title: Bevacizumab and interferon reduce venous recanalization following sclerotherapy.
abstract: OBJECTIVE
  The 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.
  
  
  METHODS
  To establish an animal model of recanalization of sclerosed facial veins, 18 rabbits had ethanol sclerotherapy of 1 facial vein followed by venography after 4weeks (n=6), 12weeks (n=6), and 24weeks (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 1month prior to and during the procedure. Vessel patency was determined 24weeks later using venography.
  
  
  RESULTS
  Venous recanalization occurred in 33.3% of sclerosed facial veins after 4weeks and 50.0% after 12 and 24weeks. 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).
  
  
  CONCLUSIONS
  Systemic 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.
authors: Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors: Ann M
authors: AM
authors: Kulungowski
authors: Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA. Electronic address: ahhassanein@partners.org.
authors: Aladdin H
authors: AH
authors: Hassanein
authors: Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors: Carolyn C
authors: CC
authors: Foster
authors: Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors: Arin K
authors: AK
authors: Greene
authors: Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA. Electronic address: steven.fishman@childrens.harvard.edu.
authors: Steven J
authors: SJ
authors: Fishman
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000818:Animals; D000068258:Bevacizumab / Q000008:administration & dosage*; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004337:Drug Carriers; D016898:Interferon-alpha / Q000008:administration & dosage*; D010690:Phlebography; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011817:Rabbits; D011994:Recombinant Proteins / Q000008:administration & dosage; D012008:Recurrence; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000379:methods*; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000175:diagnosis / Q000628:therapy*; D014680:Veins / Q000002:abnormalities*
chemical_list: D020533:Angiogenesis Inhibitors; D004337:Drug Carriers; D016898:Interferon-alpha; D011994:Recombinant Proteins; D012597:Sclerosing Solutions; D000068258:Bevacizumab; D011092:Polyethylene Glycols; C100416:peginterferon alfa-2a
keywords: Recurrence; Sclerotherapy; Vascular anomaly; Venous malformation