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Laryngoscope. 2016 Dec;126(12):2726-2732. doi: 10.1002/lary.26077. Epub 2016 Jul 20.

Foamed bleomycin sclerosis of airway venous malformations: The role of interspecialty collaboration.

Author information

1
Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A.
2
Department of Radiology, Gundersen Health System, La Crosse, Wisconsin, U.S.A.
3
Department of Endovascular Neurosurgery, WellSpan Health, York, Pennsylvania, U.S.A.
4
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A.

Abstract

OBJECTIVES/HYPOTHESIS:

To assess clinical outcomes of patients with airway venous malformations treated with percutaneous sclerotherapy (VMPS). We highlight the role of foamed bleomycin as a less inflammatory sclerosant and the importance of collaboration between interventional radiology and otolaryngology-head and neck surgery (OHNS).

STUDY DESIGN:

Retrospective, consecutive, single-center series.

METHODS:

Sixteen airway VMPS treatment sessions were performed (5 patients). Endoscopic needle guidance was performed by OHNS. Sclerosants included ethanol and foamed bleomycin. The following data were tabulated for each patient: hospital length of stay (LOS), clinical response, and the presence/absence of airway swelling requiring prolonged intubation. Univariate analysis was performed. P < 0.05 was considered significant.

RESULTS:

Thirty-one percent (5 of 16) of treatments required endoscopic guidance. Eighty-seven percent (7 of 8) of airway VMs treated with ethanol caused significant airway swelling compared to 0% (0 of 8) of airway VMs treated with bleomycin (P = 0.0004). The LOS was significantly greater for ethanol (5 ± 0.3 days) than for bleomycin (1 day, P = 0.001). Ninety-four percent (15 of 16) of airway VM treatments had at least a partial clinical response. There was no significant difference in clinical response between ethanol and bleomycin (P = 0.30).

CONCLUSION:

Endoscopic and image-guided needle placement may be necessary to treat deep airway VMs. Bleomycin may cause less significant airway swelling than ethanol. This may reduce hospital LOS and prolonged intubation. Our results should be interpreted with caution because this is a very small retrospective study. Additional investigation is needed to establish safety and efficacy of foamed bleomycin.

LEVEL OF EVIDENCE:

4. Laryngoscope, 126:2726-2732, 2016.

KEYWORDS:

Vascular anomaly; bleomycin; percutaneous sclerotherapy; venous malformation

PMID:
27437862
DOI:
10.1002/lary.26077
[Indexed for MEDLINE]

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