Walter A Wohlgemuth1, Rene Müller-Wille2, Lutz Meyer3, Moritz Wildgruber4, Moritz Guntau5, Susanne von der Heydt6, Maciej Pech7, Alessandro Zanasi8, Lilit Flöther9, Richard Brill5. 1. Clinic and Policlinic of Radiology, University Hospital Halle (Saale), Halle (Saale). Electronic address: walter.wohlgemuth@uk-halle.de. 2. Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany. 3. Kinderchirurgie, Klinikum Barnim GmbH, Werner Forßmann Krankenhaus, Eberswalde, Germany. 4. Department of Radiology, University Hospital Ludwig-Maximilians-Universität, Campus Großhadern, Munich, Germany. 5. Clinic and Policlinic of Radiology, University Hospital Halle (Saale), Halle (Saale). 6. Department of Pediatric Surgery, Charité University Medicine, Virchow Medical Center, Berlin, Germany. 7. Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany. 8. IGEA SpA, German Branch, Munich, Germany. 9. Department of Anesthesiology and Critical Care Medicine, University Hospital Halle (Saale), Halle (Saale), Germany.
Abstract
OBJECTIVE: Bleomycin is one of the most commonly used agents in sclerotherapy for slow-flow vascular malformations worldwide. However, its efficiency remains unknown. The objective of the present study was to assess whether reversible electroporation combined with bleomycin would increase the sclerotherapy effect in patients with previously unsuccessfully treated venous malformations (VMs). METHODS: We performed, to the best of our knowledge, the first retrospective observational case series from January 2019 to January 2020 of 17 patients (20 lesions) with symptomatic VMs, who had previously undergone at least two unsuccessful invasive treatments. Reversible electroporation was performed with various electrodes and directly injected bleomycin. All patient records, magnetic resonance imaging data, documentation of previous treatments, and data regarding the intervention, complications, and clinical symptoms were analyzed. RESULTS: The 17 VM patients (mean age, 20.8 ± 8.2 years; 9 females) had previously undergone an average of 4.2 invasive treatments. These patients had subsequently undergone 22 electrosclerotherapy sessions of 20 lesions. The median dose of bleomycin was 3 mg. The median magnetic resonance imaging-derived lesion volume before treatment was 24.9 cm3, which had decreased by 86% to 3.5 cm3 after treatment. After 3.7 months, eight patients were asymptomatic without residual symptoms and nine patients showed improvement. CONCLUSIONS: Bleomycin electrosclerotherapy appears to be an effective therapy for patients with VMs resistive to previous invasive therapy. Because of the small sample size and short follow-up period, our results should be examined further using a larger patient population.
OBJECTIVE:Bleomycin is one of the most commonly used agents in sclerotherapy for slow-flow vascular malformations worldwide. However, its efficiency remains unknown. The objective of the present study was to assess whether reversible electroporation combined with bleomycin would increase the sclerotherapy effect in patients with previously unsuccessfully treated venous malformations (VMs). METHODS: We performed, to the best of our knowledge, the first retrospective observational case series from January 2019 to January 2020 of 17 patients (20 lesions) with symptomatic VMs, who had previously undergone at least two unsuccessful invasive treatments. Reversible electroporation was performed with various electrodes and directly injected bleomycin. All patient records, magnetic resonance imaging data, documentation of previous treatments, and data regarding the intervention, complications, and clinical symptoms were analyzed. RESULTS: The 17 VM patients (mean age, 20.8 ± 8.2 years; 9 females) had previously undergone an average of 4.2 invasive treatments. These patients had subsequently undergone 22 electrosclerotherapy sessions of 20 lesions. The median dose of bleomycin was 3 mg. The median magnetic resonance imaging-derived lesion volume before treatment was 24.9 cm3, which had decreased by 86% to 3.5 cm3 after treatment. After 3.7 months, eight patients were asymptomatic without residual symptoms and nine patients showed improvement. CONCLUSIONS:Bleomycin electrosclerotherapy appears to be an effective therapy for patients with VMs resistive to previous invasive therapy. Because of the small sample size and short follow-up period, our results should be examined further using a larger patient population.
Authors: Mirjam Gerwing; Philipp Schindler; Kristian Nikolaus Schneider; Benedikt Sundermann; Michael Köhler; Anna-Christina Stamm; Vanessa Franziska Schmidt; Sybille Perkowski; Niklas Deventer; Walter L Heindel; Moritz Wildgruber; Max Masthoff Journal: Diagnostics (Basel) Date: 2022-06-09