Learn how bleomycin is used in sclerotherapy to treat vascular malformations. Find information about the advantages of using bleomycin as well as any risks involved and precautions to be considered.
Key points
Sclerotherapy is used to treat vascular malformations. The solution (sclerosant) is injected into the vascular malformation by an interventional radiologist to shrink the malformed blood vessels.
Bleomycin is a sclerosant that can be used for sclerotherapy for lymphatic and venous malformations.
Bleomycin is associated with less swelling than other sclerosants.
Using bleomycin for sclerotherapy is usually considered a low-risk procedure.
Patients who have had bleomycin treatment need to get a yearly health assessment by their primary care provider.
A chest X-ray will need to be done one to two years following the completion of bleomycin treatment.
Introduction
What are vascular malformations?
Vascular malformations are abnormal clusters of blood vessels that develop before birth. Some may not be noticed until many years later. Some vascular malformations cause no problems, but others interfere with blood flow and can be dangerous. Vascular malformations can cause disfigurement, pain, troublesome swelling, bleeding and infection. Some are associated with growth abnormalities in the affected body part.
What is sclerotherapy?
Sclerotherapy (sometimes called “sclero”) is a procedure used to treat vascular malformations. A needle is inserted into the skin and injects a solution (sclerosant) into the abnormal blood vessel. This makes the blood vessel shrink. Sometimes the malformations can enlarge again and sclerotherapy may be done in stages. Bleomycin is a type of sclerosant.
Sclerotherapy is done using image guidance by an interventional radiologist.
Sclerotherapy using bleomycinA: An abnormal blood vessel is injected directly with a needle filled with a liquid called bleomycin. B: Bleomycin works by clotting and shrinking the blood vessel.
What is bleomycin?
Bleomycin is a medicine that is used as a chemotherapy to kill cancer cells, but it also has other uses. It is also used as a sclerosant to shrink blood vessels. Many medical centres around the world use bleomycin for treatment of vascular malformations that involve veins and lymph vessels.
More information
What is the advantage of using bleomycin?
Although traditional sclerotherapy works well, there is often a lot of swelling associated with the treatment. When bleomycin is used, there is less swelling. It is, therefore, the preferred treatment when injecting malformations close to your child’s neck, near their airway. Bleomycin works best on some vascular malformations that involve veins and lymph vessels.
Risks of the treatment
Is bleomycin safe for my child?
Bleomycin should not be used in patients receiving chemotherapy medications or those with abnormal kidney or liver function.
What are the risks of using bleomycin?
Sclerotherapy is usually considered a low-risk procedure. The risk may increase depending on your child’s condition, age and health.
The major risk associated with bleomycin is lung fibrosis (scarring of the lung). Lung problems have been associated with large doses of bleomycin in older adult patients, patients with abnormal kidney function and patients using bleomycin in conjunction with another chemotherapy medicine.
Treatment of vascular malformations in interventional radiology uses very small doses of bleomycin and the total dose your child receives is carefully monitored.
Preparing for the treatment
How will it be determined if my child can receive bleomycin?
Your child will have a clinic visit with the interventional radiologist a few weeks before the procedure to decide on the best treatment options.
During the visit, your child may:
see physiotherapy and/or occupational therapy
obtain information about pressure garments
have a health assessment to make sure they are healthy and it is safe to have sedation or general anaesthesia
be sent for photography
review the consent forms
have blood work done
Follow-up care
Follow-up after bleomycin treatment
After your child has had bleomycin treatment, they will have both short- and long-term follow-up:
Re-evaluation in the image-guided therapy clinic three months after the treatment is complete.
Continued re-evaluation in the vascular anomalies clinic until they are 18 years of age.
A yearly health assessment by their primary care provider.
A chest X-ray one to two years after treatment is complete.
Special precautions to be considered
Patients who have been treated with bleomycin for chemotherapy are given precautions to follow. Even though the dosage of bleomycin used in bleomycin sclerotherapy is very low, the same precautions are followed.
Patients who have been treated with bleomycin should:
avoid activities that require extra oxygen such as scuba diving
inform their health-care provider if they are to undergo general anaesthesia
avoid smoking
At SickKids
At SickKids
If you have any questions about the procedure, please call the Image Guided Therapy (IGT) clinic at (416) 813-7654 ext. 201804. Speak to the IGT clinic nurse during working hours or leave a non-urgent message.
