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Bouwman FCM, Verhoeven BH, Klein WM, Schultze Kool LJ, de Blaauw I. Congenital Vascular Malformations in Children: From Historical Perspective to a Multidisciplinary Approach in the Modern Era-A Comprehensive Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:567. [PMID: 38790562 PMCID: PMC11119901 DOI: 10.3390/children11050567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
Congenital vascular malformations (CVMs) are the result of an aberrant development during embryogenesis. Although these lesions are present at birth, they are not always visible yet. Once symptomatic, patients suffer from pain, bleeding, ulcers, infections or lymphatic leakage, depending on the subtype of vessels involved. Treatment includes conservative management, surgery, sclerotherapy, embolization and pharmacological therapy. The clinical presentation varies widely and treatment can be challenging due to the rarity of the disease and potential difficulties of treatment. This review gives an overview of the historical developments in diagnosis and classification and exposes the key elements of innovations in the past decades on the identification of genetic mutations and personalized treatment. These advances in the field and a multidisciplinary approach are highly valuable in the optimization of clinical care aimed at both curing or stabilizing the CVM and pursuing physical and psychosocial wellbeing.
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Affiliation(s)
- Frédérique C. M. Bouwman
- Department of Pediatric Surgery, Amalia Children’s Hospital, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.C.M.B.); (B.H.V.)
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.K.); (L.J.S.K.)
- Hecovan Center of Expertise for Hemangiomas and Vascular Malformations Nijmegen, VASCERN VASCA European Reference Center, Amalia Children’s Hospital, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Bas H. Verhoeven
- Department of Pediatric Surgery, Amalia Children’s Hospital, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.C.M.B.); (B.H.V.)
- Hecovan Center of Expertise for Hemangiomas and Vascular Malformations Nijmegen, VASCERN VASCA European Reference Center, Amalia Children’s Hospital, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Willemijn M. Klein
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.K.); (L.J.S.K.)
- Hecovan Center of Expertise for Hemangiomas and Vascular Malformations Nijmegen, VASCERN VASCA European Reference Center, Amalia Children’s Hospital, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Leo J. Schultze Kool
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.K.); (L.J.S.K.)
- Hecovan Center of Expertise for Hemangiomas and Vascular Malformations Nijmegen, VASCERN VASCA European Reference Center, Amalia Children’s Hospital, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Amalia Children’s Hospital, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.C.M.B.); (B.H.V.)
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Alway T, Bastiaenen R, Pantazis A, Robert L, Akilapa R, Whitaker J, Page SP, Carr-White G. The development of inherited cardiac conditions services: current position and future perspectives. Br Med Bull 2024:ldae003. [PMID: 38400770 DOI: 10.1093/bmb/ldae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Over the last two decades, inherited cardiac conditions (ICC) centres have emerged with the aim of improving outcomes for patients and their families, through early diagnosis, genetic testing, risk assessment and specialist treatment. SOURCES OF DATA A literature search was performed using PubMed (https://pubmed.ncbi.nlm.nih.gov/). Commissioned ICC service reviews from NHS England, NHS Improvement and PHG Foundation were evaluated. AREAS OF AGREEMENT ICC patient management requires a multi-disciplinary approach. ICC services are predominantly based within tertiary centres. Despite expansion, provision of care remains inadequate to meet rising demands. Access to services is inconsistent, partly due to geographic variation and lack of standardized pathways. AREAS OF CONTROVERSY The optimal ICC care model remains undecided, although there is growing interest in 'hub-and-spoke' networks, which could aid secondary and tertiary service integration and repatriation of care. GROWING POINTS Genetic mainstreaming is a priority for the Genomic Medicine Service Alliance. The benefits of telehealth and virtual clinics have been validated by their use during the COVID-19 pandemic. Other innovations to improve resource efficiency, such as clinical scientist-led and nurse-led clinics, show promise. AREAS TIMELY FOR DEVELOPING RESEARCH An update for the NHS ICC service specifications is planned that appears well timed given the rapid evolution of the ICC landscape in the decade since last review. This has the potential to address needs including national audit, standardized pathways and ICC networks to improve governance and equity of care. Delegation of commissioning for specialist services to integrated care systems may also provide opportunity for increased regional direction.
