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Bleomycin Electrosclerotherapy (BEST) for treatment of slow-flow vascular malformations in children
Constantin Goldann1,2, Anna Deleu3,4, Marie Sophie Schüngel3
1Universitätsklinikum Halle (Saale), University Clinic and Policlinic for Diagnostic and Interventional Radiology, Halle (Saale), Saxony-Anhalt, Germany. constantin.goldann@muenchen-klinik.de.
Insights
Bleomycin electrosclerotherapy (BEST) effectively reduces pediatric slow-flow vascular malformations, showing significant lesion volume reduction and symptom improvement with minimal side effects. This prospective study highlights BEST as a safe and promising treatment option for children.
Area of Science:
- Pediatric vascular surgery
- Minimally invasive treatments
- Medical imaging in pediatric care
Background:
- Limited prospective data exists for Bleomycin electrosclerotherapy (BEST) in pediatric slow-flow vascular malformations.
- Retrospective studies suggest efficacy, necessitating further investigation in pediatric cohorts.
Purpose of the Study:
- To prospectively evaluate the effectiveness and safety of BEST for pediatric slow-flow vascular malformations.
- To assess lesion volume reduction and clinical symptom improvement following BEST treatment.
Main Methods:
- A prospective study involving 30 pediatric patients (mean age 9.5 years) with slow-flow vascular malformations.
- Patients received at least one BEST treatment session between 2020-2021, with follow-up through 2024 (mean 25 months).
- Standardized MRI volumetry and clinical evaluations were used to assess treatment outcomes.
Main Results:
- A median lesion volume reduction of 59.4% was observed after a mean of 1.81 BEST sessions per patient.
- Symptom improvement was noted in 20 out of 24 patients with reported symptoms.
- Minor side effects included hyperpigmentation and inflammation; no serious complications occurred.
Conclusions:
- Bleomycin electrosclerotherapy (BEST) is a safe and effective treatment for pediatric slow-flow vascular malformations.
- BEST achieves significant lesion volume reduction and symptom relief in pediatric patients.
- Further research is recommended to optimize BEST protocols and evaluate long-term outcomes.
Background:
This prospective study evaluates the effectiveness and safety of Bleomycin electrosclerotherapy (BEST) for treating slow-flow vascular malformations in a pediatric cohort. While retrospective studies have reported its efficacy, prospective data in pediatric populations are limited.
Methods:
30 pediatric patients (mean age: 9.5 years) with venous, veno-lymphatic, or capillary-veno-lymphatic malformations were enrolled in the study between 2020 and 2021 and received at least one BEST treatment. Follow-up continued through 2024 (mean: 25 months). MRI volumetry and clinical evaluation were performed at each follow-up.
Results:
A total of 58 sessions (mean: 1.81 per patient) led to a median lesion volume reduction from 232 cm³ (range: 1.69 cm³-9814.12 cm³) pre-treatment to 41 cm³ (range: 0.57 cm3-1789.63 cm3) after the final session, corresponding to mean relative volume reduction of 59.4%. Symptoms resolved in 2 patients, improved in 18, and remained unchanged in 4. Minor side effects included skin hyperpigmentation (n = 6), inflammation (n = 3), temporary motion restriction (n = 1), and lymphorrhea (n = 1). No serious complications were observed.
Conclusion:
BEST is a safe, effective treatment for pediatric slow-flow malformations, achieving lesion reduction and symptom relief. Future studies are warranted to optimize treatment protocols and establish long-term benefits.
Impact Statement:
Bleomycin Electrosclerotherapy (BEST) is a safe and effective treatment for slow-flow vascular malformations in pediatric patients, achieving lesion volume reduction and symptom improvement. The study assesses BEST exclusively in a pediatric cohort using standardized MRI-based volumetry alongside clinical outcomes. BEST can be effective not only in refractory cases but also as a first-line or early-line treatment option, broadening its potential indications. By indicating a cumulative therapeutic benefit of repeated BEST sessions, the study encourages further investigations into tailored, session-based treatment strategies for large or progressive malformations.
