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Review
. 2024 Nov 28;58(4):469-479.
doi: 10.2478/raon-2024-0061. eCollection 2024 Dec 1.

Current Operating Procedure (COP) for Bleomycin ElectroScleroTherapy (BEST) of low-flow vascular malformations

Tobian Muir  1 , Walter A Wohlgemuth  2 , Maja Cemazar  3   4 , Giulia Bertino  5 , Ales Groselj  6   7 , Lakshmi A Ratnam  8   9 , Ian McCafferty  10 , Moritz Wildgruber  11   12 , Bernhard Gebauer  13 , Francesca de Terlizzi  14 , Alessandro Zanasi  14 , Gregor Sersa  3   15
Affiliations
Review

Current Operating Procedure (COP) for Bleomycin ElectroScleroTherapy (BEST) of low-flow vascular malformations

Tobian Muir et al. Radiol Oncol. .

Abstract

Background: Bleomycin ElectroScleroTherapy (BEST) is a new approach in the treatment of vascular malformations. After bleomycin is administered to the malformation, electric pulses are applied to the target area to enhance the effectiveness of bleomycin. The mode of action is comparable to the effect of electrochemotherapy on tumour vasculature. For the wider and safer use of BEST in the clinical treatment of low-flow vascular malformations, this Current Operating Procedure (COP) is being prepared. It is a proposal for the clinical standardisation of BEST using the Cliniporator® as the electrical pulse generator with its associated electrodes. The electrical parameters considered in this protocol are those validated by the European Standard Operating Procedures for Electrochemotherapy (ESOPE) with the Cliniporator®.

Conclusions: General requirements are proposed, and, depending on the type of lesion, local skills and the availability of radiological equipment, two technical approaches of BEST are described based on ultrasound guided intervention or combined ultrasound and fluoroscopic guided intervention.

Keywords: BEST; bleomycin electrosclerotherapy; bleomycin sclerotherapy; low-flow vascular malformations.

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Figures

FIGURE 1.
FIGURE 1.
After Bleomycin ElectroScleroTherapy (BEST) flagellate dermatitis can occur on the sites of skin. (A) Scratching can cause permanent hyperpigmentation due to bleomycin. (B) Marks of the electrode insertion are visible at the site of the treatment.
FIGURE 2.
FIGURE 2.
Procedure of Bleomycin ElectroScleroTherapy (BEST) in the treatment of low-flow vascular malformation on the lip. (A) Patient pre-treatment. (B) After the injection of bleomycin solution, the (C) electric pulses were applied on several areas with the finger electrode, avoiding overlap of the electric field. Procedure was completed in 10 minutes. The treated malformation was compressed (D) for several minutes to stop bleeding. Due to the vascular effects of BEST, the bleeding stopped spontaneously.
FIGURE 3.
FIGURE 3.
Example of Bleomycin ElectroScleroTherapy (BEST) treatment effectiveness on low-flow vascular malformation. After treatment, the treated area is oedematous, with a scab over the treated area after 3 weeks. The scab falls off in about 6 weeks with already visible treatment effectiveness. After 3 months, an excellent effect is visible after one treatment only.
FIGURE 4.
FIGURE 4.
Microcystic lymphatic malformation before Bleomycin ElectroScleroTherapy (BEST) (A) and one year after (B). A significant reduction of the malformation is observed.
See this image and copyright information in PMC

References

    1. Muir T, Bertino G, Groselj A, Ratnam L, Kis E, Odili J. et al. Bleomycin Electrosclerotherapy (BEST) for the treatment of vascular malformations. An International Network for Sharing Practices on Electrochemotherapy (InspECT) study group report. Radiol Oncol. 2023;57:141–9. doi: 10.2478/raon-2023-0029. - DOI - PMC - PubMed
    1. Horbach SER, Wolkerstorfer A, Jolink F, Bloemen PR, Van Der Horst CMAM. Electrosclerotherapy as a novel treatment option for hypertrophic capillary malformations: a randomized controlled pilot trial. Dermatol Surg. 2020;46:491–8. doi: 10.1097/DSS.0000000000002191. - DOI - PubMed
    1. Wohlgemuth WA, Müller-Wille R, Meyer L, Wildgruber M, Guntau M, Heydt SVD. et al. Bleomycin electrosclerotherapy in therapy-resistant venous malformations of the body. J Vasc Surg Venous Lymphat Disord. 2021;9:731–9. doi: 10.1016/j.jvsv.2020.09.009. - DOI - PubMed
    1. McMorrow L, Shaikh M, Kessell G, Muir T. Bleomycin electrosclerotherapy: new treatment to manage vascular malformations. Br J Oral Maxillofac Surg. 2017;55:977–9. doi: 10.1016/j.bjoms.2017.10.002. - DOI - PubMed
    1. Kostusiak M, Murugan S, Muir T. Bleomycin electrosclerotherapy treatment in the management of vascular malformations. Dermatol Surg. 2022;48:67–71. doi: 10.1097/DSS.0000000000003220. - DOI - PubMed

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