Revolutionary “Best” Technique Offers Hope for Children with Vascular Malformations
Trieste,Italy is emerging as a leading center for the treatment of complex vascular malformations in children,thanks to a novel technique dubbed “Best” – a combination of targeted drug delivery and electroporation.Spearheaded by Dr. Schleef, a pediatric surgeon who recently specialized at the Gaslini Institute in Genoa, and Dr. Guida, the approach is demonstrating remarkable clinical efficacy.
The work began in 2022, focusing on establishing specific protocols and building a dedicated team. A multicenter study involving 40 patients yielded “extraordinary” results, showcasing a high percentage of clinical betterment in treated malformations.Notably, the Trieste center is the only one in Europe currently utilizing a defined protocol for administering bleomycin – a key drug in the treatment – intravenously or directly, based on the specific characteristics of the malformation.
Vascular malformations are congenital anomalies affecting blood vessels or the lymphatic system,appearing at birth,during prenatal diagnostics,or even later in life following trauma. These malformations can range from superficial to deep, localized to extensive, and frequently enough worsen over time, perhaps impacting vital functions like breathing, feeding, and speech if located in sensitive areas like the face.
Historically, treatment relied heavily on sclerotherapy – injecting a drug directly into the malformation to induce scarring and reabsorption. Though, this method frequently enough proved limited, notably for larger, deeper lesions. the “Best” technique introduces a significant advancement: electroporation. This involves applying electrical impulses to enhance the effectiveness and safety of the drug, allowing for substantially lower dosages and reduced side effects in young patients.
The procedure is performed under general anesthesia or sedation. For macrocystic malformations (those comprised of large cysts), the drug is injected directly into the lesion, diluted with a contrast medium to visualize the anatomy, followed by electroporation via small needles. Microcystic malformations (composed of numerous small cysts) receive intravenous bleomycin to ensure widespread penetration, again followed by electroporation to maximize its therapeutic impact. Some cases resolve with a single session,while more complex malformations may require multiple treatments.
The experience gained at the IRCCS Giuliano hospital is paving the way for the “Best” technique to become the standard of care for pediatric vascular malformations. The approach is attracting international attention, and the Burlo hospital is actively collaborating with the Inspect network to validate its large-scale request.
Recognition of the technique’s success came recently with a first-prize award for a poster presentation at the 2025 Congress of the European Paediatric Surgeons’ Association (UUPSA) in Dubrovnik. Moreover, a detailed account of the center’s experience and the promising results achieved with the “best” technique has been published in the international journal Children (link).
Drs. Guida and Schleef conclude that the “Best” technique represents a “epochal change” in managing these often-disabling conditions, offering a new and hopeful future for children affected by vascular malformations.