Advancements in Image-Guided Bleomycin Electrosclerotherapy for Vascular Anomalies

Bleomycin electrosclerotherapy (BEST) is a validated, minimally invasive option for treatment‑resistant vascular anomalies, offering improved lesion reduction with an acceptable safety profile, according to a recent review in Springer review. It shows benefit mainly in slow‑flow malformations and selected vascular tumors.

The review shows that BEST pairs intralesional bleomycin with electroporation to increase local uptake and efficacy versus standard liquid or foam sclerotherapy. The authors emphasize multidisciplinary selection—interventional radiology, dermatology, and vascular anomalies teams—for appropriate candidates, chiefly patients with slow‑flow malformations and certain vascular tumors. Procedural prerequisites include image guidance, periprocedural planning, and anesthesia tailored to lesion location and patient comorbidity.

Procedure essentials include patient selection and consent, lesion mapping with ultrasound plus contrast‑enhanced MRI or CT, and percutaneous access under ultrasound or fluoroscopic guidance; the review provides a practical checklist for these steps.

Intralesional bleomycin is dosed per lesion or by weight while electrodes are positioned to deliver short electric pulses that transiently permeabilize cells and enhance drug uptake. Immediate imaging confirms agent distribution and electrode position.

Postprocedural monitoring focuses on local tissue effects and cumulative‑dose considerations. Use ultrasound for real‑time needle placement, fluoroscopy or CT for device visualization, and MRI for pre/post volumetric assessment. Reported outcomes show high lesion reduction with mostly localized, self‑limited adverse effects such as ulceration and hyperpigmentation.

Follow‑up begins with baseline MRI and ultrasound; early post‑treatment imaging (24–72 hours) with ultrasound or contrast‑enhanced CT confirms treatment distribution. Interval volumetric MRI at about 3–6 months documents lesion reduction and symptom change. Clinical endpoints to monitor include pain, bleeding, functional improvement, and aesthetic outcome; integrate these with volumetric measures to guide retreatment timing. Most local adverse effects resolve over weeks to months, and the combined imaging–clinical assessment directs retreatment intervals.

And so based on all of this, BEST provides a high‑efficacy, image‑guided option for refractory slow‑flow malformations and select vascular tumors and is best deployed within multidisciplinary care pathways. Programs should consider harmonizing protocols and integrating BEST into multidisciplinary practice, with prospective data collection to refine indications and safety parameters.

Key Takeaways:

• High lesion‑reduction rates with primarily localized safety outcomes—refer refractory lesions to multidisciplinary teams.
• Image‑guided electrode placement and MRI/ultrasound follow‑up are critical to maximize efficacy and limit tissue injury.
• Standardize dosing, electroporation parameters, and imaging follow‑up across programs to support safe, broader adoption.