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Bleomycin Electrosclerotherapy (BEST) of Slow-Flow Vascular Malformations (SFVMs) in Children
Julia Haehl1, Beate Haeberle1, Oliver Muensterer2
1Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany; Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, München, Germany.
Insights
Bleomycin electrosclerotherapy (BEST) effectively treats pediatric slow-flow vascular malformations (SFVMs), improving symptoms and quality of life with a low complication rate. This study confirms BEST
Area of Science:
- Vascular Surgery
- Pediatric Interventional Radiology
- Dermatology
Background:
- Slow-flow vascular malformations (SFVMs) present significant challenges in pediatric patients.
- Limited data exists on the efficacy and safety of bleomycin electrosclerotherapy (BEST) in children.
- Assessing patient-reported outcomes is crucial for evaluating treatment success in pediatric SFVMs.
Purpose of the Study:
- To evaluate the safety and effectiveness of bleomycin electrosclerotherapy (BEST) in pediatric patients with symptomatic SFVMs.
- To assess patient-reported outcomes, including mobility, aesthetics, pain, and social participation.
- To compare outcomes between simple and infiltrative SFVM lesion types.
Main Methods:
- A monocenter cohort study analyzed records of pediatric patients (<18 years) undergoing BEST for symptomatic SFVMs.
- Data collected included procedural details, complications, and objective symptom severity.
- Patient-reported outcomes were assessed using a specific questionnaire and visual analogue scale (VAS) for pain.
Main Results:
- Physician-rated symptom severity significantly improved post-BEST (p<0.001).
- Patient-reported outcomes showed improvements in mobility (34.1%) and pain reduction (median VAS 2.0 to 0.0, p<0.001).
- High rates of improved or perfect outcomes were reported for aesthetics (80.5%) and social participation (85.4%); 100% experienced skin discoloration, mostly transient.
Conclusions:
- Bleomycin electrosclerotherapy (BEST) is a safe and effective treatment for pediatric SFVMs, demonstrating significant objective and subjective improvements.
- BEST provides therapeutic success even in infiltrative SFVMs, expanding treatment options for children.
- The low complication rate and positive patient-reported outcomes support BEST as a valuable therapeutic modality for pediatric SFVMs.
Rationale And Objectives:
Bleomycin electrosclerotherapy (BEST) is a promising treatment for slow-flow vascular malformations (SFVMs). Due to limited paediatric data, this study aimed to assess the safety, effectiveness, and patient-reported outcomes of BEST in children with SFVMs.
Material And Methods:
This monocenter cohort study included patients <18 years with symptomatic SFVMs treated by BEST. Patient records were analysed for procedural details and complications. Symptom severity was objectively classified before and after BEST. A treatment-specific, patient-reported questionnaire assessed mobility, aesthetic concerns, swelling, social participation, pain using a visual analogue scale (VAS), and post-procedural skin discoloration. Outcomes were compared between simple and infiltrative lesions.
Results:
Overall, 68 BEST sessions were performed in 45 children. Total complication rate was 10/68 (14.7 %), most commonly pes equinus deformities (5/68, 7.4 %) after treating SFVMs in calf muscles. Physician-rated overall symptom severity improved significantly (p < 0.001). Treatment-specific, patient-reported questionnaire revealed improved mobility in 14/41 (34.1 %) and symptom-free patients in 10/41 (24.4 %). Outcome in both aesthetic measure and social participation was mostly rated as improved or perfect (33/41, 80.5 %; 35/41, 85.4 %). Median VAS pain scale improved significantly (2.0 vs. 0.0, p < 0.001). Postprocedural swelling occurred in all children, in 26/41 cases (64.4 %) persisting for 2-4 weeks. Postprocedural skin discoloration (41/41, 100 %) was mostly (25/41, 61.0 %) reported to fade over time. No differences between simple and infiltrative lesions were revealed in all outcome parameters.
Conclusion:
BEST is effective for paediatric SFVMs by objective and subjective measures while maintaining low complication rates. Notably, BEST achieves therapeutic success even in infiltrative SFVMs expanding the range of available treatment options.
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