Classification of vascular anomalies

I write further to a recent paper in The Annals entitled 'Rare case of combined vascular malformation of the face: a successful surgical management'. 1 The authors report a 'revised' International Society for the Study of Vascular Anomalies (ISSVA) classification; however, the cited literature and indeed the description are based on the 2014 version. 1 They report that the malformations are divided into simple and combined, 1 whereas in the 2014 version two further divisions of malformations were described, namely that of major named vessels and those associated with other anomalies. 2 This classification has undergone subsequent revisions (even prior to the reporting of this paper).The 2018 revision divided vascular anomalies into vascular tumours and vascular malformations. 3 The tumours were further divided into benign, borderline/locally aggressive or malignant. 3The malformations were divided into simple (capillary, lymphatic, venous, arteriovenous and arteriovenous fistula), combined (CVM, CLM, CAVM, LVM, CLVM, CLAVM, CVAVM and CLVAVM; C: Capillary, V: Venous, AV: Arteriovenous, M: Malformation), anomalies of major named vessels/truncal/channel type (affecting: arteries, veins or lymphatics; anomalies of: length, number, course, origin, persistence, communication, valves or diameter) and associated with other anomalies. 3 The 2025 revision (Figure 1) adds the category of PUVA (Potentially Unique Vascular Anomaly) to tumours and malformations and retains the tumour subdivisions. 4Vascular malformations are further divided into fast-flow (isolated, multifocal or syndromic), slow-flow (capillary, lymphatic, venous or combined) and developmental anomalies pertaining to named vessels. 4