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Published on: June 15, 2020
Patient characteristics and disease spectrum in a German vascular anomalies center
Felix Strübing1, Annette Laurich1, Christel Weiss2
1Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany.
Insights
Patients with vascular anomalies often face misdiagnosis and delayed treatment. Early referral to a specialized vascular anomaly center (VAC) is crucial for accurate diagnosis and effective management of these rare conditions.
Area of Science:
- Vascular Medicine
- Rare Diseases
- Medical Diagnostics
Background:
- Vascular malformations are rare conditions requiring specialized care at dedicated Vascular Anomaly Centers (VACs).
- Limited data exists on the diagnostic and therapeutic pathways for patients prior to VAC referral.
- Understanding pre-referral patient journeys is essential for optimizing care.
Purpose of the Study:
- To characterize patients with vascular anomalies treated at a German VAC.
- To identify disease-specific patient characteristics influencing diagnostic and therapeutic decisions.
- To evaluate the diagnostic accuracy and prior treatments received before VAC referral.
Main Methods:
- Retrospective analysis of 593 patients treated at a VAC between April 2014 and August 2021.
- Review of patient records to assess referral diagnoses, previous consultations, and treatments.
- Analysis of diagnostic and therapeutic interventions performed within the VAC.
Main Results:
- Nearly all patients (99.7%) consulted multiple physicians before referral, with a mean of two consultations.
- Correct referral diagnoses were established in only 44% of patients, indicating a high rate of misdiagnosis.
- A significant proportion of patients received prior treatments including pharmacotherapy, compression, surgery, and sclerotherapy.
Conclusions:
- Patients with vascular anomalies frequently experience diagnostic delays and mistreatment due to complex care pathways.
- A high risk of misdiagnosis and prolonged medical conditions underscores the need for specialized centers.
- Timely referral to a dedicated Vascular Anomaly Center is paramount for optimal patient outcomes.
Background:
Vascular malformations are rare diseases that should be treated in dedicated vascular anomaly centers (VAC). There is only a small amount of data on the diagnostic and therapeutic handling of these patients, before they are referred to a VAC.
Purpose:
To demonstrate the disease-specific patient characteristics in a German VAC, which are required to determine diagnostic and therapeutic steps.
Material And Methods:
In a retrospective study, all patients who were treated in the VAC from April 2014 until August 2021 were identified. In total, 593 patients were included in this study.
Results:
Almost all patients had previously consulted a physician (591/593, 99.7%). A mean of two different physicians had been consulted (range 0-10). Patients with more complex, syndromal vascular malformations had significantly more previous appointments (P = 0.0018). In only 44% (261/593) of patients, the referral diagnosis was made correctly. Most patients had been previously treated for their vascular anomaly: pharmacotherapy (n = 130; 21.9%), compression garments (n = 141; 23.8%), surgical resection (n = 80; 17.3%) and sclerotherapy (n = 68; 11.5%). Fifty-two patients who had been falsely diagnosed had also received therapy prior to their referral to the VAC (8.8%). Most patients received an ultrasound examination in the VAC (n = 464; 78.2%). Most frequently, compression therapy was prescribed (n = 256; 43.2%), followed by sclerotherapy (n = 175, 29.5%) and pharmacotherapy (n = 55; 9.3%).
Conclusion:
Patients suffering from vascular anomalies often go through a complicated scheduling with numerous outpatient appointments and have a high risk of misdiagnosis and mistreatment prolonging the medical condition. Therefore, patients with vascular anomalies should be treated in a dedicated vascular anomaly center.
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