Bleomycin electrosclerotherapy: new treatment to manage vascular malformations

Venous malformations are congenital anomalies of the vascular system. The injection of bleomycin (a cytotoxic, antitumour drug) into the lesion is a safe and effective treatment for low-flow (venous and lymphatic) malformations, but its use systemically has been associated with pulmonary fibrosis. Intralesional injection of bleomycin is considered to have a lower risk, but caution should be used when planning treatment, with particular regard to respiratory function. Electroporation is the temporary application of an electrical field across a tissue to increase (briefly) the permeability of the cell membrane in that tissue. We successfully treated a venous malformation in a patient with severe respiratory compromise with a low dose of bleomycin into the lesion, which we augmented using electroporation. To the best of our knowledge, this is the first reported use of bleomycin electrosclerotherapy in the management of a venous malformation.