Bevacizumab and interferon reduce venous recanalization following sclerotherapy

PurposeThe treatment of venous malformations is difficult because these lesions frequently recur after resection or sclerotherapy. The purpose of this study was to determine whether recanalization of sclerosed venous lumens could be prevented with systemic angiogenic inhibition using bevacizumab or peginterferon alfa-2a.MethodsTo establish an animal model of recanalization of sclerosed facial veins, 18 rabbits had ethanol sclerotherapy of 1 facial vein followed by venography after 4 weeks (n = 6), 12 weeks (n = 6), and 24 weeks (n = 6). Subsequently, 21 different leporids underwent sclerotherapy of both facial veins (n = 42 veins) and were treated pharmacologically in three ways: (1) control (n = 14); bevacizumab (n = 14); or peginterferon alfa-2a (n = 14). Animals received 2 systemic drug doses 1 month prior to and during the procedure. Vessel patency was determined 24 weeks later using venography.ResultsVenous recanalization occurred in 33.3% of sclerosed facial veins after 4 weeks and 50.0% after 12 and 24 weeks. For animals treated with systemic medication, recanalization occurred less frequently when bevacizumab (14.3%, n = 2/14) (P = 0.04) or peginterferon alfa-2a (7.7%, n = 1/14) (P = 0.01) was administered compared to controls (57.1%, n = 8/14).ConclusionsSystemic treatment with bevacizumab or peginterferon alfa-2a reduces venous recanalization following sclerotherapy in an animal model. Further studies are indicated to determine whether anti-angiogenic pharmacotherapy can prevent recurrence of venous malformations in humans after sclerotherapy.