{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T07:04:16Z","timestamp":1774422256163,"version":"3.50.1"},"reference-count":43,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Background: Vascular malformations (VMs) are congenital anomalies of the vascular system\u2014capillary, venous, lymphatic, arteriovenous, or combined\u2014frequently associated with notable morbidity and reduced quality of life. Electrochemotherapy (ECT), a locoregional treatment that combines chemotherapeutic agents (most commonly bleomycin) with electroporation, has emerged as a promising alternative in managing therapy-resistant or anatomically challenging lesions. Methods: A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and the Cochrane Library were searched from inception to January 2025 for studies reporting on the efficacy and\/or safety of ECT for vascular malformations. Data extraction encompassed study design, patient demographics, VM type, ECT protocols, outcomes, follow-up duration, and adverse events. Studies that lacked relevant outcome data or focused solely on other therapeutic approaches were excluded. Results: Twelve primary studies met the inclusion criteria and were analyzed. These covered diverse VMs, including venous, slow-flow, high-flow malformations, aggressive hemangiomas, and composite lesions in adult and pediatric populations. ECT protocols usually combined bleomycin (or occasionally other agents such as pingyangmycin or polidocanol foam) with various electroporation parameters. Across studies, ECT resulted in meaningful lesion-size reduction (50\u201397% in most cohorts), symptom relief (e.g., reduced pain and bleeding), and favorable cosmetic outcomes. While side effects (local edema, hyperpigmentation, procedure-related discomfort) were occasionally reported, they were typically mild and transient. Conclusions: ECT represents a valuable minimally invasive option in the therapeutic armamentarium for vascular malformations. Despite consistent demonstrations of efficacy and acceptable toxicity profiles, future high-quality, multicenter studies are warranted to confirm outcomes, refine treatment guidelines, and potentially expand its use as a standard of care.<\/jats:p>","DOI":"10.3390\/clinpract16010006","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T07:52:59Z","timestamp":1766994779000},"page":"6","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Electrochemotherapy in the Management of Vascular Malformations: An Updated Systematic Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2371-1879","authenticated-orcid":false,"given":"Antonios","family":"Michailidis","sequence":"first","affiliation":[{"name":"Interventional Radiology Department, \u201cGeorgios Papanikolaou\u201d General Hospital of Thessaloniki, 57010 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9792-5434","authenticated-orcid":false,"given":"Ioannis","family":"Tsifountoudis","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Radiology Department, 424 General Military Hospital of Education, 56429 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4576-5117","authenticated-orcid":false,"given":"Evangelos","family":"Perdikakis","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Radiology Department, 424 General Military Hospital of Education, 56429 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgios","family":"Fragkos","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Radiology Department, 424 General Military Hospital of Education, 56429 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5139-2890","authenticated-orcid":false,"given":"Ola","family":"Furmaga-Rokou","sequence":"additional","affiliation":[{"name":"Radiology Department, Asklipios Diagnostic Center, 56626 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7083-0718","authenticated-orcid":false,"given":"Prodromos","family":"Koutoukoglou","sequence":"additional","affiliation":[{"name":"First Department of Medical Oncology, Theagenio Cancer Hospital, 54639 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danae","family":"Makri","sequence":"additional","affiliation":[{"name":"Interventional Radiology Department, \u201cGeorgios Papanikolaou\u201d General Hospital of Thessaloniki, 57010 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6252-1130","authenticated-orcid":false,"given":"Evangelos","family":"Petsatodis","sequence":"additional","affiliation":[{"name":"Interventional Radiology Department, \u201cGeorgios Papanikolaou\u201d General Hospital of Thessaloniki, 57010 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefanos","family":"Finitsis","sequence":"additional","affiliation":[{"name":"Department of Radiology, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1148\/rg.2016150197","article-title":"2014 Revised Classification of Vascular Lesions from the International Society for the Study of Vascular Anomalies: Radiologic-Pathologic Update","volume":"36","author":"Merrow","year":"2016","journal-title":"RadioGraphics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e203","DOI":"10.1542\/peds.2014-3673","article-title":"Vascular Anomalies Classification: Recommendations From the International Society for the Study of Vascular Anomalies","volume":"136","author":"Wassef","year":"2015","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.nic.2009.01.005","article-title":"Neurointerventional Management of High-Flow Vascular Malformations of the Head and Neck","volume":"19","author":"Wu","year":"2009","journal-title":"Neuroimaging Clin. 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