Vascular Anomalies In Children Research Articles

Is the identification of multiple infantile cutaneous haemangiomas always a definitive diagnosis? A case report of an infant with multifocal hepatic haemangioma

Multifocal hepatic haemangiomas are the most common benign vascular tumours of the liver that are detected in children with concomitant multiple infantile haemangiomas. Reported lesions are usually undetectable at birth, which presents a diagnostic problem for general practitioners. Ultrasound should be the imaging examination performed in the first instance in search for vascular anomalies in children. In pharmacotherapy, the first-choice treatment is propranolol, administered orally. In the described case, a boy with multiple hepatic and skin haemangiomas, after treatment with propranolol, achieved a significant improvement in the ultrasound image of the liver. Skin lesions were also reduced. The importance of the physical examination should be emphasised in the context of detecting cutaneous haemangiomas, which usually accompany multifocal hepatic haemangiomas and should prompt the physician to regularly observe and repeat abdominal ultrasound examinations of the diagnosed and/or treated child.

Lymphangiomas in the head and neck region in children

The treatment of lymphangiomas in children is a challenge because of slow but insidious growth, as well as because of infiltrative growth. In the region of the head and neck in children the problem of solving is a very difficult moment. On the one hand, the damage to the organs located in this region, on the other hand, the cosmetic problem and the growth of the child. Surgical treatment is the mainstay in the treatment of lymphangiomas in children, but the only method does not solve the problem in question. The goal. Evaluation of methods of treatment of lymphangiomas in children. Materials and methods. The study was carried out on the bibliographic basis and in particular the treatment of lymphangiomas in children in the head and neck region with pharmaceutical preparations. The ones reported in the bibliography were Sirolimus and Bleomycin. Several parameters were examined in both groups - age, sex, location of neoplasm, treatment and complications following treatment Results. More severe adverse effects were found in the group of children who received Serolim compared to those who were treated by sclerotherapy with Blaomycin. Conclusion Safety is a major concern in the treatment of vascular anomalies in children. The use of Sirolimus is indicated in cases of danger to the child’s life. Further research with randomized controlled trials is needed to establish the benefits of off-label use of sirolimus in these complex pathological processes.

Non-invasive detection of early microvascular changes in juveniles with type 1 diabetes

Aims/HypothesisThe study aimed to assess the usefulness of capillaroscopy and photoplethysmography in the search for early vascular anomalies in children with type 1 diabetes.MethodsOne hundred sixty children and adolescents aged 6–18, 125 patients with type 1 diabetes, and 35 healthy volunteers were enrolled in the study. We performed a detailed clinical evaluation, anthropometric measurements, nailfold capillaroscopy, and photoplethysmography.ResultsPatients with diabetes had more often abnormal morphology in capillaroscopy (68.60%, p = 0.019), enlarged capillaries (32.6%, p = 0.006), and more often more over five meandering capillaries (20.90%, p = 0.026) compared to healthy controls. Meandering capillaries correlated with higher parameters of nutritional status. In a photoplethysmography, patients with diagnosed neuropathy had a higher percentage of flow disturbance curves (p < 0.001) with a reduced frequency of normal curves (p = 0.050).ConclusionsCapillaroscopic and photoplethysmographic examinations are non-invasive, painless, fast, and inexpensive. They are devoid of side effects, and there are no limitations in the frequency of their use and repetition. The usefulness of capillaroscopy and photoplethysmography in the study of microcirculation in diabetic patients indicates the vast application possibilities of these methods in clinical practice.

Endoscopic Resection for Vascular Anomalies in Children: A New Standard.

