Multidisciplinary Treatment Needed for Vascular Anomalies

Physicians in MVACs manage relatively large volumes of these relatively rare anomalies, which enables them to recognize favorable treatment plans. It also allows them to recognize treatment complications and to challenge the use of certain medications. In the 1990s, interferon (IFN) was advocated to treat symptomatic hemangiomas. A decade later, however, the association between spastic diplegia (SD) and IFN use during early infancy was recognized, and the drug is no longer advocated except in life-threatening circumstances. This illustrates how acceptable treatments can quickly become unacceptable when side effects outweigh their benefit.

The ability to assess long-term outcomes across generations of physicians is another advantage of MVACs. I cared for two women with massive arteriovenous malformations (AVMs) of their faces, whose care had all been provided at a single institution by several generations of physicians across the span of 30 years. Reviewing the yellowed preoperative and postoperative black-and-white photos would make one marvel at the impressive outcome. The cure afforded them a great life for many years, but was of course temporary and, over time, the lesions recurred, tapping into vessels from the internal carotid artery and abolishing the surgeon’s work. I can only hope that future generations of physicians will look at our management and know that we were doing the best we could at the time of our care.

The commitment of a health care institution to foster a MVAC is a tremendous one, as the revenue from such a clinic often pales in comparison to that from multiple single-specialty clinics. I typically see half the number of patients in the MVAC at Children’s National Medical Center that I would see in my otolaryngology clinic, and I see them in conjunction with four other faculty members from various disciplines. The presence of an otolaryngologist on MVACs is of vital importance, however, to preserve our role in treating lesions of the face and neck.

Physicians who have experience in treating vascular anomalies, but who do not have the opportunity to be part of a MVAC, can still benefit by orchestrating a referral of their patients to a MVAC. The goal of MVACs is to improve patient management, and rendering an opinion regarding treatment rather than assuming the care of the patient is in the clinic’s, patient’s, and referring physician’s best interest.

Treating vascular anomalies is a constant challenge, but it is a rewarding one. Fortunately, many are easy to treat, and they keep us in the arena to prepare for those that are not. I am hopeful that our continued efforts in conducting basic science research and outcome-based clinical studies will be fruitful and improve our ability to treat patients with these anomalies.