Effect of Foam and Liquid Bleomycin in the Management of Venous Malformations in Head and Neck Region. A Comparative Study | ||||
The Egyptian Journal of Plastic and Reconstructive Surgery | ||||
Article 9, Volume 43, Issue 3, October 2020, Page 401-408 PDF (5.89 MB) | ||||
Document Type: Original Article | ||||
DOI: 10.21608/ejprs.2020.68170 | ||||
View on SCiNiTO | ||||
Author | ||||
Nada A Mahmoud* | ||||
The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt | ||||
Abstract | ||||
Background: Many treatment options for Venous Malformations (VM) has been documented in the literature but injection sclerotherapy has been considered a current mainstay for their treatment. We conducted this study to determine efficacy and durability of different injectable forms of bleomycin sclerotherapy in the treatment of VMs in cervico-facial region. Patients and Methods: Thirty patients complaining of venous malformation in the head and neck region, diagnosed clinically and confirmed by magnetic resonance imaging, had been injected with bleomycin sclerosing material. They were divided into two equal groups according to the form of bleomycin injected; Group A: Foam form was injected and Group B: Liquid form was injected. Patient's data, anatomical sites, type and volume of the VM, number of injection sessions and the average dose of injected agents were documented and statistically compared between the 2 groups. Results: MRI imaging showed a decline of more than 90% from the initial size of lesions in 66.7% cases and considerable decline (60%-90%) in 33.3% of cases. In Group A the number of sessions were (1-4), while in Group B were (1-6). the amount of sclerosing material injected in Group A were (2-7.5mg), while in Group B were (3.5-13mg), which was statistically significant. The cumulative dose in the equal size lesions was lower in the foam form rather than the liquid one, and show statistically significant difference. Conclusion: Foam form has greater promise compared with liquid form in the treatment of VMs and would encourage us to continue use the bleomycin in its foam form in the future on a bigger number of patients with larger size lesion and different location without reaching to the toxic cumulative life time dose. | ||||
Keywords | ||||
Venous malformations – Head and neck – Foam –; Liquid – Bleomycin | ||||
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References | ||||
1- Derby L.D. AND Low D.W.: Laser treatment of facial venous vascular malformations. Ann. Plast. Surg., 38: 371-8, 1997. 2- Mahady K., Thust S., Berkeley R., Stuart S., Barnacle A., Robertson F. and Mankad K.: Vascular anomalies of the head and neck in children. Quant. Imaging Med. Surg., Dec., 5 (6): 886-97, 2015. 3- Mulliken J.B. and Glowacki J.: Hemangiomas and vascular malformations in infants and children: A classification based on endothelial characteristics. Plast. Reconstr. Surg., 69: 412Y420, 1982. 4- ISSVA classification for vascular anomalies© (approved at the International Society for the Study of Vascular Anomalies workshop, Melbourne, April 2014). Available from URL: issva.org/classification (accessed October 2016). 5- Lee B.B.: Critical issues on the management of congenital vascular malformation. Ann. Vasc. Surg., 18: 380-92, 2004. 6- Belov S.: Anatomopathological classification of congenital vascular defects. Semin. Vasc. Surg., 6 (4): 219-24, 1993. 7- Belov S.T.: Classification of congenital vascular defects. Int. Angiol., 9: 141-6, 1990. 8- Deveikis J.P.: Percutaneous ethanol sclerotherapy for vascular malformations in the head and neck. Arch. Facial Plast. Surg., 7: 322-5, 2005. 