To report an innovative endoscopic surgery for subcutaneous vascular malformations and intramuscular fibro-adipose vascular anomaly (FAVA) at our center. Historically, open surgical resection has been the treatment of choice. Recent advances in minimally invasive surgery have led to the successful application of endoscopic resection techniques for the surgical management of diseases of soft tissue. Patients who underwent endoscopic resection of vascular anomalies were included in this retrospective review. Data were extracted from our Vascular Anomalies Center database between September 2019 and October 2022, including sex, age, symptoms, diagnosis, sites of surgery, previous treatment, surgery, and follow-up. There were 13 females and 15 males in the current study, with ages ranging from 1 to 17 years. The diagnoses included microcystic lymphatic malformation (LM) (n = 8), Klippel-Trénaunay syndrome (n = 7), venous malformation (n = 6), FAVA (n = 6), and mixed cystic LM (n = 1). Surgical sites included the lower extremity (n = 24), abdominal wall (n = 2), upper extremity (n = 1), and thoracic wall (n = 1). Five patients had an intramuscular lesion (FAVA). The endoscopic technique used 2 or 3 small ports in a gas inflation manner. Surgery included thrombectomy, radical resection, and debulking of vascular anomalies. Postoperative sclerotherapy with bleomycin was performed through a drainage tube in 6 patients with microcystic LM. Technical success was obtained in 27 patients. The conversion to open surgery was performed in one patient owing to the deep location of the lesion. No wound-related complication was observed. Endoscopic surgery is a minimally invasive, effective, and safe treatment for subcutaneous vascular malformations and intramuscular FAVA. This approach can set a new standard that minimizes wound complications and reduces recovery time in patients undergoing resection for benign soft-tissue lesions.

Prevalence and clinical features of orbital vascular anomalies in children

ABSTRACT Purpose To report the prevalence, clinical characteristics, and natural history of orbital vascular anomalies diagnosed among children over a 50-year period. Methods The medical records of all patients <19 years diagnosed with any form of an orbital vascular anomaly (OVA) at Mayo Clinic, Rochester, Minnesota from January 1 1966, through December 31 2015, were retrospectively reviewed. Results A total of 109 children were diagnosed with OVA during the 50-year period, of which 24 were from Olmsted County, MN, yielding a birth prevalence of 1 in 4,305 live births. The median age at diagnosis for the 109 patients was 1.2 years (range, 0–17.9 years) and 67 (61.5%) were female. Common presenting symptoms included proptosis in 80 (73.4%) patients, abnormalities in skin color in 45 (41.3%) patients, and pain in 18 (16.5%) patients. There were 55 (50.5%) vascular malformations [50 (91%) low-flow lymphatic malformations, 3 (5.5%) high-flow arteriovenous malformations, and 2 (3.5%) low-flow venous malformations] and 54 (49.5%) vascular tumors [53 (98%) capillary hemangiomas and 1 (2%) kaposiform hemangioendothelioma]. During a mean follow-up of 5.95 years (range 0–27.7 years), amblyopia and/or strabismus were diagnosed in 46 (43.4%) patients. Conclusions Capillary hemangiomas and low-flow lymphatic malformations comprise most of the orbital vascular anomalies in this cohort of children. Amblyopia and strabismus are common sequelae, highlighting the importance of early diagnosis and appropriate management.

Birthmarks and Vascular Anomalies in Children: Classification, Diagnosis and Management

Birthmarks are a common presentation among newborns and the majority do not require any medical intervention. However, vascular anomalies, which are an umbrella of diverse pathological conditions require special attention for a multitude of factors. Vascular anomalies lesions can appear at any stage of development, including prenatal, perinatal, and childhood. They are broadly classified as vascular malformations and vascular tumours. While many lesions have a straightforward natural course, more complex, extensive, or progressive lesions can pose a threat to life due to mass effects and severe complications including haemorrhage, or high-volume arteriovenous shunting. Infantile haemangioma, congenital haemangioma, and kaposiform hemangioendothelioma are the sub-classifications of vascular tumours, with infantile haemangioma being the most prevalent. Depending on the nature, location, extent, and accompanying manifestations of the tumour, there are several management options for vascular tumours, including conservative methods, pharmacological therapy, and surgical intervention. Low-flow and high-flow lesions are two subcategories of vascular malformations. Capillary, venous, and lymphatic malformations are examples of low-flow lesions, while arteriovenous malformations, a highly varied set of lesions that can present in a number of ways, are classified under high-flow lesions. Endovascular or surgical obliteration is the basis of treatment for these dynamic lesions. The purpose of this research is to review the available information about birthmarks and vascular anomalies in children; classification, diagnosis, and management.

