Bleomycin Electrosclerotherapy in Fibro-Adipose Vascular Anomalies

Fibro-adipose vascular anomaly (FAVA) is an intramuscular lesion with both components of secondary overgrowth of fibro-adipose tissue and of vascular malformation. Its treatment is multidisciplinary and symptom-based. Interventional methods like sclerotherapy or cryoablation have been described with various effectiveness. Bleomycin electrosclerotherapy (BEST)/bleomycin electroembolotherapy is a novel approach for vascular malformations, with promising results in both slow- and high-flow lesions. We present 7 FAVA patients treated with BEST, with standardized clinical and imaging follow-up at 6 months: Four female and 3 male patients (median age, 15.5 years; range, 9–49 years) underwent a median of 2 BEST procedures (range, 1–3). All patients (7/7, 100%) demonstrated regressed vascular components, whereas tissue-level imaging responses were more heterogeneous, remaining stable in 4/7 patients (57.1%) and regressed in 3/7 patients (42.9%). This case series highlights the complex pathophysiology of FAVA, demonstrating that BEST is effective for vascular components, while structural tissue changes often necessitate complementary therapeutic strategies. As BEST yields good clinical outcomes in selected cases, careful patient selection is crucial to optimize the benefits of this treatment modality.