Bleomycin electrosclerotherapy in therapy-resistant venous malformations of the body

Wohlgemuth, Walter A.; Müller-Wille, René; Meyer, L.; Wildgruber, Moritz; Guntau, Moritz; Heydt, Susanne; Pech, Maciej; Zanasi, Alessandro; Flöther, Lilit; Brill, Richard

doi:10.1016/j.jvsv.2020.09.009

Cited by 20 publications

(13 citation statements)

References 27 publications

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“…This notion is supported by the good outcome results in the presented study, as shown by significant improvement in patients’ quality-of-life. However, there are currently no established baseline patient characteristics or imaging parameters that may predict such responses prior to VM treatment [ 29 ]. Similarly, all common baseline parameters, as well as interventional procedure data, were not associated with patient outcome neither after first sclerotherapy nor at last available follow-up after repetitive cycles of sclerotherapy in the presented study.…”

Section: Discussionmentioning

confidence: 99%

Diffusion-Weighted Imaging Prior to Percutaneous Sclerotherapy of Venous Malformations—Proof of Concept Study for Prediction of Clinical Outcome

Gerwing

Schindler

Schneider³

et al. 2022

Diagnostics

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Prediction of response to percutaneous sclerotherapy in patients with venous malformations (VM) is currently not possible with baseline clinical or imaging characteristics. This prospective single-center study aimed to predict treatment outcome of percutaneous sclerotherapy as measured by quality of life (QoL) by using radiomic analysis of diffusion-weighted (dw) magnetic resonance imaging (MRI) before and after first percutaneous sclerotherapy. In all patients (n = 16) pre-interventional (PRE-) and delta (DELTA-) radiomic features (RF) were extracted from dw-MRI before and after first percutaneous sclerotherapy with ethanol gel or polidocanol foam, while QoL was assessed using the Toronto Extremity Salvage Score (TESS) and the 36-Item Short Form Survey (SF-36) health questionnaire. For selecting features that allow differentiation of clinical response, a stepwise dimension reduction was performed. Logistic regression models were fitted and selected PRE-/DELTA-RF were tested for their predictive value. QoL improved significantly after percutaneous sclerotherapy. While no common baseline patient characteristics were able to predict response to percutaneous sclerotherapy, the radiomics signature of VMs (independent PRE/DELTA-RF) revealed high potential for the prediction of clinical response after percutaneous sclerotherapy. This proof-of-concept study provides first evidence on the potential predictive value of (delta) radiomic analysis from diffusion-weighted MRI for Quality-of-Life outcome after percutaneous sclerotherapy in patients with venous malformations.

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Section: Discussionmentioning

confidence: 99%

Diffusion-Weighted Imaging Prior to Percutaneous Sclerotherapy of Venous Malformations—Proof of Concept Study for Prediction of Clinical Outcome

Gerwing

Schindler

Schneider³

et al. 2022

Diagnostics

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“…The patient was offered ECT combined with superselective catheterization as the potentially curative treatment option, and after detailed information about its advantages and drawbacks, she signed informed consent for treatment and publication of the data. This approach was proposed as treatment option based on reports of successful vascular malformation treatments with electrosclerotherapy ( 11 , 16 , 18 ). The National Ethics Committee approved the study (approval numbers 0120-135/2021/3 and 102/09/14).…”

Section: Methodsmentioning

confidence: 99%

“…There are several reports on good treatment outcomes of different vascular malformations: venous and arterial malformations, high- and low-flow, treatment-resistant venous malformations and capillary malformations ( 1 , 10 , 11 , 14 – 16 ). BLM is given either directly into the malformation or intravenously.…”

Section: Introductionmentioning

confidence: 99%

Combining superselective catheterization and electrochemotherapy: A new technological approach to the treatment of high-flow head and neck vascular malformations

et al. 2022

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IntroductionThe study aims to demonstrate a combination of superselective catheterization and electrochemotherapy as a feasible and effective new technological approach in treating high-flow vascular malformations of the head and neck region.Patients and methodsIn the patient with high-flow arteriovenous malformation of the lower lip, superselective catheterization was performed under general anesthesia. The microcatheter was used to administer 750 IU BLM intra-arterially into the feeding vessel. The whole malformation surface was then covered with 15 applications of electric pulses using the plate electrode.ResultsExcellent response, without functional or aesthetic deficits, was obtained in 10 weeks. During this period, debridement and necrectomy were performed regularly on follow-up visits. The pain was managed with oral paracetamol and sodium metamizole.ConclusionCombining electrochemotherapy using bleomycin with superselective catheterization and arteriography is a feasible treatment option for high-flow vascular malformations in the head and neck region and could play a significant role in managing these challenging lesions.

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“…49 In case of resistance to prior invasive treatment, the combination of injected bleomycin with reversible electroporation may improve therapy outcome. 50 In case of relatively solid lesions presenting resistive to previous sclerotherapy, the evidence increases that percutaneous cryoablation may be a further feasible and safe treatment alternative. [51][52][53] MVs are a special type of tubular VMs caused by defective development during the later stage of embryogenesis while the vein trunk is already formed.…”

Section: Venous Malformationsmentioning

confidence: 99%

“…49 In case of resistance to prior invasive treatment, the combination of injected bleomycin with reversible electroporation may improve therapy outcome. 50…”

Section: Interventional Treatment Optionsmentioning

confidence: 99%

Interventional Treatment Options in Children with Extracranial Vascular Malformations

et al. 2022

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Extracranial vascular malformations vary greatly and belong to the complex field of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic system. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) represents an important guidance for selecting appropriate therapy. Although many of the principles of endovascular treatment, including image-guided sclerotherapy and embolization, are similar in adult and pediatric practice, there are some distinct differences regarding the treatment of vascular malformations of children. Thus, it is crucial to involve longer-term plan about managing these chronic diseases and their impact on a growing child. This review provides a detailed overview over the clinical presentation of venous, lymphatic, and arteriovenous malformations in children and emphasizes the specifics of their interventional treatment options, including distinct pediatric dose limitations and procedure-related side effects.

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Bleomycin electrosclerotherapy in therapy-resistant venous malformations of the body

Cited by 20 publications

References 27 publications

Diffusion-Weighted Imaging Prior to Percutaneous Sclerotherapy of Venous Malformations—Proof of Concept Study for Prediction of Clinical Outcome

Diffusion-Weighted Imaging Prior to Percutaneous Sclerotherapy of Venous Malformations—Proof of Concept Study for Prediction of Clinical Outcome

Combining superselective catheterization and electrochemotherapy: A new technological approach to the treatment of high-flow head and neck vascular malformations

Interventional Treatment Options in Children with Extracranial Vascular Malformations

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