Comparison of bleomycin polidocanol foam versus absolute ethanol for sclerotherapy of venous malformations.

OBJECTIVE: The purpose of this study was to compare the efficacy and safety between two sclerosants for venous malformations (VMs), bleomycin polidocanol foam (BPF) and absolute ethanol (AE), and provide more clinical evidence for the application of BPF for VMs. METHODS: We conducted a retrospective study of 104 patients with VMs who had been treated with BPF and AE sclerotherapy. Patients were followed-up after treatment to assess clinical efficacy and complications. Clinical efficacy was independently evaluated by three experts based on pre- and post-treatment photos and magnetic resonance images. Complications were categorized according to the Society of Interventional Radiology Adverse Event Classification System. RESULTS: A total of 104 patients with VM were enrolled in this study, of which 53 (51%) received BPF sclerotherapy, and 51 (49%) received AE sclerotherapy. Most of the patients had head and neck VMs (n = 64; 62%), and the most common symptom was disfigurement. The number of sessions in the BPF group was significantly lower than in the AE group (1.5 vs 2.2; P < .05). The median treatment efficacy score was 3.0 for the BPF group and 2.7 for the AE group, with no significant difference between two groups. The median follow-up was 45 months for the BPF group and 33 months for the AE group, with no significant difference between two groups. Complications occurred in 11 patients in the BPF group and in 15 patients in the AE group, but there was no significant difference between the two groups. Mild adverse events occurred in 10 of 53 patients (19%) in the BPF group and 10 of 51 (20%) in the AE group. Moderate adverse events occurred in one patient (2%) in the BPF group and three patients (6%) in the AE group. Two patients (4%) in the AE group had nerve injury, evaluated as severe adverse events, whereas no patients in the BPF group did. CONCLUSIONS: BPF has comparable treatment efficacy to AE in sclerotherapy for VMs. BPF showed a trend toward a lower rate of severe adverse events, although this difference was not statistically significant in our cohort. It could be an optimal sclerosant to treat VMs.