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FOOTPRINTS
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Your specialist says a word you’ve never heard — not GNAQ, not PIK3CA, but a diagnosis or label you didn’t know existed.
You nod like you understood. You didn’t, quite. That’s fair; most of us don’t, most families don’t.
In the preceding notes, we talked about a series of experiences, our natural evolution or progression through milestones — from Speculations, to Symptoms, to Syndromes, to Specialists.
So much to remember and learn.
I relate to wanting direct, straight answers. Never expected to be reading and trying to understand pre-med and medical classwork and studies.
Here’s something we are rarely told: there isn’t one way doctors classify vascular malformations. There are two major systems in use around the world, and they don’t always speak to each other.
So, I dove into yet another milestone: the World’s two most predominant classification systems for diagnosing and caring for vascular malformations.
Note 6 earlier touched on one of these, the ISSVA framework. This note explores the other one: why it exists, what it means when two conditions share a code, and how it fits alongside the ISSVA framework.
If your specialist trained in Europe, or uses Hamburg terminology, this document lets the two of you speak the same language.
The Hamburg Category Management model — the first to be created, developed in Europe and used widely internationally. It classifies malformations by when, during development, they occurred, and whether they arose from vessels that had already formed or from primitive tissue that never finished its job. That distinction predicts something clinically important: how likely the condition is to come back after treatment.
Recalling: the ISSVA framework — the Diagnostic Classifications model that classifies differently: by structure: is it a capillary issue, a venous issue, a lymphatic issue, or some combination? One hundred and three names in all. 103! It’s the newer of the two, introduced in 2014 and updated again in 2018 and 2024/2025.
Our Hamburg Manual sorts an entire catalog by Hamburg code (our invented and ascribed code). When you see several conditions listed under the same Hamburg code, that’s not a mistake — it means those conditions, different as they may look or be named, share the same biological behavior and the same treatment challenges.
Where do you go from here? Into our Classification Catalog itself — the 103 names/ labels, and the synthesized system we built so you’d never have to memorize any of them.