Bleomycin-Electrosclerotherapy in the treatment of superficial slow-flow vascular malformations of head and neck

Introduction: Recently, Bleomycin-Electrosclerotherapy (BEST) has emerged as a novel alternative in the treatment of slow-flow vascular malformations. Regarding the commonly affected head and neck area, this procedure has to be safe and controllable due to the close anatomical proximity of critical structures. The aim of this study is to evaluate the safety and clinical outcome of BEST for slow-flow vascular malformations of the head and neck region. Methods: Twenty-five patients with symptomatic predominantly superficial SFVMs were treated by 41 BEST sessions between 11/21 and 09/24. Treatments of lesions involving the aerodigestive tract were excluded. Patient records and imaging findings were analyzed with respect to clinical and procedural details. Changes in overall symptom severity were classified into five categories (complete-, marked-, mild-, no response, and progress) based on patients' reports. Pre- and postprocedural lesion size was determined by measuring the maximum diameter in three orthogonal planes on MRI. Complications and side-effects including skin discoloration were assessed. Results: The most common indications for treatment were swelling in 17/25 patients (68%), followed by pain (7/25, 28%), and functional impairment (7/25, 28%). Patients received 1.6 ± 1.1 BEST sessions with a median bleomycin dose of 5 mg (range 1-15 mg). Complete response at the end of follow-up was observed in 8/25 (32%), strong reduction of symptoms in 14/25 (56%), and mild reduction in 3/25 (12%) patients. No patients showed progression or were non-responders. Follow-up MRI revealed a lesion size reduction in all patients for which a follow-up MRI was available and complete or partial reduced contrast uptake in 8/10 (80%) patients. Prolonged pain and swelling were observed after 4/41 (9.8%) of BEST sessions. There were no major complications following the treatment of superficial SFVMs, especially no nerve injury. Skin discoloration was observed in 9/25 (36%) of patients while all patients already reported partially fading during follow-up. All complications were temporary only and subsided at follow-up. Discussion: BEST is safe and effective for treating slow-flow vascular malformations of the head and neck region with an acceptable risk- and complication profile.