Japanese clinical practice guidelines for vascular anomalies 2017

Abstract

The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence‐based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence‐based guidelines for the management of vascular anomalies.

Update on infantile hemangioma

“…CMs may occur as a component of Sturge-Weber syndrome, Klippel-Trenaunay syndrome, and other syndromes such as CLOVES and Beckwith-Wiedemann ( Table 1 ) [ 1 , 3 , 10 ]. CMs are treated with PDL beginning in infancy [ 17 , 18 ].…”

“…As some AVMs are progressive, leading to significant morbidity and even mortality, an early diagnosis and multidisciplinary team approach are necessary. AVMs and arteriovenous fistula are treated with embolization and/or surgery [ 3 , 5 , 17 , 18 , 27 ].…”

“…After the first report on the successful treatment of IHs with oral propranolol [ 58 ] followed by a large prospective multicenter RCT of 456 young infants with IHs in Europe and the US by Léauté-Labrèze et al, oral propranolol hydrochloride solution was approved by the U.S. Food and Drug Administration (FDA) and European Medicines Evaluation Agency in 2014 and Korean FDA in 2016 for the systemic treatment of proliferating IHs [ 51 , 59 ]. Oral propranolol therapy is now the gold standard therapy and first-line treatment for proliferating high-risk IHs [ 9 , 11 - 13 , 16 - 18 , 51 , 58 , 59 ]. Propranolol hydrochloride is available in solution and tablet form, and its recommended dosage for IHs is 2–3 mg/kg/day divided into 2 daily doses, although the best outcomes occur at 3 mg/kg/day divided into 2 daily doses when maintained for at least 6 months and often continued until 12 months of age or occasionally longer depending on IH size without increased side effects ( Table 7 ) [ 9 , 11 - 13 , 16 , 59 , 60 ].…”

“…Because of the spontaneous involution, most IHs do not require treatment, but about 10% of cases require early treatment due to size, location, and complications [ 9 , 11 - 13 ]. Since 2015, IH management guidelines have been published in Europe, America, Australia, and Japan [ 12 , 13 , 16 - 18 ]. The American Academy of Pediatrics (AAP) published its first clinical practice guideline (CPG) for the management of IHs in 2019, which recommends that pediatricians and other primary care clinicians frequently monitor infants with IHs during the first few weeks and months of life to screen for growth and complications, educate the parents about the clinical course, and refer infants with potentially problematic IHs to IH specialists as early as 1 month of age [ 11 ].…”

Application of topical betaxolol to cure superficial infantile hemangioma: A pilot study

“…Around 60% of IHs can be found in the head and neck area, with a preference for the face, eyelids, ears, lips or cornea, whereas about 25% and 15% respectively are located in the trunk and extremities 1,2 . Given the possibility of negative outcomes, for instance functional impairment, morphological deformation, associated structural anomalies or general complications, it is necessary to intervene as soon as possible as recommended by European, American, Australian, and Japanese IH management guidelines since 2015 11–14 . Treatments aimed at superficial IHs have included intralesional injection, local laser radiation, oral medication, and finally topical delivery of remedies 15 .…”