The paediatric oncologist and the evolving medical management of complex vascular anomalies: An institutional experience

Background: Complex vascular anomalies in children are amenable to medical therapy that can result in complete resolution or improvement in cosmesis and function or serve as a conduit to definitive surgery.Aim: This study aimed to retrospectively review the management and outcomes of children with complex vascular anomalies.Setting: The study was conducted at a haematology/oncology unit based out of a paediatric hospital in the Western Cape.Methods: All patients with biopsy-proven lesions and those diagnosed on magnetic resonance imaging (MRI) from 01 January 2005 to September 2021 were considered eligible for inclusion.Results: Twenty-five patients presented with a variety of capillary, venous and lymphatic malformations. There were 11 males and 14 females, with a median age of 35 months at presentation (range: 0–156 months). Patients presented with a mass or compartmental enlargement, cutaneous stigmata or bleeding. Hepatic haemangioendotheliomas, kaposiform haemangioendotheliomas and capillary haemangiomas were most common. Kassabach-Merritt syndrome was present in 5/25 (20%) patients. Prednisone, propranolol and vincristine were the most commonly employed first-line medical treatments (15/21; 47.6%). Twelve patients received sirolimus, (11/21; 52%), four as single agent first-line therapy and eight as combination therapy, complicated by transient hyperlipidaemia in only one patient. All but one patient survived: 10 are disease free and 12 are alive with disease. Two patients with Gorham’s disease are maintained on long-term low-dose Sirolimus.Conclusion: The medical management of complex vascular anomalies yields good results in children. Sirolimus is well tolerated with few manageable side effects with cost being the only prohibitive factor to its broader application.

Pelviureteric Junction Obstruction Due to Vascular Anomalies in Children - Simple Surgical Options.

ABSTRACTAims:Pelviureteric junction obstruction (PUJO) due to aberrant lower polar artery is conventionally managed with pyeloplasty. We present our experience of managing PUJO due to “vascular” anomalies-aberrant lower polar artery and vascular adhesions with simpler surgical options.Subjects and Methods:This is a protocol based, retrospective study of PUJO. Preoperative investigations included ultrasonography (USG) and diuretic renogram. An intraoperative methylene blue test (MBT) assessed transit across the Pelviureteric junction (PUJ) after release of vascular compression. Surgical management included adhesiolysis for vascular adhesions and pyelopyelostomy anterior to the aberrant polar artery. Postoperative studies were repeated after 3 and 6 months.Results:Fourteen of 144 PUJO (9.7%) were “vascular” obstructions. Those with vascular adhesions (six) were largely infants with antenatal hydronephrosis. Children with aberrant lower polar artery (eight) were older, had fleeting symptoms, minimally increased pelvic diameter and subtle impairment on diuretic renogram. Majority were term males with urinary tract infection. The MBT showed normal transit across the PUJ in all. Postoperatively, there was progressive improvement on USG and diuretic renogram after 3 and 6 months. None had any complication or redosurgeries. At a mean follow-up of 41.2 months, all are asymptomatic.Conclusions:PUJO due to extrinsic vascular anomalies is rare. Intraoperative evaluation with the MBT ruled out associated intrinsic pathology. We describe two simple surgical alternatives preserving the normal PUJ - adhesiolysis for vascular adhesions and pyelopyelostomy for aberrant lower polar artery. The preliminary outcomes are comparable to conventional pyeloplasty.

Approach to clinically significant vascular anomalies in children.

Vascular anomalies consist of tumours or malformations made up of abnormal growth or collections of blood vessels that can result in functional or cosmetic problems. While many vascular anomalies are present at birth, some do not appear until later in life, making diagnosis more challenging. Although many vascular anomalies are benign, some are associated with serious complications and may involve multiple organ systems. This article highlights the important features of clinically significant vascular anomalies to help physicians promptly identify and refer these cases to a specialised multidisciplinary team for evaluation and management. The discussion includes the various presenting complaints of vascular anomalies in children, namely, rapidly growing birthmarks, painful lesions, seizures/neurological manifestations, bleeding diathesis, cardiac/airway abnormalities and part of an overgrowth syndrome.

Gastrointestinal Bleeds.

Gastrointestinal Bleeds.

Expression of β1 adrenergic receptor in vascular anomalies in children.

ObjectiveControversial, heterogeneous, and inconsistent responses to beta-blockers have been reported in some cases of infantile proliferative hemangiomas. On the basis of these clinical observations, we aimed to examine the β1 adrenergic receptor (β1-AR) protein expression distribution among different types of pediatric vascular anomalies.MethodsImmunohistochemistry (IHC) was performed for β1-AR on 43 surgical specimens.ResultsWe found positive β1-AR IHC staining in all intramuscular hemangiomas, capillary–lymphatic, lymphatic, venous, and combined malformations, and Masson’s tumor cases, as well as in 7 of 10 cases of proliferative infantile hemangiomas.ConclusionsOur research demonstrates, for the first time, the degree of heterogeneous expression of β1-AR among pediatric vascular malformations. Our results support the need for β1-AR assessment in pediatric vascular anomalies to select cases with a robust response to β1-selective blockers. β1-AR assessment may have a strong impact on therapeutic refinement for pediatric vascular anomalies by selecting cases with a stronger response to beta-blockers.

