What are the roles of medical therapies in treating vascular anomalies?
I think of medical therapies for vascular anomalies in three categories: blood thinners to prevent blood clots, established medicines for vascular tumors and innovative therapies for challenging lesions. In the first category, aspirin or heparin are used to prevent blood clots (or sometimes to prevent bleeding), often around procedures. Since we have a large experience with surgical therapies for vascular lesions, I gained experience with this quickly and now manage these cases routinely. In the second category, some vascular tumors (infantile hemangioma and kaposiform hemangioendothelioma, for example) have been managed with medications for decades. There are new medications for both of these tumors and we are involved in designing protocols to standardize these treatments. The last category is rapidly evolving and fascinating. For patients with vascular lesions for which there aren’t good surgical or interventional options, I’m asked about safe medications to help. This leans on years of research at our center and others (pioneered here by the late Dr. Judah Folkman) and years of trying reasonably safe medicines. We’ve learned which types of medicines works for different types of tumors or malformations, in some cases. I really help do two things. First, I share the experience of our center with a family, patients and referring physician. I summarize what a condition is, how we treat this condition, why we treat it that way, how many patients we’ve had with that condition, etc. The other thing that I do, in collaboration with folks here and with other centers around the country, is design clinical trials to ask the next question, the new question for certain lesions.

Cameron Trenor, MD

What medical therapies do you use?
We recommend medicines that change blood vessels or the interaction of blood with blood vessels. These include common medications like steroids or aspirin or heparin. We use several medications, designed for other reasons, which may have interactions with vascular anomalies. Propranolol is used for infantile hemangioma, but was designed as a blood pressure medication. Sirolimus is approved to suppress the immune system, but is used for certain lymphatic conditions. Numerous drugs designed for and used in cancer patients block blood vessel formation and are important in our field.

Cameron Trenor, MD