Abstract No. 81 Bleomycin-soaked bio-resorbable particle embolization of benign vascular anomalies

Abstract

Report our early experience using bleomycin-soaked, bio-resorbable particles via trans-arterial embolization to treat benign vascular tumors/malformations refractory to medical therapy and not amenable to surgical resection. Between January 2019 and July 2020, 8 patients (median age: 7 years [range: 2-15 years], median weight: 26 kg [range: 12-81 kg]) underwent trans-arterial embolization of non-involuting congenital hemangiomas (n = 3), infantile hemangiomas (n = 3), and intra-muscular capillary high-flow malformations (n = 2). Median number of treatments was 2 (range: 1-5). Indications for treatment: pain, worsening function in extremity/affected body part, swelling and dysmorphic overgrowth. The particles (300-500μm) were prepared with the bleomycin solution (dose: 1 unit/kg; maximum 15 units reconstituted in 4mL normal saline) and allowed to soak for 20-30 minutes prior to endovascular delivery. Particles were delivered via micro-catheter (2.5F) into the affected locations (lip = 5; leg = 1; posterior chest wall = 1; face = 1). 8 patients underwent 19 embolization procedures. Technical success (pruning/elimination of the lesion’s arterial supply and diminished lesional blush) was achieved in all procedures. There were no major or minor complications. Angiographic follow-up was available in 6 patients, with all patients showing angiographic improvement or resolution. Clinical success, defined as symptomatic and/or functional improvement, was achieved in all 7 patients for which clinical follow-up was available (1 patient lost to follow-up). Average clinical follow-up: 8 months (range: 2-17). Arterial embolization of benign vascular tumors/malformations with bleomycin-soaked, bio-resorbable particles is technically feasible with a seemingly favorable safety profile in appropriately selected patients. Further investigation is warranted to assess long-term efficacy.