Revolutionary “Best” Technique โOffers Hope for Children with Vascular Malformations
Trieste,Italy is emergingโข as a leading center for the treatment of complex โฃvascular malformations โinโข children,thanks to aโค novel technique dubbed “Best” – a combination ofโ targeted drugโ delivery and electroporation.Spearheaded by Dr. Schleef, a pediatric surgeon who recently specialized at the Gaslini โInstitute in Genoa, and Dr.โ Guida, the approach is demonstrating remarkable clinical efficacy.
The work began inโฃ 2022, โขfocusing on establishing specific protocolsโค and building a dedicated team. A multicenter studyโฃ involving 40โค patients yielded “extraordinary” results, showcasing a high โpercentage of clinical betterment in treated malformations.Notably, theโข Trieste centerโค is the only โone in Europe currently utilizing โaโค 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 rangeโ from superficial to deep, localized to extensive, andโฃ frequently enough worsen over time, perhaps impacting vital functions โฃlike breathing, feeding, and speech if located โin sensitive areas likeโข the face.
Historically, treatment relied heavily onโข sclerotherapy – injectingโ 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”โข technique introduces a significant advancement: electroporation. This involvesโ applying electrical impulses to enhance the effectiveness and safety of โขthe drug, allowing for substantially lower dosages โand reduced side effects in โyoung patients.
The procedure is performed under general anesthesia or sedation. For macrocystic malformationsโ (those comprised of largeโ cysts), the drug is injected โdirectly into the lesion, diluted with aโค contrast medium to visualize the anatomy, followed byโฃ electroporation via small needles. Microcystic malformations (composed of numerous small cysts) receive intravenous bleomycin โขto โensure widespread penetration, again followed by electroporation to maximize its therapeutic impact. โSome cases resolve with a single session,whileโข more complex malformations may require multiple โtreatments.
The experience gained at the IRCCS Giulianoโ hospital is paving the way โfor the “Best” technique to become the standard of care for pediatric vascular malformations. The approach is attracting international attention, and โคthe Burlo hospital is actively collaboratingโ with the Inspect network to validate its โlarge-scale request.
Recognition of the technique’sโ success came recently with a first-prize award for a poster presentationโฃ at the 2025 โCongress of the European Paediatric Surgeons’ Association (UUPSA) inโฃ Dubrovnik. Moreover, aโฃ detailed account of the center’s experience โand theโ promising results achieved with the “best” technique has โฃbeen 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.
