Background <p>Slow-flow vascular malformations are rare congenital diseases which can sometimes have severe courses and limited treatment options.</p> Objective <p>The mechanism of action and performance of bleomycin electrosclerotherapy as well as its benefits and risks in comparison to alternative treatment options for slow-flow vascular malformations.</p> Material and methods <p>Description of the sclerosing effects of bleomycin, development of conventional sclerotherapy into bleomycin electrosclerotherapy (BEST) and its application to slow-flow vascular malformations as well as an overview of the current literature.</p> Results <p>The reversible electroporation of slow-flow vascular malformations carried out during BEST enables an elevated local intracellular concentration of bleomycin. Subsequently, the applied bleomycin dose can be greatly reduced compared to conventional sclerotherapy. The spectrum of different configurations of electrodes used enables the treatment of different localizations of the lesions. Potential side effects are local swelling, pain and mostly reversible discoloration of the skin. Severe side effects, such as bleomycin-induced pulmonary injury have not so far been described. The effectiveness could be confirmed in previous studies. In comparison to previously established treatment procedures the side effects are mostly mild. Further prospective studies are in preparation.</p> Conclusion <p>Bleomycin electrosclerotherapy is a&#xa0;novel treatment option for slow-flow vascular malformations and according to current data has proven efficacy and safety with limited side effects.</p>