For 25 years, the Arkansas Children’s vascular anomalies center has pushed the boundaries on care for complex conditions, attracting patients from as far away as Asia.
For many years, surgery was the only option for treating vascular anomalies. However, as treatments have expanded to include interventional radiology, chemotherapy and anticoagulation agents, so too has the need for a coordinated team of specialists to oversee these therapies.
The team at the Arkansas Children’s Hospital vascular anomalies center includes:
The entire multidisciplinary team meets monthly to discuss each patient’s case and develop a comprehensive treatment plan that allows patients to receive care in one setting during a single visit.
“We wanted to be a hub where patients saw a surgeon, interventional radiologist, pediatric oncologist, geneticist and psychologist all in one place,” said Joana Mack, M.D., pediatric hematologist and oncologist at Arkansas Children’s Hospital and assistant professor of Pediatrics in the Division of Hematology and Oncology at the University of Arkansas for Medical Sciences (UAMS). “People from Russia, Mexico and Asia all come to be treated here because of our reputation for putting patients’ needs first.”
The addition of psychology — a field not typically included at other vascular anomaly treatment centers — was particularly important, added Shelley Crary, M.D., pediatric hematologist and oncologist at Arkansas Children’s Hospital and associate professor of Pediatrics in the Division of Hematology and Oncology at UAMS.
"For a lot of these kids, vascular anomalies are a cosmetic issue on top of another medical issue," Dr. Crary said. "They have a lot of psychological and emotional needs related to school, friends and bullying. Kids need to have access to that type of care."
Arkansas Children's Hospital researchers are involved in targeted pharmaceutical therapies to address vascular anomalies. A phase 2 clinical trial involving a MEK inhibitor to treat arteriovenous malformations is in development and will be open to recruitment soon.
"We are looking to see if anticoagulation improves the quality of life," Dr. Mack said. "These patients deserve to know they have a future free of pain and free of kids bullying them for the way they look. It's important to help them with these vascular anomalies, even if it's 1% of the population. When I first got involved in vascular anomaly care six years ago, we only treated symptoms because there was no cure. We could resect a vessel, but it would grow back. With targeted therapy, we're developing more medications or utilizing cancer medications, like the MEK inhibitor, to treat vascular anomalies."
In addition to medications, innovative surgical options are also available to patients at the vascular anomalies center. Gresham Richter, M.D., F.A.C.S., F.A.A.P., chief of pediatric otolaryngology at Arkansas Children’s Hospital (ACH) and UAMS, director of the vascular anomalies center at ACH and professor in the Department of Otolaryngology at UAMS, performs a procedure for AVM that involves resecting the AVM in stages, rather than during an initial procedure. He uses laser strategies and sclerosing agents to control the disease and reduce bleeding.
Sclerotherapy involves injecting a medication into the malformation, which causes swelling and shrinkage of the blood vessel. Patients often repeat sclerotherapy until they are satisfied with the results.
Dr. Crary is a hematologist interested in the coagulation system and in 2021 presented at the International Society for the Study of Vascular Anomalies about Arkansas Children’s Hospital’s approach to managing bleeding and clotting in vascular anomaly patients.
"I became interested in vascular malformations because I specialize in bleeding and clotting disorders," Dr. Crary said. "These patients have slow flow through vascular malformations, and they have many complications with both bleeding and clotting."
"We are one of the larger research centers in the country," Dr. Crary said. "We have the multidisciplinary expertise to lead these studies and to be involved in cutting-edge research about new medications and treatments that are becoming available for our patients."
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Learn more about the collaborative expertise of the multidisciplinary Vascular Anomalies Center.
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