Bleomycin sclerotherapy

This information is for patients whose doctor has requested you have bleomycin sclerotherapy. 

We hope that the following information will answer some of the questions you may have about this procedure.

What is bleomycin sclerotherapy and why is it needed?

Bleomycin sclerotherapy is used to treat vascular and lymphatic malformations. It is usually suggested as a treatment for some kinds of malformations e.g:

  • Microcystic lymphatic malformations.
  • Venous malformations with a larger solid part.
  • A second form of treatment of standard sclerotherapy has failed.
  • Malformations on the surface of the skin where the skin is directly involved as it is less likely to cause skin blistering or scarring.
  • Treatment of malformations in areas where the doctors are keen to avoid swelling.

Sclerotherapy is carried out in the Imaging Department by a doctor (radiologist) who specialises in doing procedures under imaging guidance with X-rays or ultrasound.

What is a lymphatic malformation?

A lymphatic malformation is an abnormality of the lymphatic system that results in a collection of fluid filled spaces. These malformations are congenital (they were present when you were born). The cysts are filled with a clear fluid, similar to the fluid in a blister. Lymphatic malformations are not dangerous but can cause pain and swelling. 

Microcystic malformations contain lots of tiny cysts and usually cause problems because they are bulky, unsightly, or get infected. Sclerotherapy is a way of trying to reduce the size of the cysts so that they are smaller and less troublesome.

What is a venous vascular malformation?

A venous vascular malformation is a collection of abnormal venous vascular spaces. These spaces will have some connections to nearby normal veins. 

Venous malformations are congenital (they were present when you were born). They contain vascular spaces with slow flowing blood and solid tissue.

Like lymphatic malformations venous vascular malformations are not usually dangerous, but can cause pain and swelling, particularly when blood clots form within the lesion. 

What is bleomycin?

Bleomycin is a medicine that has been used for many years to treat other conditions such as cancer. More recently small doses of bleomycin have been found to be useful for treating vascular and lymphatic malformations. 

When it has been used in higher doses in cancer treatment and has been injected straight into the bloodstream, bleomycin can cause damage and changes to the lungs and how they function. This can happen during the treatment or afterwards. This is extremely unlikely to happen when bleomycin is being used in sclerotherapy, as the doses are much lower, and the medicine is not given in the same way.

However, always tell your doctor if after treatment with bleomycin you: 

  • Develop a wheeze.
  • Develop a cough.
  • Have a fever.
  • Feel breathless.

You should also let them know if any existing breathing problems get worse.

What happens before the sclerotherapy?

Before you attend for bleomycin sclerotherapy we will send you a clinic appointment to meet with the radiologist. Here they will assess your suitability for the procedure.

If necessary, we will arrange for you to have some breathing tests before you have bleomycin treatment.

You will need to have a blood test a few days before the procedure to check that you are not at increased risk of bleeding and that it will be safe to take to proceed with the bleomycin treatment. This may be arranged to take place at your GP surgery. 

You can continue taking your normal medication. If you are on any medication which thins the blood (e.g., aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran, apixaban) please call the Imaging Department using the number on your appointment letter as we may need to adjust your medication.  

On the day of the procedure

  • You should not eat anything from midnight the night before the procedure. You may drink clear fluids until 7am on the day of the procedure. 
  • You will arrive at the Imaging Department, Gate 19, and be accompanied into our day case area. 
  • You may take your normal medication unless instructed otherwise.
  • Please inform us if you are allergic to anything. 
  • The radiologist will discuss the procedure with you. You will be given an opportunity to ask questions. If you want to go ahead with the procedure you will be asked to sign a consent form.
  • You will be asked to change into a hospital gown and a small plastic tube (cannula) may be put into your arm.
  • Once all the checks have been performed and consent signed, you will be taken to the X-ray room on the trolley. There will be a radiologist, nurses and a radiographer with you throughout the procedure.
  • The radiologist will use an ultrasound machine to look at the malformation to find the correct area to be treated.
  • Your skin will be cleaned with an antiseptic solution and covered with sterile drapes. 
  • The radiologist will then inject local anaesthetic into the area selected, which will briefly sting and then go numb. The radiologist may then inject X-ray dye into the malformation to confirm the needle position and that it is safe to inject bleomycin. The bleomycin will then be injected through one or several small needles into the malformation under ultrasound and sometimes X-ray guidance. 
  • The procedure is likely to take about 30 minutes.
  • Once the procedure is complete the needle(s) will be removed, and the radiologist will apply a dressing if necessary. 

What happens after the procedure?

  • You will be taken back to the day case area, so that nursing staff may monitor you closely.
  • If you are in pain, tell the nursing staff so you can be given appropriate painkillers.
  • You will be advised to stay in our day case area for up to 4 hours.
  • You will be able to eat and drink as normal.
  • If everything is satisfactory, you will be free to go home. 

What are the risks associated with sclerotherapy?

Bleomycin sclerotherapy is usually a safe procedure. Potential complications include:

  • In the first 24 hours following bleomycin sclerotherapy, the area is likely to be swollen. You may take over the counter pain medication as necessary to keep the inevitable associated pain under control. The pain will resolve within a few days, but it may take several weeks for the swelling to settle completely.
  • There is a slight risk of the malformation developing an infection after the treatment. You will need a short course of oral antibiotics if this happens.
  • Very rarely, bleomycin can cause some discolouration of the skin or nails or make some hair fall out. This usually gets better with time. We think that the skin is more likely to be affected if there are monitoring leads or plasters stuck to the skin at the time of treatment. We will try to put these on parts of the skin that are less noticeable.
  • In some cases, when bleomycin has been used in much higher doses straight into the bloodstream for treating cancers, patients have developed scarring of their lungs, causing breathing problems. This has only been reported for high dose treatment with bleomycin, not at the doses used for sclerotherapy of vascular malformations. 
  • If the bleomycin spreads beyond the malformation it may cause damage to nearby normal tissues. 
    This is a rare complication but can cause permanent damage to the affected tissues. One example could be damage to the overlying skin which may ulcerate and cause scarring of the area. Other structures that could be affected depend on where in the body the malformation is, but could include muscle or nerve damage which may be permanent. 

If you experience any symptoms you are concerned about, please contact the Imaging Department directly on the number on your appointment letter or alternatively contact your GP or the Emergency Department.

Are there any alternatives to sclerotherapy?

Sclerotherapy is the best treatment option for many malformations as it can be an effective treatment and usually carries lower risks than open surgery. However, as every malformation is different, sclerotherapy may not always be the best option. 

Alternative options may include having no treatment, surgery or a combination of surgery and sclerotherapy. Your doctor will explain the options for treatment suitable for you.

Am I likely to need more than one treatment session?

You might need several sclerotherapy procedures to reduce the malformation. Sclerotherapy will not ‘cure’ the malformation, but it should shrink it significantly. 

We will also review you at an outpatient clinic appointment around 2 - 3 months after treatment.

Again, if you experience any symptoms you are concerned about, please contact the Imaging Department directly on the number on your appointment letter or alternatively contact your GP or the Emergency Department.

Finally, we hope this information is helpful. If you have any questions either before or after the procedure the staff in the Imaging Department will be happy to answer them.

© North Bristol NHS Trust.  This edition published July 2023. Review due July 2026. NBT003584

Imaging Department Contact Centre

If you are unable to attend your appointment please let us know as soon as possible. You can also contact the Imaging Department Contact Centre if you wish to change or discuss your appointment.

Telephone: 0117 414 8989

Bleomycin sclerotherapy