The Efficacy of Bleomycin Sclerotherapy in the Treatment of Low-Flow Vascular Malformation

Background: Low-flow venous malformations (VMs) are a class of vascular anomalies that are recognized by dilated or ectatic, thin-walled channels that are often involved with cosmetic sensitive areas or functionally crucial areas. Sclerotherapy has become the mainstay of treatment, and bleomycin is of great interest for its safety and efficacy. Objective: To evaluate the clinical outcomes, safety, and thrombotic response associated with ultrasound-guided bleomycin foam sclerotherapy in patients with low-flow VMs. Methods: In this prospective, single-center study, 2​3 patients (mean age 25.22 ± 17.30 years; 52.2% female) were treated at a triage practice in Baghdad. All patients received ultrasound-guided bleomycin foam injections intralesionally with a standardized maximum of 5 mg/session. The number of sessions (1-6 sessions), pre- treatment and post-treatment lesion sizes, and the development of a thrombotic reaction were recorded. Clinical outcomes were assessed using Doppler ultrasound and clinical examination at a four-month follow-up. Results: Lesion location was predominantly on the face (43.5%), in addition to some involvement on the limbs and trunk. Most patients required one or two treatment sessions (Mean ± SD: 2.52 ± 1.50). Statistically significant decreases in dimensions were shown for the lesions (D1: decreased by 0.93 cm (p = 0.001) & D2 decreased by 0.66 cm (p = 0.001)). Complete thrombosis of their lesion occurred in 56.5% of cases, with partial regression in the rest. No significant complications occurred. The only minor adverse effects reported were transient erythema and local swelling (11.5%). Conclusion: Bleomycin sclerotherapy safely and effectively treats low-flow VMs, producing significant volumetric reduction and thrombotic response with limited morbidity. This data support its wider use in mixed-anatomical presentations, particularly where aesthetic or functional outcomes are vital.