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New Clinic Caters to Kids with Blood Vessel Abnormalities

Clinic co-director Dr. Timothy KingMadison, Wisconsin – American Family Children's Hospital announces the opening of the new Vascular Anomalies Clinic to facilitate care for children and adults with birthmarks, hemangiomas and other congenital vascular abnormalities, conditions that often require the input of physicians from multiple medical specialties.

Although patients with these disorders have been treated at UW Hospital and Clinics for many years, clinic co-directors Beverly Aagaard Kienitz, MD, a neurointerventionalist, and Timothy King, MD, PhD, a pediatric plastic and reconstructive surgeon, believe the new clinic represents a comprehensive and efficient method of helping patients with these disorders.

A dedicated group of specialists from plastic surgery, neuroendovascular surgery, ophthalmology, otolaryngology, interventional radiology, cardiology, hematology/oncology, dermatology, genetics, vascular surgery, neuroradiology and others who share a deep interest in providing more comprehensive and innovative care will work together in a twice-monthly clinic, collaboratively evaluating patients and formulating treatment plans. Many have trained in hospitals with vascular anomaly clinics during residencies and fellowships, and, like plastic surgeon Michael Bentz, MD, chairman of plastic surgery, have decades of experience.

Clinic co-director Beverly Aagaard Kienitz, MDDr. Aagaard Kienitz refers to her current patients as evidence for the clinic's need. She recently treated a 4-week-old girl with swelling in the soft tissue around her right eye. An MRI clearly showed a vascular lesion but was it a tumor containing abnormal blood vessels or an arteriovenous malformation (AVM)? The proper course of treatment depended on an appropriate identification of the lesion.

After consulting with neuroradiologist Lindell Gentry, MD, pediatric ophthalmologist Megan Collins, MD, pediatric otolaryngology specialist Tony Kille, MD, and pediatric hematologist/oncologist Carol Diamond, MD, Dr. Aagaard Kienitz performed an angiogram on the child, which indicated the lesion was not an arteriovenous malformation. After the work-up was completed the group reached a consensus that Dr. Colllins would treat the lesion with medication therapy. But all involved agreed the process would have been better with an integrated clinic drawing on all of their talents and seeing the child and parents together.

"We had multiple doctors trying to coordinate care," Dr. Aagaard Kienitz says. "The girl was was an excellent example of the need to create the Vascular Anomalies Clinic."

Conditions like these require multiple evaluations with different specialists, with patients and parents facing as many as a half-dozen appointments to determine the most effective course of treatment. With the creation of the Vascular Anomalies Clinic, however, they would only have to worry about one appointment. Clinic physicians and staff would be responsible for soliciting the counsel of the doctors best-suited to treat the patient.

As pediatric otolaryngologist J. Scott McMurray, MD, says, “With the evolution of the Children's Hospital, children with increasingly complex problems have come to us seeking help. The creation of the this new clinic will give the children and their families a multidisciplinary group of experts devoted to the most advanced therapies, working as a singular group with one goal in mind.”

Not only will straightforward cases be better assessed and treated but unusual presentations of disorders will also be better evaluated and diagnosed. Dr. David Wargowski, chief of genetics and metabolism, relates, “I saw a young infant a few months ago with a large lesion on her leg that led to a broader diagnosis of Beckwith-Wiedemann syndrome. In some cases medication can be used to treat these lesions."

Dr. Diamond became interested in vascular anomalies when she assumed care of a number of patients with diffuse lymphangiomas who were not candidates for surgery or interventional therapy. “Providing medical therapy has been challenging, educational and very satisfying. But, clearly there is more we would like to be able to do to serve these patients and families,” she says.

"It's more convenient for the families when we can pull in the relevant specialty physicians who will be instrumental in treating the child," says Dr. King. "If you have a complicated case, it's so much better to come to one clinic instead of having to bounce through five or six."

The streamlined clinic process should prove a relief for parents whose children may have serious medical conditions. Vascular anomaly describes a wide range of complex lesions, including venous malformations both superficial and deep, lymphatic malformations, vascular lesions such as arteriovenous malformations, Klippel-Trenauany and other syndromic conditions. Some require no treatment, as they resolve themselves as the child grows. Others require vigilance and treatment for a number of years.

American Family Children's Hospital's new hybrid Angio/O.R. suiteMultiple procedures increase patient exposure to radiation. But with the introduction of American Family Children's Hospital's new hybrid Angio/O.R. suite, physicians in the Vascular Anomalies Clinic will be able to perform these crucial procedures while subjecting patients to as much as 60 percent less radiation. The suite features the Siemens Q.Zen biplane, a state-of-the-art interventional imaging system designed to minimize radiation while improving the quality of the images physicians use to guide their work.

This January American Family Children's Hospital became the first hospital in the United States to use the Q.Zen biplane to treat children.

"This is a remarkable advancement in pediatric care," says Jeff Poltawsky, vice president at American Family Children's Hospital. "As one of the first to offer this advanced technology, we anticipate serving as a model for other children's hospitals while also participating in research studies demonstrating the enhanced safety benefit to patients."

The room is also a fully-functional operating room, which allows combined open surgical treatment with percutaneous or endovascular treatment under a single anesthetic. Access to the suite, combined with the opportunity to collaborate with colleagues on complex medical cases, have created heavy interest in the new clinic among American Family Children's Hospital specialists. They anticipate an opportunity to learn as well as heal.

"There are many physicians here who are increasingly interested in underlying genetic differences and in developing new treatments for these complex disorders,” says Dr. Aagaard Kienitz. "We want to advance the science as well as treat our patients."

She and her colleagues envision a day when managing a disease is replaced with the possibility of curing it.

"Now that we have this beautiful new suite, where we can do low-dose imaging, and a great team of doctors and nurses with a strong interest helping patients with these conditions," she said. "The time was right to help get this done."


Date Published: 04/25/2014