9- Greene A.K. and Alomari A.I.: Management of venous malformations. Clin. Plast. Surg., 38: 83-93, 2011. 10- Sachin K., Rashmi S., Manish S., et al.: Haemangiomas and venous malformations of the head and neck: A retrospective analysis of endovascular management in 358 patients. Indian J. Plast. Surg., 109-16, 2013. 11- Legiehn G.M. and Heran M.K.: Classification, diagnosis, and interventional radiologic management of vascular malformations. Orthop. Clin. North Am., 37: 435-74, 2006. 12- Legiehn G.M. and Heran M.K.: Venous malformations: Classification, development, diagnosis, and interventional radiologic management. Radiol. Clin. North Am., 46: 545-97, 2008. 13- Zheng J.W., Yang X.J., Wang Y.A., et al.: Intralesional injection of Pingyangmycin for vascular malformations in oral and maxillofacial regions: An evaluation of 297 consecutive patients. Oral Oncol., 45: 872-6, 2009. 14- Yang Y., Sun M., Ma Q., et al.: Bleomycin A5 sclerotherapy for cervico-facial lymphatic malformations. J. Vasc. Surgery, 53: 150-5, 2011. 15- Yang Y., Sun M., Cheng X., et al.: Bleomycin A5 plus dexamethasone for control of growth in infantile parotid hemangiomas. Oral Surg. Oral Med. Oral Pathol. Oral Radiol Endod., 108: 62-9, 2009. 16- Muir T., Kirsten M., Fourie P., et al.: Intralesional Bleomycin Injection (IBI) treatment for haemangiomas and congenital vascularmal formations. Pediatr. Surg. Int., 19: 766-73, 2004. 17- Zhao J.H., Zhang W.F. and Zhao Y.F.: Sclerotherapy of oral and facial venous Malformations with use of pingyangmycin and/or sodium morrhuate. Int. J. Oral Maxillo. Fac. Surg., 33: 463-6, 2004. 18- Zhi K., Wen Y., Li L., et al.: The role of intralesional Pingyangmycinin the treatment of venous malformation official and maxillary region. Int. J. Pediatr. Otorhinolaryngol., 72: 593-7, 2008. 19- Seigel R.D. and Schiffman F.J.: Systemic toxicity following intracavitatory administration of bleomycin, Chest, 98 (2): 507, 1990. 20- Luce J.K.: Clinical trial of bleomycin in solid tumours and lymphomas. Proc. Am. Assoc. Cancer Res., 10: 38, 1969. 21- Tessari L., Cavezzi A. and Frullini A.: Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol. Surg., 27: 58-60, 2001. 22- Yamaki T., Nozaki M., Fujiwara O., et al.: Duplex-guided foam sclerotherapy for the treatment of the symptomatic venous malformations of the face. Dermatol. Surg., 28: 619-22, 2002. 23- Cabrera J., Cabrera J. Jr., Garcia-Olmedo A. and Redondo P.: Treatment of venous malformations with sclerosant in microform foam. Arch. Dermatol., 139: 1409-16, 2003. 24- Pascarella L., Bergan J.J., Yamada C. and Mekenas L.: Venous angiomata: Treatment with sclerosant foam. Ann. Vasc. Surg., 19: 457-64, 2005. 25- Bergan J., Pascarella L. and Mekenas L.: Venous disorders: Treatment with sclerosant foam. J. Cardiovasc. Surg., 47: 115-24, 2005. 26- Yamaki T., Nozaki M., Sakurai H., et al.: Prospective randomized efficacy of ultrasoundguided foam sclerotherapy compared with ultrasound-guided liquid sclerotherapy in the treatment of symptomatic venous malformations, Journal of Vascular Surgery, March, 578-84, 2008. 27- Ul Haq F., Mitchell S.E., Tekes A. and Weiss C.R.: Bleomycin foam treatment of venous malformations: A promising agent for effective treatment with minimal swelling. J. Vasc. Interv. Radiol., 26: 1484-93, 2015. 28- Azene E., Mitchell S., Radvany M., et al.: Foamed Bleomycin Sclerosis of Airway Venous Malformations: The Role of Interspecialty Collaboration Laryngoscope, 126: 2726-32, 2016. 