Bleomycin sclerotherapy for venous vascular malformations of the tongue

Background: Venous vascular malformations (VVMs) are congenital vascular anomalies, often impacting quality of life due to discomfort, swelling, and functional impairments. This study evaluates the efficacy of bleomycin sclerotherapy as a treatment for symptomatic VVMs of the tongue.

Methods: We conducted a retrospective review of all patients treated with this method in our institution between 2004 and 2024. Sclerotherapy procedures were performed under general anesthesia in the neuroangiography suite with fluoroscopic guidance using a negative subtraction technique. Outcomes were assessed through subjective patient reports and magnetic resonance imaging (MRI) where available.

Results: In total, 140 percutaneous bleomycin sclerotherapy procedures were performed on 36 patients (aged 19-80) with tongue VVMs. On average, patients required 2.06±1.8 treatment sessions and 2.29±1.4 procedures per session. The average interval between treatment sessions was 28.6±19.4 months. Per procedure, the total units of bleomycin injected was 11.2±3.9 mg/mL (2-15 mg/mL). Results revealed that 93.8% of procedures yielded subjective symptom improvement. Follow-up imaging was available in 14 patients and confirmed lesion reduction in nine (64.3%). Post-procedural complications were minimal, with transient swelling as the most common.

Conclusion: Percutaneous bleomycin sclerotherapy presents an effective, well-tolerated treatment for tongue VVMs, offering significant symptom relief. To our knowledge, this study represents the largest retrospective series of bleomycin sclerotherapy for tongue VVMs to date. Our findings support bleomycin sclerotherapy as a valuable option for managing VVMs in this challenging anatomical site.