Safety and efficacy of bleomycin slow infusion sclerotherapy using a syringe pump for microcystic and mixed lymphatic malformations

To evaluate the safety and efficacy of bleomycin infusion sclerotherapy using a syringe pump in microcystic and mixed (microcystic components with the presence of a cyst over 1 cm) lymphatic malformations (LMs).

Materials and Methods:

Patients who received bleomycin sclerotherapy with a syringe pump for microcystic or mixed LMs were reviewed. Cystic components of LMs were accessed under sonographic guidance, followed by injection of an opacified bleomycin solution using a syringe pump (infusion rate, 10-20 mL/h) under fluoroscopic guidance. Imaging outcomes were graded as complete ( >90% size reduction), partial (25-90%), or no response (< 25%). Clinical outcomes and procedure-related complications were also reviewed.

Results:

Forty-nine patients with 81 sclerotherapies were analyzed. The mean age was 17 years (range, 0.1-65 y). Thirty-one (63%) patients had microcystic LMs, and 18 (37%) had mixed.  A mean of 1.7 sessions (range, 1-4) of sclerotherapy was performed using a mean cumulative dose of bleomycin of 10.8 U (range, 1.5-39 U). The mean infusion time per session was 39 minutes (range, 14-130 minutes). Regarding imaging outcomes, there was a complete response in 29% (n=14), a partial response in 57% (n=28), and no response in 14% (n=7). Regarding clinical outcomes, there was a complete response in 39% (n=19), a partial response in 51% (n=25), and no response in 10% (n=5). No major complications were identified.

Conclusion:

Bleomycin infusion sclerotherapy using a syringe pump provides gradual filling of sclerosant to target microcystic components. This technique is safe and feasible for the management of microcystic or mixed LMs.