Bleomycin sclerotherapy for eyelid venous malformations as an alternative to surgery or laser therapy

Shigematsu, Tomoyoshi; Sorscher, Michelle; Dier, Evelyn C; Berenstein, Alejandro

doi:10.1136/neurintsurg-2018-013813

Cited by 16 publications

(17 citation statements)

References 26 publications

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“…4,28,29 Superficial VMs are likely best treated with milder agents such as bleomycin or STS. 5,26,28,29 The results from our study compare favorably to other modalities of treatment including medical therapy, surgical resection and laser therapy. Conservative management techniques for VMs are centered around pain control, prevention of phlebitis or thrombosis and prevention of bleeding.…”

Section: Discussionmentioning

confidence: 71%

Sclerotherapy for Venous Malformations of Head and Neck: Systematic Review and Meta-Analysis

et al. 2020

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We performed a systematic review and meta-analysis of studies performing sclerotherapy for treatment of venous malformations (VMs) of the face, head and neck. It is our hope that data from this study could be used to better inform providers and patients regarding the benefits and risks of percutaneous sclerotherapy for treatment of face, head and neck VMs. We searched PubMed, MEDLINE, and EMBASE from 2000–2018 for studies evaluating the safety and efficacy of percutaneous sclerotherapy of neck, face and head VMs. Two independent reviewers selected studies and abstracted data. The primary outcomes were complete and partial resolution of the VM. Data were analyzed using random-effects meta-analysis. Thirty-seven studies reporting on 2,067 patients were included. The overall rate of complete cure following percutaneous sclerotherapy with any agent was 64.7% (95% confidence interval [CI], 57.4–72.0%). Sodium tetradecyl sulfate had the lowest complete cure rate at 55.5% (95% CI, 36.1–74.9%) while pingyangmycin had the highest cure rate at 82.9% (95% CI, 71.1–94.7%). Overall patient satisfaction rates were 91.0% (95% CI, 86.1–95.9%). Overall quality of life improvement was 78.9% (95% CI, 67.0–90.8%). Overall permanent morbidity/mortality was 0.8% (95% CI, 0.3–1.3%) with no cases of mortality. Our systematic review and meta-analysis of 37 studies and over 2,000 patients found that percutaneous sclerotherapy is a very safe and effective treatment modality for treatment of VMs of the head, neck and face.

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Section: Discussionmentioning

confidence: 71%

Sclerotherapy for Venous Malformations of Head and Neck: Systematic Review and Meta-Analysis

et al. 2020

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“…Nine studies with 132 patients met the inclusion criteria for this review (Table 2). These studies were from Pakistan, 14 India, 15 Bangladesh, 16 China, 17–19 USA 20 , 21 and France. 22 All the included studies were retrospective by design.…”

Section: Resultsmentioning

confidence: 99%

Bleomycin for orbital and peri-orbital veno-lymphatic malformations – A systematic review

et al. 2020

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Background Orbital and peri-orbital venolymphatic malformations (VLM) are low flow vascular malformations. Intralesional bleomycin is now commonly being used to treat such malformations. Objective The purpose of this systematic review is to synthesize evidence on the safety and efficacy of bleomycin/pingyangmycin sclerotherapy for the treatment of orbital and peri-orbital VLM. Methods We searched Medline, Embase, Scopus and Cochrane database for studies reporting outcomes of bleomycin/pingyangmycin sclerotherapy for orbital and peri-orbital VLM between 1974 to April 5th, 2019. Nine retrospective cohort studies enrolling 132 patients were included. Two reviewers independently screened and extracted data and assessed the risk of bias. Predefined outcome measures were subjective and objective reduction of the lesion and associated complications. Results Subjective reduction of the lesions was seen in 96.2% of the studies. Objective reduction of the lesion and symptomatic improvement were reported in 91.6 and 95% of the studies respectively. Non responders were 9.0%. Minor adverse events were reported in 18.1% of the studies. Major complications like pulmonary toxicity or pulmonary fibrosis was not encountered in any of the included studies. Quality of evidence was generally low. Conclusion Bleomycin/pingyangmycin sclerotherapy is very effective and relatively safe for the treatment of orbital and periorbital VLM and is not associated with any major side effects including pulmonary fibrosis. Limitations: The systematic review is limited mainly due to low quality of the included studies with retrospective design.

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“…Bleomycin has three commonly used forms A2, B2, and A5, activating the mTOR pathway to produce a unique G2-phase cell cycle-specific endothelial cytotoxicity [84], with success rate varying from 30 to 95% in reports [85][86][87][88], and excellent size reduction seen in 87% cases in a meta-analysis [89]. Response was found about 30% lower than ethanol by Zhang et al [90].…”

Section: Bleomycinmentioning

confidence: 99%

Image-Guided Percutaneous Injection Sclerotherapy of Venous Malformations

Kumar

Bhavana

Sinha

et al. 2020

SN Compr. Clin. Med.

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Venous malformations (VM) are the commonest types of vascular malformations, with an appropriate clinico-radiological diagnostic pathway being critical for establishing the correct diagnosis, mapping the extent of disease and involvement of important structures, guiding appropriate therapy, and predicting prognosis. Ultrasound (US) with color Doppler examination is the first-line radiological investigation with magnetic resonance imaging being used for further evaluation, providing the exact lesion extent and involvement of muscles, bones, and neurovascular bundles. Direct puncture phlebography of the lesion confirms the diagnosis and classifies the lesion in four types. Type 1 is an isolated malformation without peripheral drainage, type 2 malformation drains into normal veins, type 3 malformation drains into dilated veins, and type 4 malformation represents dysplastic venous ectasia. Treatment is sought for cosmetic reasons, pain, and functional issues. Sclerotherapy is the first-line treatment and image guidance, either US or phlebographic, is employed for the same. Various techniques are described including double or multiple puncture technique, subtraction-guided technique, filling defect technique, or a combination of these. Various sclerosants have been used including dry ethanol, polidocanol, ethanolamine oleate, sodium tetradecyl sulfate, sodium morrhuate, OKC 432, bleomycin, and doxycycline, either in liquid form or as microfoam prepared using Tessari's technique. Typically, multiple sessions are needed and the lesions may recur; however, overall response rate, quality of life improvement, and patient satisfaction are significantly improved. Local complications like pain, swelling, and ulcerations are common. Major complications of sclerotherapy are infrequent; however, pulmonary embolism, stroke, vision loss, compartment syndrome, tissue necrosis, hemolysis, anaphylaxis, nerve palsy, and pulmonary complications do occur and the patient and treating physicians should be aware of.

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Bleomycin sclerotherapy for eyelid venous malformations as an alternative to surgery or laser therapy

Abstract: The use of bleomycin appears to be a simple, safe, and effective treatment for venous malformations involving the eyelid, avoiding more elaborate and challenging surgical or laser interventions, and is even effective in full thickness lesions.

Cited by 16 publications

References 26 publications

Sclerotherapy for Venous Malformations of Head and Neck: Systematic Review and Meta-Analysis

Sclerotherapy for Venous Malformations of Head and Neck: Systematic Review and Meta-Analysis

Bleomycin for orbital and peri-orbital veno-lymphatic malformations – A systematic review

Image-Guided Percutaneous Injection Sclerotherapy of Venous Malformations

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