Intralesional bleomycin sclerotherapy for head and neck low-flow vascular malformations - A retrospective single-center experience

Low-flow vascular malformations (LFVMs) account for over 90% of all vascular malformations, with the highest prevalence in the head and neck region. Intralesional sclerotherapy is the treatment of choice for subcutaneous LFVMs, although there is no consensus on optimal agent selection or dosage. Mild sclerosing agents, such as bleomycin, are commonly used in sensitive anatomical areas, including the head and neck, due to their favorable safety profile, despite slightly lower efficacy. This study presents our experience with fluoroscopy-guided, percutaneous or permucosal sclerotherapy using bleomycin for head and neck LFVMs, evaluating its safety and clinicoradiological outcomes. In total, 18 patients treated from December 2018 to August 2023 were retrospectively identified. All 50 procedures evaluated were technically successful, and over half of the patients who completed treatment showed marked improvement (lesion volume reduction of at least 50% on MRI). Most cases were managed on an outpatient basis, with no major complications during follow-up. Only one case of posttreatment intralesional hematoma required percutaneous drainage, resulting in a 2% complication rate. Our results support intralesional bleomycin sclerotherapy as a safe and effective treatment modality for head and neck LFVMs.