FACULTY

Drs. Ernest Chiu & Jeffrey Poole are Co-Directors of the Vascular Anomalies Center of New Orleans at Children's Hospital. They lead a multidisciplinary team consisting of with various specialties such as plastic surgery, dermatology, otorhinolaryngology, interventional radiology, hematology, orthopedics, nursing, and social work. The VACNO team will assist patients and families with evaluating vascular lesions throughout the body. Vascular lesions are a type of birthmark or congenital growth, such as a "hemangioma", which is composed of abnormal blood vessels.

VACNO Sub-Specialties:

Plastic Surgery
Dermatology
Interventional Radiology
Pediatric Radiology
Pediatric Hematology
Pediatric Orthopedics
Pediatric Otorhinolaryngology

COMMONLY ASKED QUESTIONS

What is a "hemangioma"?
Hemangioma is a common, non-cancerous vascular outgrowth (tumor) from the skin. It may first appear as a red mark on a newborn; however, they often times are discovered in the first few weeks of life by parents who remember their infant were born without skin blemishes. Other times, hemangiomas may first be noticed in the nursery as a type birthmark. Their gradual manifestation after birth is due to the tumor growing at a faster rate than the baby is growing. These lesions are also called capillary, strawberry, or cavernous hemangioma.

What causes "hemangioma"?
Hemangiomas result from an imbalance in factors that promote and inhibit cell growth in the lining of blood vessels (endothelial cells). In the beginning, the factors that promote growth are abundant, whereas the inhibitory factors are diminished. This is called the proliferative phase (lasting for about 1 year). After this period, the involution phase begins, and the reversal in level of growth factors is seen. Eventually the tissue that overgrew will begin to regress as cell death is activated. This involutional phase continues for a few years.

Who gets "hemangioma"?
As of yet, we have not identified the source of the imbalance or any risk factors that may predispose families to having hemangiomas. But studies have shown that up to 10% of Caucasian children have hemangiomas, but prevalence increases up to 25% in small premature babies. Female are three times more likely to have these tumors than males. Of those children who have hemangiomas, up to 20% have more than one.

What should parents expect?
For the most part, parents can expect that these benign tumors will not cause major problems because they grow to only a small size. They eventually begin to involute beginning by 1 year and continue over the next 4-6 years. A scar may remain at the site of the tumor.

However, there are occasions in which the tumor may require urgent care. Physicians can refer a child to the Vascular Anomalies Center for vascular tumors that can potentially lead to life-threatening conditions. These conditions include hemangiomas that involve critical anatomical locations (i.e. throat or eye region), associated heart failure or bleeding disorders, as seen in systemic hemangiomatosis or Kasselbach-Merritt syndrome. Another potentially life-threatening event is uncontrollable bleeding from an ulcerating vascular lesion.

Proliferating Forehead Hemangioma

Involuting Forehead Hemangioma

Patient Example 2

Proliferating Cheek Hemangioma

Involuting Cheek Hemangioma

Patient Example 3

Proliferating Abdominal Trunk Hemangioma

Involuting Abdominal Trunk Hemangioma

What is a "vascular malformation"?
These are another type of birthmark, but are true malformations of arteries, veins, capillaries, or lymphatic vessels. These are present at birth, grow with the child, and do not regress as hemangiomas.

Arterio-Venous Malformation

Venous Malformation

How is the correct diagnosis made?
Early proper diagnosis is required to determine the appropriate treatment options. This requires detailed clinical history and examinations. MRI imaging remains the gold standard radiologic study for diagnostic confirmation.

IMAGING STUDIES

We offer state of the art radiological imaging services. At the multidisciplinary conference, all available radiological studies are carefully reviewed by a board-certified radiologist to guide us in making the correct diagnosis!

Sagittal Magnetic Resonance Image of AVM

3-D Computed Tomography Reconstruction of AVM


TREATMENT OPTIONS

Non-Surgical Treatment Options
The most common non-surgical treatment is the use of steroids to inhibit tumor growth. This medication can be given orally, injected locally, or systemically. If this fails, other medications can be administered such as interferon alfa. All non-surgical treatment options should be performed by a qualified physician to follow the treatment progress and possible drug side effects.

Laser Therapy
Laser treatment is also available. However, in certain techniques, only the surface discoloration will fade because the laser beam only penetrates 0.75-1 mm into the skin. The underlying tumor remains, and therefore the discoloration, ulceration, and bleeding may recur as the tumor continues to grow. A different laser treatment is available in which a laser fiber is inserted into the tumor. An experienced technician may be to produce rapid shrinkage, but ulceration is a common complication of this procedure.

Surgical Treatment Options
If non-surgical treatments fail, surgical removal of the tumor may be pursued. This is also warranted in cases in which:

Who is a candidate for the Vascular Anomalies Conference?
Our multi-disciplinary team treats children and adults with vascular anomalies throughout Louisiana, Mississippi, and Gulf Coast region.

When and where is the conference held?
Please see the Conference Location section of the website for the details of the conference.

To be enrolled in our multi-disciplinary VACNO conference, patients must be first seen by a VACNO co-director. Patient medical information, physical examination, and imaging studies are obtained by our physicians on a more personal basis to improve diagnostic accuracy and conference efficiency. Please contact any director to make an appointment:

Ernest S. Chiu, MD
Plastic and Reconstructive Surgery
504-896-2838

Jeffrey Poole, MD
Pediatric Dermatology
504-838-8225