A publication from Japan offers clinical practice guidelines for the management of hemangiomas and vascular malformations. The full list of recommendations was published in the Journal of Dermatology.

The new guideline revised the 2013 practice guideline and is based on research data published from 1980 to the end of September 2014. A committee answered 33 clinical questions related to vascular anomalies and provided a corresponding recommendation for each answer. The first recommendation stated that clinicians should use an individualized approach to judge the time to begin either endovascular or surgical treatment for arteriovenous malformations (AVMs). In addition, the committee recommends clinicians avoid proximal ligation/coil embolization of the feeding artery for treatment of AVM.

Based on the literature, the Japanese guideline recommend a combination of surgical intervention with endovascular embolization for maxillomandibular AVM, depending on the patient. The guideline suggests that laser therapy may be effective for venous malformation (VM) treatment; however, the committee recommends evaluation of the treatment’s net benefit vs its required costs and resources compared with sclerotherapy and surgical resection. Sclerotherapy is recommended to alleviate symptoms of VM and to reduce the size of an associated lesion.


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In terms of capillary malformation (CM), the guideline suggests dye laser treatment may be more effective in the face and neck compared with other regions. The committee recommends early initiation of dye laser irradiation for CM, as laser therapy for patients >1 year of age is effective. For infantile hemangiomas, the guideline recommends oral propranolol therapy under careful monitoring as the possible first treatment choice. Topical therapy is also suggested as a potentially effective option for infantile hemangiomas. Compression therapy, if performed by a physician skilled in the technique, is also suggested as an option for infantile hemangioma.

Several other recommendations were presented in the guideline, including recommendations on surgical resection for lymphatic malformation (LM) of the tongue, sclerotherapy for intra-abdominal LM, aggressive surgical intervention for chylous pleural effusion in the neonatal period, and treatments for refractory chylous pleural.

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Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Mimura H, Akita S, Fujino A, et al. Japanese clinical practice guidelines for vascular anomalies 2017 [published online March 22, 2020]. J Dermatol. doi: 10.1111/1346-8138.15189