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Affiliation(s)
- Thomas Alway
- University Hospitals Sussex NHS Foundation Trust, Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton, East Sussex, BN2 5ND,UK
| | - Rachel Bastiaenen
- Guys and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Antonis Pantazis
- Royal Brompton and Harefield Hospitals, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - Leema Robert
- Guys and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Rhoda Akilapa
- Guys and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - John Whitaker
- Guys and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Stephen P Page
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Gerald Carr-White
- Guys and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Bouwman FCM, Verhaak C, de Blaauw I, Kool LJS, Loo DMWMT, van Rooij IALM, van der Vleuten CJM, Botden SMBI, Verhoeven BH. Health-related quality of life in children with congenital vascular malformations. Eur J Pediatr 2023; 182:5067-5077. [PMID: 37665335 PMCID: PMC10640403 DOI: 10.1007/s00431-023-05166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
A cross-sectional study was performed to evaluate health-related quality of life (HRQOL) in children with congenital vascular malformations (CVM) and to investigate factors associated with an impaired HRQOL. Children (2-17 years) with CVMs who visited the HECOVAN expertise center between 2016-2018 were included. The PedsQL 4.0 Generic Core Scales were used and a score ≥ 1.0 SD below the normative mean was defined as an impaired HRQOL. Factors associated with impairment were investigated using univariate and multivariate logistic regression analysis. The median overall HRQOL was 84.8/100 (n = 207; 41% boys, 59% girls; self-reported IQR 73.9-92.4 and parent-reported IQR 71.4-92.4). Patients aged 13-17 years reported significantly worse physical functioning than those aged 8-12 years (median 84.4, IQR 71.1-93.8 versus median 90.6, IQR 81.3-96.9; p = 0.02). Parents reported a significantly lower overall HRQOL than their children (median 80.4, IQR 70.7-90.8 versus median 85.9, IQR 76.1-92.4; p = 0.001). HRQOL was impaired in 25% of patients. Impairment occurred significantly more often in lower extremity CVMs (38%, p = 0.01) and multifocal CVMs (47%, p = 0.01) compared to CVMs in the head/neck region (13%). Other associated factors included invasive management (31% versus 14%; p = 0.01), age at first treatment ≤ 5 years (48% versus 25%; p = 0.02) and ongoing treatment (38% versus 18%; p = 0.004). After correction for other factors, significance remained for lower extremity CVMs and ongoing invasive treatment. CONCLUSIONS Overall median HRQOL was reasonable and not significantly different from the norm sample. Parental ratings were significantly lower than their children's ratings. A quarter of the patients had an impaired HRQOL, which seemed to worsen with age. Independently associated factors included a lower extremity CVM and invasive management. WHAT IS KNOWN • Congenital vascular malformations could affect health-related quality of life (HRQOL). • Studies on pediatric patients are limited and either very small or in combination with adult patient series. WHAT IS NEW • This study raises awareness of an impaired HRQOL in 25% of pediatric patients with congenital vascular malformations. • Associated factors included a lower extremity CVM and invasive management.
