Outcome of bleomycin electrosclerotherapy of slow-flow malformations in adults and children

Vanessa F Schmidt; Özlem Cangir; Lutz Meyer; Constantin Goldann; Susanne Hengst; Richard Brill; Susanne von der Heydt; Milton Waner; Daniel Puhr-Westerheide; Osman Öcal; Muzaffer Reha Ümütlü; Nabeel Mansour; Jan Rudolph; Alena Sint; Florian Obereisenbuchner; Beate Häberle; Jens Ricke; Max Seidensticker; Walter A Wohlgemuth; Moritz Wildgruber

doi:10.1007/s00330-024-10723-6

Outcome of bleomycin electrosclerotherapy of slow-flow malformations in adults and children

Eur Radiol. 2024 Apr 16. doi: 10.1007/s00330-024-10723-6. Online ahead of print.

Authors

Vanessa F Schmidt^{1

2}, Özlem Cangir³, Lutz Meyer³, Constantin Goldann⁴, Susanne Hengst⁵, Richard Brill⁴, Susanne von der Heydt⁴, Milton Waner⁶, Daniel Puhr-Westerheide⁷, Osman Öcal⁷, Muzaffer Reha Ümütlü⁷, Nabeel Mansour⁷, Jan Rudolph⁷, Alena Sint^{7

8}, Florian Obereisenbuchner^{7

8}, Beate Häberle^{8

9}, Jens Ricke^{7

8}, Max Seidensticker^{7

8}, Walter A Wohlgemuth⁴, Moritz Wildgruber^{7

8}

Affiliations

¹ Department of Radiology, LMU University Hospital, LMU Munich, München, Germany. Vanessa.Schmidt@med.uni-muenchen.de.
² Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany. Vanessa.Schmidt@med.uni-muenchen.de.
³ Department of Pediatric Surgery, Center for Vascular Malformations, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany.
⁴ Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany.
⁵ Department of Radiology, Center for Vascular Malformations, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany.
⁶ Vascular Birthmark Institute of New York, New York, NY, USA.
⁷ Department of Radiology, LMU University Hospital, LMU Munich, München, Germany.
⁸ Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany.
⁹ Department for Pediatric Surgery, LMU University Hospital, LMU Munich, München, Germany.

PMID: 38627287
DOI: 10.1007/s00330-024-10723-6

Abstract

Objectives: To evaluate the safety and clinical outcome of bleomycin electrosclerotherapy (BEST) for treating extracranial slow-flow malformations.

Methods: In this retrospective investigation of a multicenter cohort presenting symptomatic slow-flow malformations, patient records were analyzed with respect to procedural details and complications. A treatment-specific, patient-reported questionnaire was additionally evaluated, obtained 3-12 months after the last treatment, to assess the subjective outcomes, including mobility, aesthetic aspects, and pain, as well as the occurrence of postprocedural skin hyperpigmentation. All outcome parameters were compared according to patients' age.

Results: Overall, 325 BEST treatments were performed in 233 patients after intralesional and/or intravenous bleomycin injection. The total complication rate was 10.2% (33/325), including 29/352 (8.9%) major complications. Patient-reported mobility decreased in 10/133 (8.8%), was stable in 30/113 (26.5%), improved in 48/113 (42.5%), and was rated symptom-free in 25/113 (22.1%) patients. Aesthetic aspects were rated impaired compared to baseline in 19/113 (16.8%), stable in 21/133 (18.6%), improved in 62/113 (54.9%), and perfect in 11/133 (9.7%) patients. Postprocedural skin hyperpigmentation occurred in 78/113 (69%) patients, remaining unchanged in 24/78 (30.8%), reduced in 51/78 (65.5%), and completely resolved in 3/78 (3.8%) patients. The median VAS pain scale was 4.0 (0-10) preprocedural and 2.0 (0-9) postprocedural. Children/adolescents performed significantly better in all parameters compared to adults (≥ 16 years) (mobility, p = 0.011; aesthetic aspects, p < 0.001; pain, p < 0.001).

Conclusions: BEST is effective for treating slow-flow vascular malformations, with few but potentially significant major complications. Regarding patient-reported outcomes, children seem to benefit better compared to older patients, suggesting that BEST should not be restricted to adults.

Clinical relevance statement: Bleomycin electrosclerotherapy is a safe and effective approach and therapy should not be restricted to adults due to good clinical outcomes in children.

Keywords: BEST; Bleomycin; Electro-chemotherapy; Sclerotherapy; Slow-flow vascular malformations.