What is the place of vascular anomalies in medicine?
Vascular anomalies are interesting because they fall between the cracks of medical care. There are vascular surgeons who take care of large blood vessels (usually arteries and veins) either in the viscera or the legs. There are vascular anomalies in the brain that belong to neurosurgeons. There are cardiac anomalies for pediatric and adult cardiac surgeons and cardiologists. Cardiac surgeons are more interested in the pump, not in the peripheral vasculature. Patients with vascular anomalies become “medical nomads” looking for someone who understands their condition. The field is truly interdisciplinary, covering many surgical as well as medical specialties.
John Mulliken, MD
How is the vascular anomalies field changing?
If physicians are exposed to vascular anomalies during their training, in general, they become more knowledgeable. It is still a much unknown field to most people. The more we learn, the more questions we have, but we do have a good construct that we work from and we understand a lot about the field. We have had a number of visiting clinicians come to our center over the years and we do a lot of training that way. There is now even an international society. Every year we meet it gets larger and larger and like anything that is new – it is catching on.
Joseph Upton, MD
Vascular anomalies are rare and there is growing interest at other centers who have seen our model; because of physician who trained at our center and have now formed other centers, there are now a number of centers with varying degrees of experience in caring for patients with vascular anomalies. That means that it is becoming easier to find local physicians to help, often people we know personally. We’re at an exciting time in the field with centers coming together to share knowledge, challenging patients, and treatment ideas, successes and failures. We’re also now having exciting conversations about designing clinical trials that will be run across multiple centers. For me, it’s an exciting time to be in the field of vascular anomalies and future is very bright.
Cameron Trenor, MD
How do you see the future of the vascular anomalies field?
I think the most important thing that will happen is continuation of understanding and further dissipating the cloud of confusion about the terminology and having better information, both in the medical sphere and in the public sphere. Along with that, I hope and think there will be more physicians who are interested and willing to treat these problems. On a scientific front, I think we’re finally starting to make some progress in understanding what causes these problems genetically, developmentally… We spend millions of dollars trying to figure out the underpinnings of these sort of bizarre conditions. At the same time that we’re more clearly delineating the different types of lesions and their natural history and developing interventional treatments (whether it be surgical or interventional radiology), we’re hoping to develop medications that will help, if not make these things go away, at least help with controlling their disturbing effects. I think there’s a real cause for hope there.
Steven Fishman, MD