Career guidance for young people

Depending on the symptoms and the severity of the vascular defect, it is possible to participate in working life even in the case of substantial findings, provided that certain conditions are met.

It is beneficial to exercise an affected extremity, especially in the case of venous and/or lymphatic malformations or Klippel-Trénaunay syndrome because, when exercise is combined with a compression garment, the muscle pump is activated and tissue pressure in the extremity can be significantly reduced.

Overall, it can be said that there are relatively few restrictions on the choice of occupation associated with peripheral vascular anomalies. The author knows of his own patients who are martial arts trainers, who work in the army and police, as IT specialists, as well as doctors and artists.

Depending on working practice, however, different problem areas may arise, which will be discussed in the following section. The choice of profession should in every case be discussed with an appropriate specialist.

Problem area: motionless sitting or standing as well as strenuous continuous physical strain

The greatest long-term limitation in the choice of a future occupation is found in patients with extensive venous and/or lymphatic malformations of the lower extremity with high lymphatic or venous pressure.

In such cases, long periods of motionless sitting or standing as well as strenuous continuous physical strain while standing are significantly more difficult because the tissue pressure in the extremity becomes too high. Typical occupations that make this necessary are service jobs in the catering or restaurant trade, working in security services or sales jobs in retail.

In contrast, regular exercise, wearing suitable compression garments, intermittently elevating (and possibly cooling) the limb are helpful. A sedentary office job with the possibility of regular exercise breaks is usually possible even in the case of extensive vascular defects.

Problem area: bleeding

Even though bleeding is often feared in the case of large, visible vascular defects, in practice it is really rare. The only exception involving an increased risk of bleeding are chronic wounds in arteriovenous malformations that do not heal and, without treatment, can bleed permanently even under slight mechanical stress. Otherwise the fear of bleeding should not play a real role in the choice of profession. In HHT patients, acute and unexpected nosebleeds can be very bothersome, but an individual “first aid kit” (put together by the patient) is very helpful, see chapter on HHT.

Problem area: erysipelas, superinfection, wounds, lymphorrhea

The risk of bacterial infection or superinfection must be considered when there are chronic open wounds, especially in connection with ulcers in venous or lymphatic malformations of the lower extremity. Especially patients with lymphorrhea, in whom the local skin’s barrier function to infections via lymphatic drainage is reduced or in whom lymphatic vesicles of the skin are present and regular erysipelas occur, strict skin hygiene is also necessary in their working life.

Working in meat processing, the zoological trade and, to some extent, in agriculture is problematic because of the specific, problematic microbial spectrum.

Problem area: chronic pain syndrome

The combination of chronic, severe illness with pain, frustrating therapy experiences with temporary worsening of symptoms and the lack of qualified contact persons often lead to severe, chronic pain syndromes. In addition to the mental strain, chronic pain often causes concentration problems, reduced performance and lack of drive. This can all have an impact on the choice of occupation and also on the continuous practice of a profession.

In the first place, qualified, interdisciplinary treatment of the underlying disease at an interdisciplinary center is of utmost importance. The team approach includes specialized anesthesiological pain therapy  and trained anesthesiologists learning individual pain management strategies. A consultation regarding chronic substance use can also be carried out as a first step. Admission to a specialized inpatient pain therapy center, which often requires long waiting periods until admission, can be part of the therapeutic approach.

Fibro-adipose vascular anomaly (FAVA) as a special form of venous malformation is a particular problem here, as in some cases it leads to a chronic pain syndrome that is particularly difficult to treat owing to the involvement of peripheral pain nerves. The specific treatment of FAVA also requires significantly more invasive measures, including total resection of the affected muscle.

Problem area: esthetic impairment

Especially combined vascular malformations and overgrowth syndromes are often visible from the outside and deviate from the esthetic social norm. This is especially true in the area of the face and hands, where extensive capillary malformations are found.

At the occupational level this poses an individual challenge for the patient and, at least initially, for others to a certain extent as they are confronted with a new situation. Otherwise, even clearly visible vascular defects do not represent a restriction in the choice of profession. The author is familiar with patients with extensive visible vascular defects who work in event management or the entertainment industry where there is a lot of public traffic. As early as childhood, parents can help to treat the anomaly as a variant from the norm and thereby strengthen their child.

Problem area: seizure disorders

Seizure disorders are rare and not part of the disease spectrum in patients with peripheral vascular anomalies, with the exceptions of Sturge-Weber syndrome, CLOVES syndrome and M-CAP syndrome (M-CAP). The possible endangerment of self and others, especially when driving machines or motor vehicles, must be assessed and treated neurologically.