Percutaneous treatment of orofacial vascular malformations

The efficacy of bleomycin sclerotherapy in the treatment of lymphatic malformations: a review and meta-analysis

OBJECTIVE

At present, bleomycin has been widely used in the treatment of Lymphatic Malformations (LMs). This study aims to perform a meta-analysis to investigate the effectiveness and influencing factors of bleomycin in the treatment of LMs.

METHODS

We conducted a systematic review and meta-analysis to clarify the relationship between bleomycin and LMs. PubMed, ISI Web of Science and MEDLINE were searched.

RESULTS

A total of 21 studies (including 428 cases) about bleomycin sclerotherapy for LMs were included in the current meta-analyses. We calculated pooled effective rate and 95% Confidence Interval (95% CI) using random effects model to evaluate the relations between bleomycin and LMs. The results suggested that the effective rate of bleomycin was the combined effective rate was 84.0% (95% CI 0.81‒0.87) and ranged from 39% (95% CI 0.22‒0.56) to 94% (95% CI 0.87-1.02). The heterogeneity among the studies was substantial (I2=61.7%, p= 0.000). In subgroup analyses, it was observed that among retrospective study and prospective study, the estimated effective rate was 80.0% (95% CI 0.76‒0.84) and 91.0% (95% CI 0.85‒0.97), respectively. In terms of the dosage, the combined effective rates of weight-based group and fixed-dose group were 86% (95% CI 0.83‒0.90) and 74.0% (95% CI 0.66‒0.82), respectively. There was no significant publication bias in Egger's test (p=0.059, 95% CI -3.81 to 0.082), but Begg's test did (p=0.023), and the funnel plot is asymmetric.

CONCLUSION

Our study suggested that bleomycin was safe and effective in the treatment of LMs and was primarily dose dependent.

Bleomycin for Percutaneous Sclerotherapy of Venous and Lymphatic Malformations: A Retrospective Study of Safety, Efficacy and Mid-Term Outcomes in 26 Patients

Percutaneous sclerotherapy is used to treat venous and lymphatic vascular malformations, which can cause significant discomfort and/or disfigurement. The purpose of this study is to describe the bleomycin sclerotherapy technique and to evaluate its clinical and radiological efficacy and safety. We retrospectively identified consecutive patients with venous malformations (VMs) and lymphatic malformations (LMs) who underwent bleomycin sclerotherapy in 2011–2020 at our institution. We collected the clinical and radiological success rates, complications and recurrences separately in the VM and LM groups. We identified 26 patients, 15 with VMs and 11 with LMs. The significant volume reductions obtained were 45% in the VM group and 76% in the LM group (p = 0.003 and p = 0.009, respectively). Significant reductions in discomfort/pain and in cosmetic disfigurement were obtained in both groups. An overall improvement was reported by 69% and 82% of patients in the VM and LM groups, respectively. No major complications occurred during the mean follow-up of 51 ± 34 months in the VM group and 29 ± 18 months in the LM group. A recurrence developed within 2 years in 23% of patients. Bleomycin is clinically and radiologically effective for the treatment of venous and lymphatic malformations, with a high level of patient safety.

Management of vascular malformations in the Oral and maxillofacial region: A systematic review

OBJECTIVE

The purpose is to determine the comprehensive review and the current concepts on the management of vascular malformation and to evaluate the long term outcomes, recurrence and complication rate.

METHODS

This systematic review followed PRISMA guidelines and registered in PROSPERO (CRD42020173735). The PUBMED, EBSCO, SCOPUS and NDH databases were used to perform a comprehensive search of articles published up until July 2020. The database search identified 1719 articles. After an intricate review, 34 studies were estimated for eligibility.

RESULTS

A total of 1719 patients with mean age of 27.48 years were treated for vascular malformation in the oral and maxillofacial region. Moderate heterogeneity was observed for the outcome (P = 0.166; 95% CI:1.01-1.46, I² = 48%). As determined by one-way ANOVA, there was no statistically significant difference between the type of diagnosis and the recurrence (F = 2.313, p = 0.092) and the complication rate (F = 2.112, p = 0.117).

CONCLUSION

In accordance with the available scientific literature, this review has highlighted the modalities and advancement in the management of vascular malformations. Complications and recurrence were reported in all types of management. It can be avoided by careful diagnosis, pre-operative assessment and treatment planning.

Bleomycin for Head and Neck Venolymphatic Malformations: A Systematic Review

BACKGROUND

Venolymphatic malformations are rare benign vascular lesions of the head and neck. Sclerotherapy has become the first-line therapy of these lesions with bleomycin being a sclerosing agent commonly used.

PURPOSE

To perform a systematic review of the published literature to synthesize evidence on the safety and efficacy of bleomycin for the treatment of head and neck venolymphatic malformations.

DATA SOURCES

A systematic review of the literature (January 1995-May 2019) was performed in PubMed, Embase, and Cochrane Library databases to identify studies on sclerotherapy of venolymphatic malformations of the head and neck.

STUDY SELECTION

A total of 32 studies with participants met the inclusion criteria among which 1121 patients were included in the systematic review.

DATA ANALYSIS

Two reviewers independently screened and extracted data and assessed the risk of bias. The primary outcome was the subjective or objective reduction of lesion size as well as minor and major complications.

DATA SYNTHESIS

The bleomycin/pingyangmycin sclerotherapy achieved subjective or objective lesion size reduction in 96.3% (95% CI 94.1%-98.5%) of patients. Minor complications were observed in 16.2% and major complications in 1.1%.

CONCLUSION

Bleomycin is a highly effective treatment of venolymphatic malformations of the head and neck with a low rate of major adverse events. This study represents an update on the "available" evidence, but only low-to-moderate quality studies were available.

LIMITATIONS

This study reviewed 32 studies performed in different parts of the world, but there was heterogeneity of the study designs and interventions.

Modified Method to Increase the Volume and Stability of Bleomycin Foam: An Experimental Study

BACKGROUND

Bleomycin foam is an effective sclerotherapy method for venous malformations. The preparation method is rather complicated, and the volume and stability of the foam are limited.

OBJECTIVE

To modify the currently used method for preparing bleomycin foam, to simplify the preparation procedure, and to produce foam with greater volume and increased stability.

MATERIALS AND METHODS

Experiment 1: 6.0 IU of bleomycin powder was dissolved in different human serum albumin (HSA):saline solution (SS) ratios of 0.5:1.5, 0.75:1.25, 1:1, 1.25:0.75, 1.5:0.5, 1.75:0.25, and 2:0 in volume; then, an air:liquid ratio of 2:1 was used to create foam using the Tessari method. Experiment 2: 6.0 IU of bleomycin was dissolved directly in 2.0 mL of HSA; then, air:liquid ratios of 1:1, 2:1, 3:1, and 4:1 were used to create foam using the Tessari method. The optimum proportions of HSA:SS and air:liquid were screened by comparing the foam half-life (FHL).

RESULTS

Experiment 1: the optimum proportion of HSA:SS was 2:0, and the FHL was 7.5 minutes. Experiment 2: the optimum proportion of air:liquid was 3:1, and the FHL was 9.0 minutes.

CONCLUSION

The modified method is simpler and could produce more stable bleomycin foam with greater volume.