorder (17.5%; 16.1%), bronchitis (8%; 13.4%), peripheral coldness (8%; 6.7%), agitation (8.5%; 4.5%), diarrhea (4.5%; 6.3%), somnolence (5%; 0.9%), nightmare (2%; 6.3%), irritability (5.5%; 1.3%), decreased appetite (2.5%; 3.6%), and abdominal pain (3.5%; 0.4%), respectively.

Adverse events such as cardiac disorders, urticaria, alopecia, hypogylcemia, and bradycardia occurred in less than 1%.

Safety and effectiveness for infantile hemangioma have not been established in pediatric patients greater than 1 year of age.

Please see Full Prescribing Information and Medication Guide .

Important Safety Information
References