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Bleomycin electrosclerotherapy (BEST) is a safe and effective treatment for pediatric slow-flow vascular malformations, including infiltrative lesions, significantly reducing symptom severity and pain while maintaining low complication rates. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 2, 2025Journal of Pediatric Surgery9 citationsOpen Access

Bleomycin Electrosclerotherapy (BEST) of Slow-Flow Vascular Malformations (SFVMs) in Children

JHJulia Haehl BHBeate Haeberle OMOliver J. Muensterer

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Abstract

RATIONALE AND OBJECTIVES: Bleomycin electrosclerotherapy (BEST) is a promising treatment for slow-flow vascular malformations (SFVMs). Due to limited paediatric data, this study aimed to assess the safety, effectiveness, and patient-reported outcomes of BEST in children with SFVMs. MATERIAL AND METHODS: This monocenter cohort study included patients <18 years with symptomatic SFVMs treated by BEST. Patient records were analysed for procedural details and complications. Symptom severity was objectively classified before and after BEST. A treatment-specific, patient-reported questionnaire assessed mobility, aesthetic concerns, swelling, social participation, pain using a visual analogue scale (VAS), and post-procedural skin discoloration. Outcomes were compared between simple and infiltrative lesions. RESULTS: Overall, 68 BEST sessions were performed in 45 children. Total complication rate was 10/68 (14.7 %), most commonly pes equinus deformities (5/68, 7.4 %) after treating SFVMs in calf muscles. Physician-rated overall symptom severity improved significantly (p < 0.001). Treatment-specific, patient-reported questionnaire revealed improved mobility in 14/41 (34.1 %) and symptom-free patients in 10/41 (24.4 %). Outcome in both aesthetic measure and social participation was mostly rated as improved or perfect (33/41, 80.5 %; 35/41, 85.4 %). Median VAS pain scale improved significantly (2.0 vs. 0.0, p < 0.001). Postprocedural swelling occurred in all children, in 26/41 cases (64.4 %) persisting for 2-4 weeks. Postprocedural skin discoloration (41/41, 100 %) was mostly (25/41, 61.0 %) reported to fade over time. No differences between simple and infiltrative lesions were revealed in all outcome parameters. CONCLUSION: BEST is effective for paediatric SFVMs by objective and subjective measures while maintaining low complication rates. Notably, BEST achieves therapeutic success even in infiltrative SFVMs expanding the range of available treatment options.

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