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Well to be honest that was the only effective sustainbility item on spectre , mask of madness seems good on paper but it just make her more squishy. I also tried dominator but to be honest it was more expensive that vanguard. The most close item that can give her sustain/regen was hood, but it was to situational if the enemy have full magic line up like zeus and others.
In the past it was urn but the haunt cd nerf hurt a lot and people abandoning urn because you can only join a far away team fight every 180 seconds, and getting urn is a bad idea if your team have a roamer that make urn as their core like pudge or bh.
I fully understand vanguard is'nt that great, but as i can say, there is no other item that suits her and give her hp and regen. Other carry have it easier because most of ranged hero usually won't get easily harrased and other mele carry have ability to sustain like jugg healing ward, or am that make bf(perseverence) that gives him regen, or buying morbid mask on luna , and many others.
Spectre saving grace was by having lvl 10 and get +5 hp regen talent, i think most pros decided to hold out till she got lvl 10 and take that talent.
well the damage block and hp regen also helps alot
250 hp really make differences with life or death, and the 70 damage block was really good at where most hero have only 80-100 damage in early game, but mostly vanguard help a lot when she was jungling, most of time without vanguard, the creep damaged me from 50-100 hp in 1 camp, no way i can farm 2-3 camps if i took that many damage at early game. Of course she was'nt made to jungle , that was the situational case where all lane was pushed or you are afraid of getting ganked in the lane and nobody can help you,
I remember with pt str and vanguard i managed to survived full combo of tiny toss-avalanche and clinkz at lvl 9, if i don't have vanguard, i am sure i will dead.
go play league of losers
ah yes, it seems they decided to rush manta by getting pt-aquila-stout-magic stick then go manta-diffu rather than saving rad. i think farming hero by having manta is more good than saving rad.