Simulated Angiography Using a Bleomycin Mixture for Sclerotherapy of Lymphatic Malformations.

Lei Guo,Yunkui Zhang,Xiaoyan Li,Dan Song,Changhua Wu,Jiali Sun

doi:10.3389/fped.2020.563517

Abstract

Objective: Repeat sclerotherapy of lymphatic malformations (LMs) is challenging. Accordingly, the aim of the present article is to describe a simulated angiography technique—a new method of bleomycin infusion for the treatment of LMs to achieve better outcome(s) in fewer sessions.Materials and Methods: A retrospective analysis of information housed in a prospectively collected LM database was performed. Patients with LM, revealed on imaging examination and treated using a simulated angiography technique with a bleomycin mixture, were included in the study. Visual evaluation and imaging examinations were performed to evaluate clinical improvement.Results: A total of 151 patients (82 male, 69 female; mean age, 28.29 months [range 1 month−12 years]) with LMs were included in this study. Excellent visual and radiological resolution was observed in 77% (117/151) of lesions, 17% (26/151) had significant improvement, and 8 patients exhibited a slight response. The number of procedures per patient varied from 1 to 5, and the average number of treatment sessions for LM was 1.34. Side effects included skin erythema at the injection site, local swelling, mild tenderness, and fever, which were controlled by oral antipyretics. No serious side effects were observed.Conclusions: Simulated angiography using a bleomycin mixture for sclerotherapy of LMs in children was feasible and demonstrated good effect with little trauma and less time per treatment.

Highlights

Lymphatic malformations (LMs)—traditionally known as lymphangiomas—are benign vascular lesions caused by developmental disorders of the lymphatic system in the embryonic stage
Simulated angiography using a bleomycin mixture based on a combined protocol of US and digital subtraction angiography (DSA) is a novel and evolving treatment for LMs
We describe the bleomycin administration procedure used in our institution for lymphatic malformation (LM) component and the bleomycin safety profile

Summary

Introduction

Lymphatic malformations (LMs)—traditionally known as lymphangiomas—are benign vascular lesions caused by developmental disorders of the lymphatic system in the embryonic stage. These lesions are most commonly found in the head and neck region, accounting for 45–52% of all cases [1], which have significant propensity for appearing at birth and, even prenatally [2], with 90% clinically apparent at 2 years of age [3]. Image-guided percutaneous sclerotherapy, using an agent such as bleomycin, is widely used to shrink cystic LMs. the use of ultrasound (US) guidance alone is sometimes unable to distinguish the sclerosing agent from the original cyst fluid, which often leads to missed lesions and prolonged treatment time [7]. Preprocedural and postprocedural clinical data and MR imaging were used to objectively and subjectively demonstrate the efficacy of this procedure

Methods

Results

Conclusion