Medical Management of Vascular Lesions: Current and the Future

The aim of managing complex vascular lesions should be to relieve acute symptoms like pain, swallowing, airway problems, prevent and treat thromboembolic events and correct the cosmetic impairment caused by vascular proliferation. Molecular genetics can be applied to head and neck vascular lesions, so the possibility of targeted primary or adjunctive medical therapy as an adjunct to surgery has become real. Alteration by germline mutations in the gamete’s genetic sequence involves all cells in the organism and causes generations’ inheritance. Somatic mutations are post-zygotic DNA variations occurring after fertilization. The future of therapy is targeted medical therapy for the positive gain of function mutations and cells with activated somatic mutations, as determined with directed genetic testing. Aim of specific regression by prevention disease recurrence rather than currently practiced resection, ablation, Sclerotherapy, Etc. We have outlined commonly used beta-blocker for pediatric proliferative phase treatment of hemangiomas. Bleomycin is the other most used therapy for cystic lymphatic malformations worldwide. Its adverse effects are subjective and dose dependent. Other than that, there are ongoing outcome reviews of various medications. Sirolimus, a drug that inhibits a downstream component of the PI3K, mTOR pathways, has produced a varied clinical response of head and neck vascular malformations or lesions associated with syndromes/disorders such as Gorham-Stout disease, kaposiform hemangioendothelioma, combined lymphatico-venous malformation, pulmonary lymphangiectasia, generalized lymphangiomatosis, and venolymphatic lesions of the tongue. It would be conceivable to test a BRAF- (vemurafenib) or MEK inhibitor (trametinib), used to treat metastatic BRAF-mutated melanoma. In HHT, receptor mutations lead to decreased BMP signaling, leading to an increase in angiogenic response. These patients could benefit from antiangiogenic agents, such as bevacizumab. The future of medical management for vascular lesions is promising. Lesions where the RAS/BRAF/MAPK/ERK pathway plays a significant role (e.g., CM, CMAVM1 and 2, PG, NICH, RICH, and verrucous venous malformation) other inhibitors may be in targeted therapy.