Intralesional Bleomycin Sclerotherapy for Low-Flow Vascular Malformations of the Head and Neck

Patients with clinically and radiologically confirmed low-flow vascular malformations of the head and neck were enrolled consecutively. Bleomycin was diluted to 3 mg/mL and injected intralesionally at multiple points, with a maximum of 15 mg per session and up to four sessions at three- to four-week intervals. Needle selection was guided by lesion depth, with ultrasound guidance used for deeper lesions. Lesion dimensions (length, width, depth) were measured by a single trained operator at each site; volume was calculated using the prolate ellipsoid formula (pi/6 x L x W x D), or by MRI-based volumetric segmentation for irregular multilocular lesions. Clinical response was graded using the modified Achauer scale. Adverse events were graded using CTCAE version 5.0, and peripheral oxygen saturation was monitored during and after each procedure.

Inclusion criteria

• Age older than one year
• Clinically and radiologically confirmed low-flow vascular malformation of the head and neck
• No prior bleomycin therapy
• Medically fit for outpatient intervention

Exclusion criteria

• High-flow vascular malformation
• Pregnancy or lactation
• Documented hypersensitivity to bleomycin
• Pre-existing pulmonary or hepatic disease
• Bleeding disorder or current anticoagulant use
• Renal impairment (serum creatinine > 1.5 mg/dL or estimated glomerular filtration rate < 60 mL/min/1.73 m²)
• Active infection at or near the treatment site