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Affiliation(s)
- Frédérique C M Bouwman
- Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
- Department of Radiology and Nuclear Medicine, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
- Radboudumc Center of Expertise for Vascular Anomalies Hecovan, VASCERN VASCA European Reference Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Chris Verhaak
- Department of Medical Psychology, Radboudumc, Nijmegen, the Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Leo J Schultze Kool
- Department of Radiology and Nuclear Medicine, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
- Radboudumc Center of Expertise for Vascular Anomalies Hecovan, VASCERN VASCA European Reference Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - D Maroeska W M Te Loo
- Radboudumc Center of Expertise for Vascular Anomalies Hecovan, VASCERN VASCA European Reference Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
- Department of Pediatric Hematology, Radboudumc-Amalia Children's Hospital, Nijmegen, the Netherlands
| | | | - Carine J M van der Vleuten
- Radboudumc Center of Expertise for Vascular Anomalies Hecovan, VASCERN VASCA European Reference Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
- Department of Dermatology, Radboudumc, Nijmegen, the Netherlands
| | - Sanne M B I Botden
- Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
- Radboudumc Center of Expertise for Vascular Anomalies Hecovan, VASCERN VASCA European Reference Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Bas H Verhoeven
- Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
- Radboudumc Center of Expertise for Vascular Anomalies Hecovan, VASCERN VASCA European Reference Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
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van de Laar IMBH, Baas AF, De Backer J, Blankenstein JD, Dulfer E, Helderman-van den Enden ATJM, Houweling AC, Kempers MJ, Loeys B, Malfait F, Robert L, Tanteles G, Frank M. Surveillance and monitoring in vascular Ehlers-Danlos syndrome in European Reference Network For Rare Vascular Diseases (VASCERN). Eur J Med Genet 2022; 65:104557. [PMID: 35779834 DOI: 10.1016/j.ejmg.2022.104557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/03/2022] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
Abstract
Vascular Ehlers-Danlos syndrome (vEDS) is a rare genetic disorder clinically characterized by vascular, intestinal and uterine fragility and caused by heterozygous pathogenic variants in the COL3A1 gene. Management of patients with vEDS is difficult due to the unpredictability of the events and clear recommendations on the care of adults and children with vEDS are lacking. Therefore, we aimed to collect data on the current strategy of surveillance and monitoring of vEDS patients by expert centers in continental Europe and Great Britain, as a first step towards a consensus statement. A survey on the clinical management of vEDS was sent to all members of the Medium Sized Artery (MSA) Working Group of the European Reference Network for Rare Vascular Diseases (VASCERN) and other expert centers. All experts endorse the importance of monitoring patients with vEDS. Despite the absence of evidence based guidelines monitoring is considered in almost all countries, but screening intervals and modalities used for monitoring may differ among centers. There is a need for more prospective multicenter studies to define proper guidelines.
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Affiliation(s)
- Ingrid M B H van de Laar
- Department of Clinical Genetics and Cardiology and VASCERN MSA European Reference Centre, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 80, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Annette F Baas
- Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Julie De Backer
- Department of Cardiology and Center for Medical Genetics Ghent and VASCERN MSA European Reference Centre, Ghent University Hospital, Ghent, Belgium
| | - Jan D Blankenstein
- Department of Vascular Surgery, Amsterdam University Medical Centres (Amsterdam UMC) Location VU Medical Centre (VUMC), Amsterdam, the Netherlands
| | - Eelco Dulfer
- Department of Genetics, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Arjan C Houweling
- Department of Human Genetics, Amsterdam University Medical Centres (Amsterdam UMC) Location VU Medical Centre (VUMC), Amsterdam, the Netherlands
| | - Marlies Je Kempers
- Department of Clinical Genetics and VASCERN MSA European Reference Centre, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bart Loeys
- Center of Medical Genetics and VASCERN MSA European Reference Centre, University Hospital of Antwerp University of Antwerp, Antwerp, Belgium
| | - Fransiska Malfait
- Department of Cardiology and Center for Medical Genetics Ghent and VASCERN MSA European Reference Centre, Ghent University Hospital, Ghent, Belgium
| | - Leema Robert
- South East Thames Regional Genetics Service, Guy's Hospital, London, UK
| | - George Tanteles
- Clinical Genetics Clinic, Cyprus Institute of Neurology & Genetics, 1683, Nicosia, Republic of Cyprus
| | - Michael Frank
- AP-HP, Hôpital Européen Georges Pompidou, Département de Génétique, Centre de Référence des Maladies Vasculaires Rares and VASCERN MSA European Reference Centre, Paris, France; INSERM, U 970, Paris Centre de Recherche Cardiovasculaire-PARCC, Paris, France
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