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Formation of an Interdisciplinary Center of Vascular Anomalies

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Formation of an Interdisciplinary Center of Vascular Anomalies Review Strategies in Interventional Radiology: Formation of an Interdisciplinary Center of Vascular Anomalies – Chances and Challenges for Effective and Efficient Patient Management Strategien in der Interventionellen Radiologie: Gründung eines Interdisziplinäres Zentrum für Gefäßanomalien – Chancen und Herausforderungen für effektives und effizientes Patientenmanagement Authors Maliha Sadick1,FranzJosefDally1, Stefan O. Schönberg1, Christian Stroszczynski2, Walter A. Wohlgemuth3 Affiliations Method Interdisciplinary case management, a broad spec- 1 Interdisciplinary Center of Vascular Anomalies, Institute of trum of diagnostic imaging facilities and dedicated endovas- Clinical Radiology and Nuclear Medicine, University cular radiological treatment options are valuable tools that Medical Center Mannheim, Germany allow radiology to set up an interdisciplinary center for vascu- 2 Department of Radiology, University Hospital Regensburg, lar anomalies. Department of Radiology, Regensburg, Germany Results Image-based diagnosis combined with endovascular 3 Interdisciplinary Center for Vascular Anomalies, University treatment options is an essential tool for the treatment of Hospital Halle, University Clinic and Polyclinic of Radiology, patients with highly complex vascular diseases. These vascular Halle (Saale), Germany anomalies can affect numerous parts of the body so that a multidisciplinary treatment approach is required for optimal Key words patient care. vascular anomaly, center formation, interdisciplinary, epide- Conclusion This paper discusses the possibilities and chal- miology, interventional radiology, minimally invasive therapy lenges regarding effective and efficient patient management received 06.01.2017 in connection with the formation of an interdisciplinary center accepted 08.06.2017 for vascular anomalies with strengthening of the clinical role of radiologists. Bibliography DOI https://doi.org/10.1055/s-0043-117047 Key points ▪ Published online: 23.8.2017 | Fortschr Röntgenstr 2017; 189: Vascular anomalies, which include vascular tumors and 957–966 © Georg Thieme Verlag KG, Stuttgart · New York, malformations, are complex to diagnose and treat. ▪ ISSN 1438-9029 There are far more patients with vascular anomalies re- quiring therapy than interdisciplinary centers for vascular Correspondence anomalies – there is currently a shortage of dedicated in- Prof. Maliha Sadick terdisciplinary centers for vascular anomalies in Germany This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. Interdisciplinary Center of Vascular Anomalies, Institute of that can provide dedicated care for affected patients. Clinical Radiology and Nuclear Medicine, University Medical ▪ Radiology includes a broad spectrum of diagnostic and Center Mannheim, Theodor Kutzer Ufer 1–3, minimally invasive therapeutic tools which allow the for- 68167 Mannheim, Germany mation of an interdisciplinary center for vascular anoma- Tel.:++49/621/3832276 lies for effective, efficient and comprehensive patient Fax: ++ 49/6 21/3 83 19 10 management. [email protected] Citation Format ABSTRACT ▪ Sadick M, Dally FJ, Schönberg SO et al. Strategies in Inter- ventional Radiology: Formation of an Interdisciplinary Background Radiology is an interdisciplinary field dedicated Center of Vascular Anomalies – Chances and Challenges to the diagnosis and treatment of numerous diseases and is for Effective and Efficient Patient Management. Fortschr involved in the development of multimodal treatment Röntgenstr 2017; 189: 957–966 concepts. Sadick M et al. Strategies in Interventional… Fortschr Röntgenstr 2017; 189: 957–966 957 Review ZUSAMMENFASSUNG komplexen vaskulären Erkrankung, die alle Körperregionen betreffen kann und somit meist nicht von einer Fachdisziplin Hintergrund Als Querschnittsfach widmet sich die Radiolo- alleine behandelt werden kann. Im Folgenden werden Chan- gie der Diagnostik und Therapie von zahlreichen Erkrankun- cen und Herausforderungen für ein effektives und effizientes gen und nimmt Anteil an der Entwicklung multimodaler Patientenmanagement, die mit der Gründung eines Interdis- Behandlungskonzepte. ziplinären Zentrums für Gefäßanomalien verknüpft sind, Methode Interdisziplinäre Ausrichtung sowie ein breites diskutiert. Spektrum an bildgestützten Diagnoseverfahren und spezielle Schlussfolgerung Radiologie als Querschnittsfach mit diag- endovaskuläre radiologische Behandlungstechniken sind nostischen und minimalinvasiven therapeutischen Möglich- wertvolle Bausteine, die die Radiologie fachlich dazu befähi- keiten bildet eine optimale Schnittstelle für die Betreuung gen, ein Interdisziplinäres