Evidence map›Paper›PMID 41128761›Full record

SynthesisEuropean radiology2026

Simply the (B)EST: what the interventionalist needs to know about (bleomycin) electrosclerotherapy for vascular anomalies.

Julien Ognard, Aysha Alateya, Gerard El Hajj, Annouk Bisdorff, Lambros Tselikas, Ahmed Ayad, Tor Lindell, Zain Alateya, Sherief Ghozy, Ramanathan Kadirvel and 2 more

Abstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Julien Ognard *Department of Radiology, Mayo Clinic, Rochester, MN, USA. ognard.julien@mayo.edu.ORCID http://orcid.org/0000-0003-4495-7464
Aysha Alateya *Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen, Bahrain.
Gerard El HajjDepartment of Radiology, Mayo Clinic, Rochester, MN, USA.
Annouk BisdorffReference Center for Vascular Anomalies FAVA-Multi, University Hospital of Lariboisière, Paris, France.
Lambros TselikasDepartment of Anesthesia, Surgery and Interventional Care (DACI), Interventional Radiology Service, Gustave Roussy; BIOTHERIS Clinical Investigation Center, INSERM CIC 1428; Faculty of Medicine, Paris‑Saclay University, Gif-sur-Yvette, France.
Ahmed AyadDiagnostic and Interventional Radiology and Neuroradiology, Alfried-Krupp-Hospital, Essen, Germany.
Tor LindellDepartment of Radiology, Mayo Clinic, Rochester, MN, USA.
Zain AlateyaRoyal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen, Bahrain.
Sherief GhozyDepartment of Radiology, Mayo Clinic, Rochester, MN, USA.
Ramanathan KadirvelDepartment of Radiology, Mayo Clinic, Rochester, MN, USA.
David F KallmesDepartment of Radiology, Mayo Clinic, Rochester, MN, USA.
Waleed BrinjikjiDepartment of Radiology, Mayo Clinic, Rochester, MN, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundVascular anomalies (VAs) require specialized multidisciplinary management. Bleomycin electrosclerotherapy (B)EST combines electroporation with intralesional bleomycin to enhance drug uptake while preserving surrounding tissue. Its role in treating VAs remains largely unexplored.

objectiveThis systematic review evaluates the efficacy, safety, and procedural protocols of BEST in VA treatment. MATERIALS AND

methodsFollowing PRISMA guidelines, a systematic search was conducted in PubMed, Web of Science, and Scopus. Inclusion criteria included peer-reviewed studies on (B)EST for VAs, excluding reviews, editorials, and animal studies.

resultsAmong 1237 records, 15 studies met the inclusion criteria, published between 2012 and 2025, primarily from Europe (13/15). A total of 566 patients were treated, including 445 with vascular malformations and 121 with vascular tumors (Kaposi sarcoma, angiosarcoma). (B)EST was mainly applied to slow-flow malformations. Across VA types, lesion-volume or symptom reduction rate was high, with five studies each reporting a 100% rate. Complete response in vascular tumors ranged from 65 to 100%. Most studies followed current guidelines, with bleomycin doses between 200 and 10,000 IU per session. Adverse effects were primarily local and self-limiting (Cardiovascular and Interventional Radiological Society of Europe classification CIRSE 1a-2); ulcerations occurred mainly in vascular tumors (CIRSE 3a); and skin hyperpigmentation (CIRSE 1a) was observed frequently, often partially resolving over time.

conclusionBEST shows promise for VA treatment, particularly venous and lymphatic malformations. While results suggest efficacy and safety, treatment heterogeneity and long-term outcomes require further investigation. Optimizing tailored protocols for each VA subtype and presentation is essential for defining (B)EST's role in VA management. KEY POINTS: Question What is the role and efficacy of (bleomycin) electrosclerotherapy (B)EST in managing vascular anomalies resistant to conventional treatments, including tumors and malformations? Findings (B)EST demonstrated significant efficacy, achieving 65-100% complete responses in vascular tumors and 54.9-100% lesion or symptom reduction in vascular malformations. Clinical relevance (B)EST offers an option for patients with treatment-resistant or recurrent vascular anomalies, improving symptom-related outcomes. This is tempered by the absence of controlled trials, the need for cumulative dose pulmonary monitoring and the potential cosmetic burden of hyperpigmentation.

Indexed as

Antibiotics, AntineoplasticBleomycinElectrochemotherapySclerotherapyVascular MalformationsHumansAntibiotics, AntineoplasticBleomycinBleomycinElectroporationElectrosclerotherapySclerotherapyVascular anomalies

Identifiers

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.