Bleomycin Electrosclerotherapy (BEST)

Context and indications

The BEST technique (Bleomycin ElectroScleroTherapy) is an innovative approach for treating low-flow vascular malformations (venous, lymphatic, venolymphatic) that are resistant to or too large for conventional sclerotherapy. Electroporation increases cellular permeability and enhances the bleomycin effect.

Benefits

Superior efficacy compared to conventional sclerotherapy for large or resistant malformations, very low bleomycin doses (minimal toxicity), ability to treat large volumes in a single session.

Procedure

Under general anesthesia, bleomycin is injected directly into the malformation under ultrasound guidance. Electrodes are then applied to deliver brief electrical pulses that permeabilize the cells, greatly enhancing the drug's effect. The procedure takes 1 to 2 hours depending on the malformation volume.

Risks

Local swelling and inflammation (expected and transient), post-operative pain, skin or nerve injury (rare), bleomycin-related pulmonary fibrosis (exceptional at the doses used), skin burn at electrode sites.

Follow-up

Overnight hospital stay is usual. Post-operative swelling peaks at 48-72 hours then gradually resolves. Follow-up MRI at 3 months. Multiple sessions may be needed for large malformations.

Practical information

This procedure is performed under general anesthesia. An overnight hospital stay is generally planned.