Recent Advances in Interventional Management of Extracranial Vascular Malformations in Children

Vascular malformations are congenital abnormalities arising from dysregulated angiogenesis, often due to gain-of-function somatic mutations. Extracranial disease involvement can cause significant pain, disfigurement, and functional limitations. Conventional sclerosing agents such as ethanol, sodium tetradecyl sulfate, and doxycycline are effective in treating the majority of slow-flow vascular malformations. However, these sclerosants have limited efficacy in lesions with significant lipomatous or stromal components and can be associated with significant local toxicity, especially if extravasated. The wider adoption of bleomycin and new interventional techniques such as bleomycin electrosclerotherapy using reversible electroporation and percutaneous thermal ablative modalities has shifted treatment paradigms for challenging cases which are refractory to conventional sclerosants. This article aims to provide an overview of these recent advances in interventional techniques and to highlight the importance of the integration of personalized precision medicine in the multidisciplinary care of children with extracranial vascular malformations.