29- Berenstein A.: E-059 Bleomycin Sclerotherapy for Eyelid Venous Malformations as an Alternative to Surgery or Laser Therapy Journal of Neuro Interventional Surgery, 8: A74, 2016. 30- Xiaofan Pan and Dylan Wolman: Percutaneous bleomycin foam effectively treats venous malformations. July 13, 2015. 31- Cooper A. and Kennedy M.W.: Biofoams and natural protein surfactants. Biophys. Chem., 151: 96-104, 2010. 32- Zhang W., Chen G., Ren J.G., et al.: Bleomycin induces endothelial mesenchymal transition through activation of mTOR pathway: A possible mechanism contributing to the sclerotherapy of venous malformations. Br. J. Pharmacol., 170: 1210-20, 2013. 33- Huang Y., Li P., Xia S., et al.: Proapoptotic effect and the mechanism of action of pingyangmycin on cavernous hemangiomas. Exp. Ther. Med., 7: 473-7, 2014. 34- Mabeta P. and Davis P.F.: The mechanism of bleomycin in inducing haemangioma regression. S Afr. Med. J., 98: 538-9, 2008. 408 Vol. 43, No. 3 / Effect of Foam & Liquid Bleomycin in the Management of Venous Malformations 35- Li P., Li D., Guo Z., et al.: Therapeutic mechanism of bleomycin A5 on infancy hemangioma: an experimental study. Zhonghua Kou Qiang Yi Xue Za Zhi, 48: 18-22, 2003. 36- Li P., Xiao X. and Guo Z.: Effect of bleomycin A5 on the hemangioma-derived endothelial cell line XTPS-1. Zhonghua Kou Qiang Yi Xue Za Zhi, 47: 324-8, 2012. 37- Yura J., Hashimoto T., Tsuruga N., et al.: Bleomycin treatment for cystic hygroma in children. Nihon Geka Hokan, 46: 607-14, 1977. 38- Tanigawa N., Shimomatsuya T., Takahashi L., et al.: Treatment of cystic hygroma and lymphangioma with the use of bleomycin fat emulsion. Cancer, 60: 741-9, 1987. 39- Muir T., Kirsten M., Fourie P., et al.: Intralesional Bleomycin Injection (IBI) treatment for haemangiomas and congenital vascular malformations. Pediatr. Surg. Int., 19: 766-73, 2004. 40- Mathur N.N., Rana I., Bothra R., et al.: Bleomycin sclerotherapy in congenital lymphatic and vascular malformations of head and neck. Int. J. Pediatr. Otorhinolaryngol., 69: 75-80, 2005. 41- Sainsbury D.C., Kessell G., Fall A.J., et al.: Intralesional bleomycin injection treatment for vascular birthmarks: A 5-year experience at a single United Kingdom Unit. Plast. Reconstr. Surg., 127: 2031-44, 2011. 42- Baskin D., Tander B. and Bankaoglu M.: Local bleomycin injection in the treatment of lymphangioma. European Journal of Pediatric Surgery: Official journal of Austrian Association of Pediatric Surgery. [et al.]=Zeitschrift fur Kinderchirurgie, 15: 383-6, 2005. 43- Mowad C.M., Nguyen T.V., Elenitsas R., et al.: Bleomycininduced flagellate dermatitis: A clinical and histopathological review. Br. J. Dermatol., 131: 700-02, 1994. 44- Sung M.W., Chang S.O., Choi J.H., et al.: Bleomycin sclerotherapy in patients with congenital and lymphatic malformation in the head and neck. Am. J. Otolaryngol., 16: 236-41, 1995. 45- Gregorya S., Burrows P.E., Ellinas H., et al.: Combined Nd: YAG laser and bleomycin sclerotherapy under the same anesthesia for cervicofacial venous malformations: A safe and effective treatment option. International Journal of Pediatric Otorhinolaryngology, 108: 30-4, 2018. 46- Lee H.J., Kim T.W., Kim J.M., et al.: Percutaneous sclerotherapy using bleomycin for the treatment of vascular malformations. International Journal of Dermatology, 56: 1186-91, 2017. 47- Hou R., Guo J., Hu K., Yang Y., et al.: A clinical study of ultrasound-guided intralesional injection of bleomycin A5 on venous malformation in cervical-facial region in China. J. Vasc. Surg., Vol. 51, 940-5, 2010 | ||||
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