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Vascular anomalies constitute some of the most difficult diagnostic and therapeutic enigmas that can be encountered in the practice of medicine.The clinical presentations are extremely protean and can range from an asymptomatic birthmark to fulminant, life-threatening congestive heart failure.Attributing any of these extremely varied symptoms that a patient may present with to a vascular malformation can be challenging to the most experienced clinician.Compounding this problem is the extreme rarity of these vascular lesions.If a clinician sees one patient every few years, it is extremely difficult to gain a leaing curve to diagnose and optimally treat them.Typically, these patients bounce from clinician to clinician only to experience disappointing outcomes, complications, and recurrence or worsening of their presenting symptoms.Vascular malformations are truly an “orphan” disease in the medical world.