Sirolimus for the treatment of vascular anomalies in children

Vascular anomalies (VA) comprise a heterogeneous group of diseases associated with congenital angiogenesis disorder. There are no currently developed unified protocols and treatment regimens for systemic forms of VA. Numerous advantages show sirolimus, an mTOR inhibitor, as a well tolerated and effective antiproliferative and antiangiogenic therapy in patients with VA. The article presents the results of treatment of 211 patients with VA (6 patients with vascular tumors and 205 patients with vascular malformations) aged 2 months to 17 years (median – 9 years), who received sirolimus therapy for 1–86 months (median – 24 months). Sirolimus was administered at a starting dose of 0.8 mg/m2/day orally in two doses with an interval of 12 hours. The concentration of the blood preparation was maintained in the therapeutic range of 6–15 ng/ml. Since 2015, concomitant therapy with co-trimoxazole for the prevention of Pneumocystis pneumonia has been prescribed only to tracheostomy carriers. When infectious episodes occurred in patients, sirolimus therapy continued without changes in the dose of the drug and did not affect the disease, provided that the therapeutic concentration was maintained. A positive response to therapy was observed in 89.1 % of patients with VA in the form of the size of the vascular mass according to the data of visual examination and instrumental control. All patients showeda clinical response to therapy in the form of relief of painsyndrome, reduction/relief of lymphorrhea, reduction/improvement of hemostasis parameters, and an increase in functional activity and quality. For the entire observation period 2012–2020, when taking sirolimus, not a single severe adverse event occurring in post-transplant patients has been reported that would require discontinuation of the drug. The article presents two clinical cases of sirolimus use in the treatment of patients with kaposiform hemangioendothelioma and extensive venous malformation. Parents are encouraged to use the information in scientific research and publications.

High-Flow Vascular Malformations in Children.

Children can have a variety of intracranial vascular anomalies ranging from small and incidental with no clinical consequences to complex lesions that can cause substantial neurologic deficits, heart failure, or profoundly affect development. In contrast to high-flow lesions with direct arterial-to-venous shunts, low-flow lesions such as cavernous malformations are associated with a lower likelihood of substantial hemorrhage, and a more benign course. Management of vascular anomalies in children has to incorporate an understanding of how treatment strategies may affect the normal development of the central nervous system. In this review, we discuss the etiologies, epidemiology, natural history, and genetic risk factors of three high-flow vascular malformations seen in children: brain arteriovenous malformations, intracranial dural arteriovenous fistulas, and vein of Galen malformations.

Imaging Approach to Suspected Vascular Anomalies in Children

The purpose of this review is to become familiar with the terminology and typical presentation of vascular anomalies in children and to present the imaging approach to these anomalies. Vascular anomalies are the most common cause of soft-tissue masses in children. Many physicians are not familiar with the correct terminology for vascular anomalies which results in errors in diagnosis, prognosis, and treatment. The updated International Society for the Study of Vascular Anomalies classification, based on the original Hamburg classification, divides vascular anomalies into two types: vascular tumours (haemangiomas) and vascular malformations (venous, lymphatic, arteriovenous). Grey-scale and Doppler ultrasound (US) are the initial imaging modalities in suspected vascular anomalies. Grey-scale US is highly nonspecific. Therefore, a diagnostic algorithm based on grey-scale and Doppler signs is proposed. Spectral Doppler analysis reveals the type of vascular flow present within the lesion: high-flow is typical for infantile haemangiomas and arteriovenous malformations, low-flow for venous and noflow for lymphatic malformations. Magnetic resonance imaging with angiography is indicated only when US has not been diagnostic, when the lesion is too big or lies too deeply, and when information about the accurate anatomic location and possible infiltration of surrounding structures is necessary. Digital subtraction angiography is performed when interventional treatment is considered. Conclusion − The new terminology of vascular anomalies should be used in everyday clinical practice to avoid misunderstandings. Grey-scale and Doppler US are the most important imaging modalities for the accurate diagnosis and follow-up of vascular anomalies in children.

