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 doctor inserts a needle into the skin and injects a special liquid (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.
For more information on sclerotherapy, please see Sclerotherapy using image guidance and Sclerotherapy: Caring for your child at home after the procedure.
What is bleomycin?
Bleomycin is a medicine that is used as a chemotherapy to kill cancer cells but it also has other uses. For example, it has been used as a sclerosant to shrink blood vessels since 1977. Many medical centres around the world use bleomycin for treatment of vascular malformations that involve veins and lymph vessels.
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 and 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.
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). However, lung problems have been associated with large doses of bleomycin, in older adult patients, patients with abnormal kidney function and use of 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.
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 after bleomycin treatment
After your child has had bleomycin treatment they will have both short- and long-term follow-up.
- Re-evaluation in clinic, three months after the treatment is complete.
- Continued re-evaluation in the clinic until they are 18 years of age.
- A yearly health assessment by their primary care physician.
- 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 doctor if they are to undergo general anaesthesia
- avoid smoking
At SickKids
At SickKids, the interventional radiologists work in the Department of Diagnostic Imaging — Division of Image Guided Therapy (IGT). You can call the IGT clinic at (416) 813-6054 and speak to the clinic nurse during working hours (8:00 to 15:00) or leave a message with the IGT clinic nurse.
For more information on fasting see Eating and drinking before surgery.
For more information on preparing your child for their procedure see Coming for surgery.