Sandra Hassink, MD, FAAP, an internationally recognized expert in child obesity prevention at Nemours/Alfred I. duPont Hospital for Children, is serving as president of the American Academy of Pediatrics (AAP). Read More »
A vascular malformation is a type of vascular anomaly where a child’s blood vessels have grown abnormally or connected in an unusual way. Most vascular malformations in children form during a baby’s development in the uterus, and some can form after birth.
If your child has a vascular malformation or a hemangioma, you can trust the internationally recognized surgeons, specialists and researchers throughout Nemours Children’s Health System to provide advanced, life-enhancing care for your child and family.
Vascular malformations and tumors vary in size and they can change over time. Depending on the type and location, a malformation may be harmless or potentially life-limiting. Vascular malformations involve four types of vessels:
- arteries, which carry blood from the heart out to the body
- capillaries, the tiny vessels in all parts of the body that allow nutrients in the blood to filter out
- veins, which return blood to the heart
- lymph vessels, which collect fluid from the tissues, channel it to the torso (body core) and return it to the bloodstream.
Vascular malformations in children often involve more than one part of the body, so our multidisciplinary vascular anomaly teams include experts from several specialties: otolaryngologists (also known as ear, nose and throat or "ENT" surgeons), pediatric interventional radiologists, pediatric neurosurgeons, pediatric orthopedists, pediatric plastic surgeons, hematologists (blood specialists), dermatologists and others.
Vascular malformations can affect a child’s physical health, but they may also impact social and emotional development. While there is no single cause for vascular malformations, there are many effective treatments to correct and manage them — and their related conditions — so that your child can live a happy, independent life.
Expert Care You Can Trust
The Nemours vascular anomaly multidisciplinary teams include highly specialized, board-certified and fellowship-trained pediatric interventional radiologists, surgeons and medical specialists who have extensive experience providing innovative, researched-based treatments — including minimally invasive procedures — to children of all ages (from the tiniest newborns to adolescents).
Types of Vascular Malformations in Children We Treat
Vascular anomalies are relatively common, occurring in about 1 in 10 births. At Nemours, we treat nearly every type of pediatric vascular anomaly, from the mildest to the most severe. Some of the vascular anomalies we treat are:
- arteriovenous malformation (a tangle of arteries and veins)
- hemangioendothelioma (a rare vascular tumor that often develops in the womb)
- kaposiform hemangioendothelioma or “KHE” (a rare vascular tumor that usually develops later)
- nevus flammeus (port-wine stain, a common birthmark)
- pyogenic granuloma (a benign skin growth that bleeds easily)
- tufted angioma (a rare benign vascular tumor that appears during infancy or early childhood)
- venous malformation
- combined vascular malformations
- lymphatic malformations (including a cystic hygroma which occurs as a baby grows in the womb)
Vascular anomalies may also be associated with other problems that occur together as a group called a syndrome. The syndromes associated with vascular malformations in children include:
- Gorham-Stout Disease (also called “disappearing bone disease”)
- Hereditary Hemorrhagic Telangiectasia (HHT syndrome)
- Kasabach-Merritt Syndrome (also called Kasabach-Merritt phenomenon, a reduction of platelet levels)
- Klippel-Trenaunay syndrome (port-wine stain, varicose veins and undeveloped lymph system)
- Maffucci syndrome
- Multifocal lymphangioendotheliomatosis with thrombocytopenia (MLT)
- CLOVES syndrome
- Parker-Weber syndrome
- Sturge-Weber syndrome
- Proteus syndrome (also known as Wiedemann syndrome)
- PHACE syndrome (also called PHACE association)
The coordinated multidisciplinary vascular malformation programs at Nemours make it possible for your child to see specialists from areas such as otolaryngology, plastic surgery, dermatology and interventional radiology during a single visit. Our experts work together and with you to develop a treatment plan that cares for your child in the short and long term.
Symptoms of Vascular Malformations in Children
Vascular malformations are usually detected as a visible irregularity of the skin such as a birthmark or lump, an area of a different color or area that may be raised, swelling or bleeding. Sometimes, vascular lesions are hidden under the skin and noticed due to related symptoms such as pain, a tendency to bleed, difficulty breathing or heart problems.
