Electrochemical sclerotherapy with bleomycin for the treatment of low-flow vascular malformations: a comprehensive review

Low-Flow Vascular Malformations (LFVMs) are a diverse group of abnormal vascular lesions characterized by slow blood flow thatcan involve veins, capillaries, or lymphatic vessels. These malformations, often diagnosed in childhood, may present with varying symptoms, including chronic pain, functional impairment, cosmetic deformities, and life-threatening complications. Electrochemical Sclerotherapy With Bleomycin (BEST) has emerged as a promising treatment. This technique combines bleomycin, a chemotherapeutic agent with sclerosing properties, with electrical pulses to enhance the drug's tissue penetration and targeting, thereby improving the efficacy of sclerotherapy. BEST has demonstrated significant success in treating venous, lymphatic, and capillary malformations, offering a minimally invasive option with fewer complications thanconventional therapies like ethanol sclerotherapy or surgical excision. Recent studies have shown that BEST results in substantial lesion size reductionandsymptom improvement, with reduced treatment duration and fewer side effects. Furthermore, electroporation allows for a reduction in the bleomycindose, minimizing the risk of systemic toxicity. The safety and effectiveness of BEST, also certified by its decades of use in oncology, make it a safe and valuable tool in managing challenging LFVM cases. Given the variability in the extent and location of the pathologies treated the reported results should be interpreted with caution. Ongoing research and clinical trials will further establish BEST’s role as a first-line treatment for vascular malformations, potentially revolutionizing the therapeutic landscape for these complex conditions.