학술논문
Outcome of bleomycin electrosclerotherapy of slow-flow malformations in adults and children
Document Type
Original Paper
Author
Schmidt, Vanessa F.; Cangir, Özlem; Meyer, Lutz; Goldann, Constantin; Hengst, Susanne; Brill, Richard; von der Heydt, Susanne; Waner, Milton; Puhr-Westerheide, Daniel; Öcal, Osman; Ümütlü, Muzaffer Reha; Mansour, Nabeel; Rudolph, Jan; Sint, Alena; Obereisenbuchner, Florian; Häberle, Beate; Ricke, Jens; Seidensticker, Max; Wohlgemuth, Walter A.; Wildgruber, Moritz
Source
European Radiology. :1-10
Subject
Language
English
ISSN
1432-1084
Abstract
Objectives: To evaluate the safety and clinical outcome of bleomycin electrosclerotherapy (BEST) for treating extracranial slow-flow malformations.Methods: In this retrospective investigation of a multicenter cohort presenting symptomatic slow-flow malformations, patient records were analyzed with respect to procedural details and complications. A treatment-specific, patient-reported questionnaire was additionally evaluated, obtained 3–12 months after the last treatment, to assess the subjective outcomes, including mobility, aesthetic aspects, and pain, as well as the occurrence of postprocedural skin hyperpigmentation. All outcome parameters were compared according to patients’ age.Results: Overall, 325 BEST treatments were performed in 233 patients after intralesional and/or intravenous bleomycin injection. The total complication rate was 10.2% (33/325), including 29/352 (8.9%) major complications. Patient-reported mobility decreased in 10/133 (8.8%), was stable in 30/113 (26.5%), improved in 48/113 (42.5%), and was rated symptom-free in 25/113 (22.1%) patients. Aesthetic aspects were rated impaired compared to baseline in 19/113 (16.8%), stable in 21/133 (18.6%), improved in 62/113 (54.9%), and perfect in 11/133 (9.7%) patients. Postprocedural skin hyperpigmentation occurred in 78/113 (69%) patients, remaining unchanged in 24/78 (30.8%), reduced in 51/78 (65.5%), and completely resolved in 3/78 (3.8%) patients. The median VAS pain scale was 4.0 (0–10) preprocedural and 2.0 (0–9) postprocedural. Children/adolescents performed significantly better in all parameters compared to adults (≥ 16 years) (mobility, p = 0.011; aesthetic aspects, p < 0.001; pain, p < 0.001).Conclusions: BEST is effective for treating slow-flow vascular malformations, with few but potentially significant major complications. Regarding patient-reported outcomes, children seem to benefit better compared to older patients, suggesting that BEST should not be restricted to adults.Clinical relevance statement: Bleomycin electrosclerotherapy is a safe and effective approach and therapy should not be restricted to adults due to good clinical outcomes in children.
Key Points: In this multicenter study investigating 325 bleomycin electrosclerotherapies, high subjective response in mobility, aesthetic aspects, and pain was reported, accompanied by few but potentially severe complications.Skin hyperpigmentation after treatment is the most common side effect, which frequently fades in the postprocedural course.Children/adolescents (0–15 years) performed significantly better in all outcome parameters regarding mobility, aesthetic aspects, and pain, when compared to adults.
Key Points: In this multicenter study investigating 325 bleomycin electrosclerotherapies, high subjective response in mobility, aesthetic aspects, and pain was reported, accompanied by few but potentially severe complications.Skin hyperpigmentation after treatment is the most common side effect, which frequently fades in the postprocedural course.Children/adolescents (0–15 years) performed significantly better in all outcome parameters regarding mobility, aesthetic aspects, and pain, when compared to adults.