Bleomycin electrosclerotherapy (BEST) of slow-flow vascular malformations (SFVMs) in children

Haehl, Julia ; Haeberle, Beate; Muensterer, Oliver J. ; Hartel, Alexandra; Fröba-Pohl, Alexandra; Dussa, Chakravarthy U. ; Ziegler, Christian M. ; Obereisenbuchner, Florian ; Puhr-Westerheide, Daniel ; Seidensticker, Max ; Ricke, Jens; Brill, Richard; Wohlgemuth, Walter A.; Olivieri, Martin ; Schmidt, Vanessa F. und Wildgruber, Moritz (2025): Bleomycin electrosclerotherapy (BEST) of slow-flow vascular malformations (SFVMs) in children. In: Journal of Pediatric Surgery, Vol. 60, No. 11, 162631

Abstract

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.

• Item Type: Journal article
• Faculties: Medicine > Medical Center of the University of Munich > MUM - Musculoskeletal University Center Munich; Medicine > Medical Center of the University of Munich > Paediatric Surgery Clinic and Polyclinic in the Dr. von Hauner Children's Hospital; Medicine > Medical Center of the University of Munich > Clinic and Polyclinic for Radiology
• Subjects: 600 Technology > 610 Medicine and health
• ISSN: 00223468
• Language: English