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Bevacizumab and interferon reduce venous recanalization following sclerotherapy
Ann M Kulungowski1, Aladdin H Hassanein2, Carolyn C Foster2
1Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Purpose:
The treatment of venous malformations is difficult because these lesions frequently recur after resection or sclerotherapy. The purpose of this study was to determine whether recanalization of sclerosed venous lumens could be prevented with systemic angiogenic inhibition using bevacizumab or peginterferon alfa-2a.
Methods:
To establish an animal model of recanalization of sclerosed facial veins, 18 rabbits had ethanol sclerotherapy of 1 facial vein followed by venography after 4weeks (n=6), 12weeks (n=6), and 24weeks (n=6). Subsequently, 21 different leporids underwent sclerotherapy of both facial veins (n=42 veins) and were treated pharmacologically in three ways: (1) control (n=14); bevacizumab (n=14); or peginterferon alfa-2a (n=14). Animals received 2 systemic drug doses 1month prior to and during the procedure. Vessel patency was determined 24weeks later using venography.
Results:
Venous recanalization occurred in 33.3% of sclerosed facial veins after 4weeks and 50.0% after 12 and 24weeks. For animals treated with systemic medication, recanalization occurred less frequently when bevacizumab (14.3%, n=2/14) (P=0.04) or peginterferon alfa-2a (7.7%, n=1/14) (P=0.01) was administered compared to controls (57.1%, n=8/14).
Conclusions:
Systemic treatment with bevacizumab or peginterferon alfa-2a reduces venous recanalization following sclerotherapy in an animal model. Further studies are indicated to determine whether anti-angiogenic pharmacotherapy can prevent recurrence of venous malformations in humans after sclerotherapy.
Insights
Systemic bevacizumab or peginterferon alfa-2a reduced venous recanalization after sclerotherapy in rabbits. This suggests potential for preventing venous malformation recurrence in humans.
Area of Science:
- Vascular biology
- Pharmacology
- Medical research
Background:
- Venous malformations (VMs) are challenging to treat due to frequent recurrence after interventions like sclerotherapy.
- Recanalization of sclerosed venous lumens contributes to VM recurrence.
- Systemic anti-angiogenic therapy is being explored to improve treatment outcomes.
Purpose of the Study:
- To evaluate the efficacy of systemic bevacizumab or peginterferon alfa-2a in preventing venous recanalization after sclerotherapy.
- To establish and utilize an animal model for studying sclerosed vein recanalization.
Main Methods:
- An animal model using ethanol sclerotherapy of rabbit facial veins was developed.
- Animals received systemic bevacizumab or peginterferon alfa-2a prior to and during the procedure.
- Vessel patency was assessed via venography at 24 weeks post-sclerotherapy.
Main Results:
- Venous recanalization occurred in 50% of control veins at 24 weeks.
- Bevacizumab significantly reduced recanalization to 14.3% (P=0.04).
- Peginterferon alfa-2a significantly reduced recanalization to 7.7% (P=0.01).
Conclusions:
- Systemic bevacizumab and peginterferon alfa-2a effectively reduce venous recanalization in a rabbit model.
- Anti-angiogenic pharmacotherapy shows promise for preventing VM recurrence after sclerotherapy.
- Further human studies are warranted to confirm these findings for clinical application.
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