Vascular Anomalies: A Comprehensive Review of Etiology, Complications, and Management Strategies

Vascular anomalies encompass a group of disorders involving abnormalities of blood and lymphatic vessels, ranging from benign cutaneous lesions to complex, life-threatening conditions. These anomalies are broadly classified into vascular tumors and malformations based on underlying pathophysiology. Despite their clinical prevalence, the management of vascular anomalies remains challenging due to their diverse presentations, variable progression, and potential for significant functional and aesthetic morbidity. This review provides a comprehensive overview of the etiology, clinical presentation, complications, and management strategies of vascular anomalies, with a focus on their relevance to plastic and reconstructive surgery. Vascular tumors, including infantile hemangiomas, congenital hemangiomas, pyogenic granulomas, and kaposiform hemangioendothelioma, are characterized by abnormal cellular proliferation and demonstrate variable natural histories ranging from spontaneous involution to aggressive growth requiring intervention. In contrast, vascular malformations arise from embryologic errors in vasculogenesis and persist throughout life, progressively enlarging without regression. These include capillary, venous, lymphatic, and arteriovenous malformations, each with distinct clinical features and treatment considerations. Management is highly individualized and often necessitates a multidisciplinary approach. Treatment modalities include pharmacologic therapy (eg, beta-blockers, sirolimus, and targeted molecular agents), laser therapy, sclerotherapy, embolization, and surgical intervention. Plastic surgeons play a critical role in addressing deformity, restoring function, and optimizing aesthetic outcomes through reconstructive techniques. Given the complexity of these conditions, a thorough understanding of classification systems, disease progression, and available treatment options is essential. This review synthesizes current evidence to guide clinicians in the evaluation and management of vascular anomalies, emphasizing a patient-centered, multidisciplinary approach to optimize both functional and cosmetic outcomes.