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Background <p>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.</p> Methods <p>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.</p> Results <p>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 cm<sup>3</sup>–1789.63 cm<sup>3</sup>) 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 (<i>n</i> = 6), inflammation (<i>n</i> = 3), temporary motion restriction (<i>n</i> = 1), and lymphorrhea (<i>n</i> = 1). No serious complications were observed.</p> Conclusion <p>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.</p> Impact Statement <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Bleomycin Electrosclerotherapy (BEST) is a safe and effective treatment for slow-flow vascular malformations in pediatric patients, achieving lesion volume reduction and symptom improvement.</p> </ItemContent> <ItemContent> <p>The study assesses BEST exclusively in a pediatric cohort using standardized MRI-based volumetry alongside clinical outcomes.</p> </ItemContent> <ItemContent> <p>BEST can be effective not only in refractory cases but also as a first-line or early-line treatment option, broadening its potential indications.</p> </ItemContent> <ItemContent> <p>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.</p> </ItemContent> </UnorderedList></p>

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Bleomycin Electrosclerotherapy (BEST) for treatment of slow-flow vascular malformations in children

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月3日

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  • Constantin Goldann,
  • Anna Deleu,
  • Marie Sophie Schüngel,
  • Julius H. Loeser,
  • Alena Akinina,
  • Moritz Guntau,
  • Moritz Wildgruber,
  • Vanessa F. Schmidt,
  • Walter A. Wohlgemuth,
  • Richard Brill

摘要

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.