Prevalence and clinical features of orbital vascular anomalies in children

While vascular anomalies have been reported to occur in up to 1% of children, there are no population-based studies describing the prevalence of orbital vascular anomalies. The purpose of this study was to report the birth prevalence, demographics, and ocular sequelae of orbital vascular anomalies diagnosed in children over a 50-year period.

Efficacy and absorption of topical sirolimus for the treatment of vascular anomalies in children: A case series.

Efficacy of topical sirolimus has recently been described in lymphatic anomalies but not in other types of vascular anomalies. To our knowledge, systemic absorption of topical sirolimus in these lesions has not yet been reported. The objective was to evaluate the efficacy, tolerance, and absorption of topical sirolimus 0.1% with different types of vascular anomalies in children. Sirolimus 0.1% was applied on cutaneous vascular anomalies in six children aged 2-17. These anomalies consisted of three extratruncular micro- and macrocystic lymphatic malformations and one each verrucous venous malformation, truncular lymphatic malformation with angiokeratomas, and infantile hemangioma. Sirolimus blood levels were measured after 1week, 1month, and 3months. A rapid decrease in the size of superficial lymphatic malformations in three of six patients and a significant decrease in discharge from oozing lesions were observed. Response occurred in less than 3months. The truncular lymphatic malformation, verrucous venous malformation, and infantile hemangioma did not respond to topical sirolimus. Sirolimus levels were undetectable. Adverse effects were limited to local irritation. Topical sirolimus 0.1% is a useful treatment for cutaneous manifestations of extratruncular lymphatic malformations. The only adverse effect is local irritation. No systemic effects are expected, because blood levels are clinically insignificant.

Role of 128 slice MSCT angiography in evaluation of congenital extra-cardiac intra-thoracic vascular anomalies in children

PurposeTo investigate the value and highlight the role of multi slice computed tomography (MSCT) angiography in evaluation of extra-cardiac intra thoracic vascular anomalies in children. Patients and methodsThis study included 24 patients (13 males and 11 females) with an age range of 1month–13years. All of these patients were clinically diagnosed to have congenital heart disease with suspected extracardiac vascular anomalies. All underwent prospective ECG-gated MSCT angiography after trans-thoracic echocardiography (TTE). Iterative reconstruction techniques were applied to reduce the radiation dose in MSCT angiography with the mean radiation dose of (4mSv). The diagnostic accuracy and sensitivity of MSCT angiography and TTE were compared in comparison with surgical outcome. ResultsThe most common congenital extra cardiac vascular anomalies are PDA (45.8%) and aortic coarctation (37.5%). The major CT angiographic findings missed by TTE were coronary artery anomalies, absence of a pulmonary artery and pulmonary artery stenosis. The overall sensitivity of the MSCT angiography in diagnosis of the extra-cardiac vascular anomalies was 98.1% which was higher than that of TTE 80%. ConclusionCG gated MSCT angiography is an accurate modality for demonstrating extra cardiac structures in complex CHD. It provides important complementary information to TTE with regard to extra cardiac vascular structures and coronary artery anatomy. This modality may reduce the need for high radiation dose invasive diagnostic cardiac catheterization.