- Conard, Katrina A. , MD
- Corao-Uribe, Diana A. , MD
- Duffy, Brian J. , MD
- Dunn, Stephen P. , MD
- Hicks, Barry A. , MD
- Hyde, Patrice M. , MD
- Johnston, Douglas R. , MD
- Katz, Douglas A. , MD
- Murphy, Stephen G. , MD
- Napoli, Joseph A. , MD
- Powell, Rhoda L , MD
- Rabinowitz, Deborah A , MD
- Sabado, Jeremiah James , MD
- Thacker, Mihir M. , MD
- Ty, Jennifer M. , MD
- Varki, Roslyn T. , MD
- Vinocur, Charles D. , MD
- photo ID
- medical and pharmacy insurance cards
- preferred pharmacy name and phone number
- names and dosage of all medications, including over-the-counter medication, your child is currently taking
- guardianship and custody papers, if a legal guardian rather than a parent accompanies your child
Please provide as much information as possible to Nemours prior to your evaluation with the vascular anomalies team, including:
- medical records pertaining to the condition (including history, prior scans, radiology images/studies, etc.)
- prior images of your child, including photographs, if applicable
- pathology reports, if available
Returning Patient Forms
- Patient Presents Without Legal Guardian (PDF)
English | Spanish
Note: A parent or legal guardian must be with a child for a first visit.
Resources for Patients & Families
- Insurance We Accept: See accepted insurance, listed by location.
- Pay Your Bill: Use online bill pay or send by mail.
- Financial Assistance: Get help with your child's health care expenses.
- MyNemours: Access your child’s medical record online.
- Your Child's Surgery Guide (PDF) in English or Spanish: What to expect before, during and right after surgery.
Our pediatric Vascular Anomalies Program in the Delaware Valley provides advanced diagnostics and treatment for children with a wide range of vascular anomalies (blood and lymphatic vessels that have developed abnormally), including hemangiomas and arteriovenous malformations.
Our coordinated, multidisciplinary program in Delaware is led by Nemours experts who are at the forefront in providing the latest in medical, minimally invasive interventional radiologic, and surgical therapies. Our goals are to restore functionality and cure disease related to vascular lesions in children.
Vascular malformations in children are often medically complex, requiring input and treatment by a number of specialists. In addition to board-certified pediatric interventional radiologists, members of your child’s multidisciplinary vascular anomaly care team at duPont Hospital for Children may include plastic surgeons, neurosurgeons, general surgeons, orthopedic surgeons, otolaryngologists (ear, nose and throat, or “ENT” specialists), pathologists, dermatologists and hematologists/oncologists.
Along with highly qualified nurses, care coordinators and social workers, the team meets regularly to review every diagnosis and track treatment progress. In complex cases, we also teleconference and collaborate with other vascular anomaly experts across the Nemours Children’s Health System.
Learn more about:
To give your child the very best treatment, our Vascular Anomalies Program staff works together as a team with any other specialists who may be involved in your child’s care. We also work closely with the nursing and anesthesiology teams, so everyone involved is well informed on your child’s behalf.
Throughout your child’s care, we count on you as an important member of the team, because no one knows your child better than you do. We know that can be stressful, so we take steps to make sure you and your child understand what’s going on every step of the way — and that you’re coping with all of the emotions and stresses you may be feeling.
In addition to the doctors listed above, your child’s vascular anomaly care team may include:
- geneticists (physicians specialized in genetic testing and counseling)
- radiologists (diagnosis through medical imaging)
- anesthesiologists and pain management specialists (manage pain from surgery, disease or injury)
- gastroenterologists (specialists in disorders of the digestive tract)
- cardiologists (heart specialists)
- pulmonologists (specialists in disease and disorders of the lungs)
- pediatric cardiothoracic surgeons (surgery of the heart and chest)
- social workers (experts who help you cope and find resources for your child)
Our program coordinator will serve as your point of contact for the Vascular Anomalies Program.
