Sclerotherapy Impact in Modern Treatment Methods of Children With Extracranial Venous Malformations

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Relevance.Venous malformation is an abnormal development of the collecting blood vessels based on the vascular wall formation disorder, which occurs during the peripheral vascular network differentiation. According to various sources, venous malformation prevalence ranges from 1 to 2 in 10 000 newborns. Head and neck VMs significantly reduce patients’ quality of life, causing severe functional and aesthetic impairments. Sclerotherapy is an effective treatment method for children with venous malformations. In recent years, bleomycin has been the most commonly used sclerosant. It is a glycopeptide antibiotic synthesized by Streptomyces verticillus and belongs to cytostatic medications. It is successfully used for venous malformations sclerotherapy, also in children. Purpose. The study aimed to improve the sclerotherapy method by combining the advantages of foam-form sclerotherapy and bleomycin. Materials and methods. We provided experimental and clinical stages of the study. There were 48 samples of rats’ external femoral veins morphologically examined in the experimental stage. We divided the rats into 2 groups depending on the administrated agent: the first group – 3% polidocanol (lauromacrogol 400), the second group – bleomycin-polidocanol mini-foam composition. The histological assessment identified the changes in the vein endothelium, necrosis of tissue structures, cell dystrophy characteristics. In the clinical stage we also divided patients into 2 groups following the same treatment protocols as in the experimental stage. The results assessment included presence or absence of clinical manifestations and magnetic resonance imaging malformation features. Results.In the experimental stage the first group, in which the bleomycin-polidocanol mini-foam composition was used, demonstrated more pronounced irreversible changes in the venous vessel endothelium compared to the second group. In the clinical stage the second group where bleomycin-polidocanol mini-foam composition was used showed rather good and satisfied results than in the group where standard polidocanol technique was carried out. Conclusions.The study revealed that the proposed method of venous malformation sclerotherapy using new bleomycin-polidocanol mini-foam composition is more effective than the polidocanol foam-form sclerotherapy. The new method is highly effective, minimally invasive, safe and can be considered an independent treatment method in children with head and neck venous malformations.