My point about Abyssal vs Spirit Visage is that Abyssal has the large advantage early-mid because it doesn't extend your early-mid game low-point. Building Spirit Visage early delays damage too much.
Then you look at mid-late game. Again, Abyssal has the advantage because, due to his passive, the HP difference is around 300 HP. Meanwhile your damage is much greater, and healing is slightly greater than SV builds as well.
Spirit Visage is used as a rush to wall a lane you normally couldn't scale in; mostly mid.
As far as protobelt goes, its really preference. I don't prefer it because I don't have a problem with getting Es or Qs off at all. I can compensate the lack of it through positioning. There is an argument to be made about the burst of the active, but the most successful use of it relies on Dark Seal start and even heading into Mejai's (Yes really; a challenger 1 trick is who brought this strategy to light). Its success seems to be much lower in other cases.
In addition, I never have problems with my burst. It always seems like I have more than enough, and protobelt DOES NOT add the DPS I often find myself needing on the level of Abyssal, which also adds to burst pretty significantly.
Regardless of what the active provides, Vlad still needs AP, and too many of his 'good' items are relatively low AP now. To the point where you often have to sacrifice Zhonya's, Rylai's, or Protobelt in your build. Abyssal is starting to look like more and more of a non-negotiable to many people, especially due to the multiplicative nature of his R, Abyssal, and Masteries. That's around a 36% damage increase. The fact that its such a reliable rush in many cases that also guarantees an impact in teamfights only adds to this.
The choice of rush items currently boils down to Protobelt or Abyssal. It is preference, but I would put money on Abyssal being better if more people were familiar with how Vlad is actually played to reliable success.
Abyssal+Void is enough to make Vlad relevant in this meta and also allow him to continue to scale, even when behind. Meanwhile Protobelt relies on having a lead. Its good when you have that lead, but pretty lackluster when you don't. That said, you can grab Abyssal+Protobelt too. Nothing's stopping you, but its often giving up Zhonya's or a sizeable amount of AP.
Spirit Visage is a win-more item on him now. Its only real use is a rush in an AP match-up that you would not have been able to lane against with Abyssal.
Also there was a typo in an above post; I meant to say Rylai's just isn't must-have. Not that it IS must have. Lol.
Its really good in some games, not so much in others.
in game. I know I am just learning the champion, but it just seems that he is not viable. In fights against melee champions he is always 1 second of a cooldown away from surviving, even with 45% cool down. His lifesteal is blocked easily as 
which require them to be below 40% hp and Vlad can't pull that off, he isn't a heavy hitter. It just seems anyone with lifesteal rekts you, while you sit back and take it, never mind being weak nearly all game, and barely hanging on late game. I mean he is barely viable in urf until 40 minutes in.