Specialized Care for Vascular Malformations in Children and Hemangiomas
The Vascular Anomalies Program at Nemours/A.I. duPont Hospital for Children includes physicians, clinical nurse specialists, advanced registered nurse practitioners (ARNPs) and physician assistants (PAs) who have special training in managing vascular malformations. Because we understand the physical, social and emotional impact a complex medical condition can have on a child during growth and development, we work to restore function and preserve the confidence and happiness that every child deserves.
At Nemours/Alfred I. duPont Hospital for Children, we treat nearly every vascular anomaly from mild to extremely complex cases, including:
- arteriovenous malformations and fistulas
- airway vascular anomalies (including subglotic hemangioma)
- capillary malformations (port-wine stain)
- lymphatic malformations (lymphangioma, cystic hygroma)
- venous malformations
- PHACE association
- pyogenic granulomas
- kaposiform hemangioendotheliomas (KHE)
- CLOVES syndrome
- Klippel-Trenaunay syndrome
- Parkes-Weber syndrome
- Proteus syndrome
- Sturge-Weber syndrome
Vascular malformations in children are sometimes called by descriptive terms, such as port wine stain, strawberry spot or salmon patch and can cause a range of symptoms and signs, including:
- recurrent bleeding
- mass effect (a growing vascular malformation may impair the function of an adjacent organ or tissue)
- exercise intolerance (the heart is unable to provide adequate circulation because the vascular anomaly is diverting oxygen-carrying blood directly into veins, wasting blood flow.)
- vascular bruit (“brew-ee”, a sound produced by high blood flow in a vascular malformation, usually heard with a stethoscope)
- weakness or palsy
Diagnosing and Treating Vascular Malformations in Children
The Diagnostic Process
Your child’s evaluation in the Vascular Anomalies Program will begin with a diagnostic appointment with one of our pediatric experts in vascular malformations and other team members as needed. We can often make a diagnosis at the time of the initial evaluation, but depending on your child’s symptoms and condition, we may recommend additional diagnostic testing (often the same day) and schedule further evaluation with other pediatric specialists — with appointments in days, not weeks.
During your child’s first visit, we’ll:
- obtain your child’s medical history and family medical history
- review your child’s medical records and previously obtained X-rays and tests (if available)
- perform a detailed physical examination
While most conditions can be diagnosed by a physical examination, we may need to order additional tests, including:
- X-rays of the head, neck, chest and abdomen
- CT scans (computed axial tomography, also called CAT scans)
- CT angiography (CT scans with contrast to create detailed 3D images of blood vessels)
- MRI (magnetic resonance imaging)
- ultrasound imaging and flow studies
- nuclear imaging (use of a radioactive tracer to create an image)
More specialized testing such as conventional angiography (a test that uses dye and special imaging to show the insides of your child’s coronary arteries) and CT angiography may be needed to map the precise structure of the vascular malformation, and to determine how the malformation and its treatment might affect normal structures nearby.
Treatments for Vascular Malformations in Children
Treatments for vascular malformations have advanced significantly and now offer many options for families to consider. In the past, “watchful waiting,” was a common approach, and patient families merely hoped for self-resolution as their child grew. Today, all patients have the option, and deserve, an expert evaluation by a specialist.
That’s because every lesion is different and often requires some combination of today’s advanced therapies. The strength of the team approach at Nemours is that every child will be given the latest treatments tailored to the individual lesion. Pediatric vascular anomaly treatment usually consists of:
- Medication Therapy: Medication therapy options for vascular malformations primarily include propranolol (for infantile hemangioma) and sirolimus (for lymphatic malformations, kaposiform hemangioendothelioma).
- Radiologic Intervention: A specially trained pediatric radiologist inserts a long, thin catheter into the blood vessels, and then advances it close to the vascular malformation. Once the tip of the catheter is in or near the malformation, the pediatric interventional radiologist uses a laser or other technique to clot or plug the blood vessels involved in the malformation, cutting off its circulation. Or in some cases, the radiologist may place a needle directly into the lesion using ultrasound guidance and then medications are directly injected.