Zentrum für Gefäßanomalien zu von Patienten mit Gefäßanomalien. Die klinische Rolle des etablieren. Radiologen ist hierbei von besonderer Bedeutung, wenn sie Ergebnisse Die Kombination aus radiologischer Diagnostik bereit ist, sich auch der klinischen Herausforderung zu stellen. und minimalinvasiver Therapie sind wesentliche Grundbau- steine in der Behandlung dieser Patienten mit einer seltenen Introduction Radiology offers a broad spectrum of diagnostic tools, and interventional radiology has a plurality of treatment options for February 28, 2017 marked the 10th anniversary of the interna- these highly complex vascular diseases that very frequently can tional "Rare Disease Day" [1]. The approximately 30 000 diseases be treated minimal invasively [12 – 17]. known worldwide include 5000 rare diseases. A disease is consid- The goal of this overview is to describe the role of radiology, ered rare when it affects less than 1/2000 people [2]. This includes which, as an interdisciplinary discipline, provides imaging-based congenital vascular anomalies comprising of vascular malforma- diagnostic methods and dedicated endovascular treatment possi- tions and rare vascular tumors. The underlying malformations bilities for effective and efficient treatment of patients with rare are highly variable in angiogenesis and vasculogenesis, can occur complex vascular diseases at an interdisciplinary center for vascu- in any region of the body, and result in significant physical impair- lar anomalies. ment depending on the degree of severity. Vascular anomalies are considered the most severe and complex amongst vascular dis- eases [3, 4]. In the past the variability of this rare disease often Disease classification resulted in utilization of imprecise or incorrect clinical terms for diagnosis (e. g. "hemangioma" or "angioma") and utilization of The ISSVA classification of vascular anomalies published by an specific, medical speciality related, nomenclatures which would international team of experts in 1992 was updated in 2014. The potentially alter the overall understanding of the disease. This goal was to establish a standardized nomenclature for all medical fact frequently induced non-standardized treatment of vascular disciplines involved in the treatment process so that diagnosis and anomalies in the past. treatment are initiated at an early point, based on the patients` Exact data regarding the number of patients with vascular symptoms. The growing scientific debate regarding the underly- anomalies is not available in Germany. According to estimates, ing genetic mutations involved in the formation of vascular 300 000 people are diagnosed with a venous malformation [1]. anomalies will allow cause-based treatment in the future [6]. Ini- Primarily very young people are affected and have to undergo tial attempts are already being made in this regard in feto-mater- complex diagnostic procedures and treatment depending on nal medicine [5]. disease severity and related symptoms [5 – 9]. Diagnosis and the Congenital vascular anomalies are rare. Vascular anomalies plurality of minimally invasive treatment techniques represent a associated with pain and functional and cosmetic limitations This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. major therapeutic challenge. The most recent advances in the un- should be treated to give patients a good quality of life and to derstanding of vascular anomalies have resulted in increased avoid secondary complications. According to ISSVA, vascular interest in this disease. The demand and necessity for interdisci- anomalies are categorized as vascular tumors and vascular mal- plinary centers for vascular anomalies providing optimized, dedi- formations. At this point please refer to the literature for a com- cated patient care, is growing [4, 10, 11]. prehensive tabulated list [6]. Vascular anomalies are based on a Based on the number of patients with vascular anomalies complex mesenchymal developmental disorder of one or a com- requiring treatment, Germany currently has an insufficient num- bination of multiple vessel types. Depending on the dominant ber of specialized centers [1]. Comprehensive dedicated care of vascular component, vascular anomalies are categorized as sim- these usually young patients is important for appropriate clinical ple arterial, venous, capillary and lymphatic lesions or combined management. Effective and efficient patient care of rare diseases arteriovenous, capillary-venous, and veno-lymphatic lesions. In in particular requires an interdisciplinary setting with combined addition to the vascular composition, the flow characteristics of diagnostic and therapeutic approach. the vascular anomaly, i. e., fast flow or slow flow, is crucial for treatment [6, 7, 15]. However, there is no generally accepted 958
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