RADIOLOGICAL VISUALIZATION OF VASCULAR ANOMALIES IN CHILDREN

Background. Clinical diagnosis of vascular anomalies is often dif ficult. The informative of dif ferent instrumental evaluations isn’t the same in terms of visualization of vascular anomalies. Purpose: to establish the diagnostic value and informative of different visualization’s methods of vascular anomalies in children. Methods. The study included 194 patients with vascular anomalies in age from 1 month to 16 years. According to the updated ISSVA classification 2014, vascular anomalies divided into vascular tumors and vascular malformations (VMs). Vascular tumors are diagnosed in 95 patients, in particular, infantile hemangiomas (IHs) of soft tissues (80.0%), liver hemangiomas (5.3%), airways IHs (5.3%), IHs as a part of PHACE syndrome (2.1%). Rare vascular tumors were in 7 (7.3%) patients. In 99 patients VMs diagnosed: lymphatic malformations (LM) in 86.8%, venous malformations in 8.1%, and combined VMs in 5.1% of children. Results. Ultrasound examinations performed as a primary method and follow-up studies. The activity of His was determined by the ratio of small diameter vessels and solid tissue. CT with contrast enhanced and MRI performed in 5.3% patients with IHs of soft tissue with atypical clinical presentations and in patients with airway His (9.3%). To confirm the diagnosis of the liver hemangiomas the CT with contrast enhanced performed. In 4.4% patients with well localized cystic LM performed ultrasound only, all other patients underwent MRI. CT scans performed in 10.2% children with LM of head and neck and symptoms of airway compression as emergency diagnostic procedure. The peculiarity of VM is phleboliths formation. It can be detected as ultrasound, so X-ray examination but to determine the distribution of process is the most informative is MRI. Arteriovenous malformation in CDS scale has the same characteristic as the IHs in proliferative phase. So if these features are revealed in older children CT with contrast enhanced is necessary . Conclusions. For the diagnosis of vascular anomalies the primary investigation is ultrasound examination. The “gold standard” for diagnosis of slow-flow VM is the MRI. For the diagnosis of high flow VM informative is the CT scan with contrast enhanced.

Surgical management of vascular anomalies in children at a tertiary care hospital in a resource-limited setting: a Tanzanian experience with 134 patients.

BackgroundVascular anomalies pose major diagnostic and therapeutic challenges among pediatricians and pediatric surgeons practicing in resource limited countries. There is paucity of published data regarding this subject in Tanzania and Bugando Medical Centre in particular. This study describes our experiences on the challenges and outcome of surgical management of childhood vascular anomalies in our environment.MethodsBetween January 2009 and December 2013, a prospective study on the surgical management of vascular anomalies was undertaken at Bugando Medical Centre.ResultsA total of 134 patients (M; F = 1:2.5) were studied. The median age at presentation was 6 years. Of the 134 patients, 101 (75.4 %) were diagnosed as having vascular tumors and 33 (24.6 %) had vascular malformations. The head and the neck were the most frequent anatomical site recorded as having a tumor (56.7 % of patients). Out of 134 patients, 129 (96.3 %) underwent surgical treatment. Failure to respond to non-operative treatment (86.8 %), huge disfiguring/obstructing mass (4.7 %), infection (3.1 %), ulceration (3.1 %) and hemorrhage (2.3 %) were indications for surgical intervention. Tumor excision and primary wound closure was the most common type of surgical procedure performed in 80.6 % of patients. Surgical site infection was the most frequent complications accounting for 33.8 % of cases. Mortality rate was 1.5 %. Tumor excision and primary wound closure gave better outcome compared with other surgical options (p < 0.001). Outcome of injection sclerotherapy in 3 (3.7 %) children, serial ligation of feeder vessels employed in 2 (1.6 %), and conservative treatment in 5 (3.7 %), were poor and required conversion to surgical excision. Despite low mortality rate recorded in this study, but ugly scar, 14 (20.6 %) and limb deformity, 6 (8.8 %) were problems. The overall result of surgical treatment at the end of follow up period was excellent in 108 (87.1 %) patients.ConclusionSurgical excision and primary wound closure gave good outcome which could be employed in complicated and vascular anomalies which failed to respond to other treatment in regions with limited resources.

Vascular anomalies of the head and neck in children.

Sixty percent of vascular anomalies in children are found in the head and neck. These lesions can present throughout antenatal, perinatal and childhood development. They broadly fall into two categories: vascular tumours and vascular malformations. Their clinical and, often, psychological impact is determined by both pathological type and location: many lesions follow an uncomplicated natural course and other more complex, extensive or progressive lesions can present a threat to life from mass effect, haemorrhage or large volume arteriovenous shunting. Vascular tumours include infantile haemangioma (IH), congenital haemangioma (CH) and kaposiform hemangioendothelioma (KH); of which IH is the most common. Management options for vascular tumours include conservative approaches, oral medications and surgical intervention as determined by tumour type, location and associated complications. Vascular malformations can be categorised into low flow and high flow lesions. Low flow lesions include capillary, venous and lymphatic malformations (LMs). High flow lesions describe the arteriovenous malformations (AVMs), a highly heterogeneous group of lesions which can present in a variety of ways-the mainstay of treatment for these dynamic lesions is endovascular or surgical obliteration. We provide a practical framework for clinical classification of vascular anomalies of the head and neck in children. We also explore principles of their clinical and radiological assessment along with management, highlighting the importance of a multi-disciplinary approach.