- Surgery: Surgical options for vascular malformations are tailored to the lesion. This may include open surgery, minimally invasive surgery — including endoscopic and laparoscopic — laser therapy, or injections. The kind of surgery recommended depends on the type, size and location of the vascular malformation. If the vascular malformation is removed, plastic surgery techniques may be used at the same time or in a subsequent surgery to improve the cosmetic appearance of the area.
- clinical trials and participation in national registries
- CO2 superficial laser ablation
- endovenous laser ablation
- surgical resection/debulking
- medication therapies (including propranolol, sirolimus, timolol)
- multidisciplinary procedures when appropriate (including hybrid procedures involving both interventional radiology and surgery)
- pulsed dye laser
Convenient Care and Support for the Entire Family
Our pediatric surgery center is located on the second floor of the duPont Hospital for Children, a hospital set in a beautiful park of oaks and green lawns, and featuring free parking for families.
If your child is getting surgery and needs to stay overnight, we’ve designed the rooms with cheerful décor, including multicolor floors and playful animal wallpaper. Each unit houses a play area/lounge with games, TV, toys, books, tables, couches, highchairs and computers. Kids’ rooms are equipped with a bathroom, a bulletin board to display cards or artwork and a special touch-screen TV that offers entertainment and educational options through a program called the GetWellNetwork. And, to help you be there as much as possible for your child, our rooms allow one parent to stay with their child overnight.
If you need a place to relax, unwind or just take a moment for yourself during your child’s hospitalization, visit the Family Resource Center and Ronald McDonald Family Room, located on the third floor of the hospital. Thanks to this joint project of duPont Hospital for Children and the Ronald McDonald House of Delaware, you can enjoy 24/7 access to:
- kitchenette with microwave to make snacks or a light meal
- laundry facilities
- telephones (with free long distance)
- fax machine
- free Internet access and wireless service
- low-cost vending machines
- library with books and periodicals from the Auxiliary
- comfortable bathroom and shower facilities
- three quiet sleep rooms (reserve by contacting the social worker assigned to your child’s unit)
The Family Resource Center also features an education area, available by appointment, where you can learn skills necessary to care for your child’s special medical needs.
Some of the very same specialists you may see at Nemours/Alfred I. duPont Hospital for Children also provide follow-up appointments at our convenient Delaware Valley specialty care locations.
No matter where your child receives care at Nemours, your medical team (including your primary care provider) can access your child’s medical history, test results and visit notes anytime through our award-winning electronic health record system.
You can also view parts of your child's health records, communicate with your Nemours care team, make appointments, request prescription refills and more through our MyNemours online patient portal.
What to Expect When Your Child is Scheduled for a Catheterization (“Cath”) Study or Treatment
Catheterization is a nonsurgical procedure in which an interventional radiologist inserts a very thin wire or tube called a catheter through blood vessels to reach a vascular malformation. The radiologist may use the catheter to determine how blood vessels flow and connect in the malformation, or use the catheter to treat it. The treatments that can be delivered through a catheter include embolization (blocking), sclerosing (closing off vessels using a chemical that triggers vessel clotting, contraction and closure), or laser coagulation and ablation, which can produce thrombosis (clotting) and closure of blood vessels.
Your child’s doctor and the Vascular Anomalies Program team will discuss the kind of anesthesia or sedation to be used during the catheterization. General anesthesia is often preferred to prevent movement that could interfere with the procedure. Depending on the type of the catheterization your child needs, admission to the hospital and an overnight stay may be required.
What to Expect With Pediatric Surgery
If your child needs surgery, you can trust our pediatric surgical team at Nemours. Our pediatric surgical specialists (surgeons, anesthesiologists and nurses) understand what kids need, psychologically and physically. Our guidebook provides step-by-step instructions and information about what to expect before, during and right after surgery at Nemours/Alfred I. duPont Hospital for Children.
Top 10 Things Kids Need to Know About Surgery
Take your child on a pediatric surgery video tour with Sheridan on her surgery day. This fun, kid-friendly video shows children and teens what to expect, step-by-step, if they need an operation at Nemours/Alfred I. duPont Hospital for Children.