INTERVENTIONAL RADIOLOGY / ORIGINAL PAPER
Figure from article: Transarterial...
 
KEYWORDS
TOPICS
ABSTRACT
Purpose:
Giant hepatic haemangiomas are among the most common benign liver tumours, with an incidence ranging from 4.0% to 20.0%. Large hepatic haemangiomas can cause symptoms such as pain and bleeding. There is currently no gold standard in their treatment. One of the methods is transarterial bleomycin-lipiodol embolisation (B/LE). The aim of this study is to evaluate the efficacy of treating hepatic haemangiomas with B/LE.

Material and methods:
We retrospectively reviewed 44 patients treated with B/LE between February 2021 and June 2022 in the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin. Before the procedure, all patients were examined by magnetic resonance imaging (MRI) or computed tomography. Vascularised lesions were embolised by intraarterial administration of a mixture of bleomycin and lipiodol, closing the vasculari­sation of the lesion, which was confirmed by control angiography. All patients were followed up clinically and by MRI for an average of 6 months.

Results:
The size of the examined haemangiomas before the procedure ranged from 5 to 16 cm. After the first procedure, 28 out of 44 patients had an essential reduction in the size of the haemangioma, while 16 patients had the procedure repeated. Eventually, the size of the haemangiomas decreased significantly (p ≤ 0.05). The average reduction in volume was 67.22%. Technical success, described as the reduction of blood supply to the haemangioma, was achieved in all the cases.

Conclusions:
Transarterial B/LE is an effective procedure resulting in reduced size of haemangiomas and alleviation of symptoms.
REFERENCES (50)
1.
Bolger K, Choudhary MM, Kouri B. Transarterial chemoembolization as the primary treatment for a super-giant hepatic hemangioma. Radiol Case Rep 2023; 18: 94-96.
 
2.
Toro A, Mahfouz AE, Ardiri A, Malaguarnera M, Malaguarnera G, Loria F, et al. What is changing in indications and treatment of hepatic hemangiomas. A review. Ann Hepatol 2014; 13: 327-339.
 
3.
Furumaya A, Van Rosmalen BV, Takkenberg RB, van Delden OM, Dejong CHC, Verheij J, van Gulik TM. Transarterial chemo embolization and lipiodolization for hepatic haemangioma. Cardiovasc Intervent Radiol 2019; 42: 800-811.
 
4.
Stankiewicz R, Kobryn K, Patkowski W, Krawczyk M. Management of giant hepatic hemangioma in atypical localization; report of a case and literature review. Pol Przegl Chir 2015; 87: 139-142.
 
5.
Ng WW, Cheung YS, Lee KF, Wong J, Yu SC, Lee PS, Lai PB. Is regu­lar follow-up scan for giant liver haemangioma necessary? Hong Kong Med J 2007; 13: 353-358.
 
6.
Yamagata M, Kanematsu T, Matsumata T, Utsunomiya T, Ikeda Y, Sugimachi K. Management of haemangioma of the liver: comparison of results between surgery and observation. Br J Surg 1991; 78: 1223-1225.
 
7.
Farges O, Daradkeh S, Bismuth H. Cavernous hemangiomas of the liver: are there any indications for resection? World J Surg 1995; 19: 19-24.
 
8.
Okano H, Shiraki K, Inoue H, Ito T, Yamanaka T, Deguchi M, et al. Natural course of cavernous hepatic hemangioma. Oncol Rep 2001; 8: 411-414.
 
9.
Pietrabissa A, Giulianotti P, Campatelli A, Di Candio G, Farina F, Signori S, Mosca F. Management and follow-up of 78 giant haemangiomas of the liver. Br J Surg 1996; 83: 915-918.
 
10.
Tait N, Richardson AJ, Muguti G, Little JM. Hepatic cavernous haemangioma: a 10 year review. Aust N Z J Surg 1992; 62: 521-524.
 
11.
Trastek VF, van Heerden JA, Sheedy PF 2nd, Adson MA. Cavernous hemangiomas of the liver: resect or observe? Am J Surg 1983; 145: 49-53.
 
12.
Dong W, Qiu B, Xu H, He L. Invasive management of symptomatic hepatic hemangioma. Eur J Gastroenterol Hepatol 2019; 31: 1079-1084.
 
13.
Bozkaya H, Cinar C, Besir FH, Parıldar M, Oran I. et al. Minimally invasive treatment of giant haemangiomas of the liver: embolisation with bleomycin. Cardiovasc Intervent Radiol 2014; 37: 101-107.
 
14.
Martínez-González MN, Mondragón-Sánchez R, Mondragón-Sánchez A, Gómez-Gómez E, Garduño-López AL, Bernal-Maldonado R, et al. Cavernous hemangioma of the liver and hepatic hemangiomatosis. Indications and results of the surgical resection. Rev Gastroenterol Mex 2003; 68: 277-282 [Article in Spanish].
 
15.
Özden İ. Long-term results of surgery for liver hemangiomas. Arch Surg 2000; 135: 978-981.
 
16.
Yu M, Lee W, Chao T, Chen M, Ho H, Wu T, et al. Surgical management of giant hepatic hemangiomas: complications and review of the literature. Biomed J 2012; 35: 70.
 
17.
Brouwers MM, Peeters PMJG, De Jong KP, Haagsma EB, Klompma­ker IJ, Bijleveld CM, et al. Surgical treatment of giant haemangioma of the liver. Br J Surg 1997; 84: 314-316.
 
18.
Duxbury MS, Garden OJ. Giant haemangioma of the liver: observation or resection? Digest Surg 2010; 27: 7-11.
 
19.
Akhlaghpoor S, Torkian P, Golzarian J. Transarterial Bleomycin–Lipiodol embolization (B/LE) for symptomatic giant hepatic hemangioma. CardioVascular and Interventional Radiology 2018; 41: 1674-1682.
 
20.
Zeng Q, Li Y, Chen Y, Ouyang Y, He X, Zhang H. Gigantic cavernous hemangioma of the liver treated by intra-arterial embolization with pingyangmycin-lipiodol emulsion: a multi-center study. Cardiovasc Intervent Radiol 2004; 27: 481-485.
 
21.
Fei L, Hongsong X. Effectiveness of microwave ablation for the treatment of hepatic hemangioma – meta-analysis and meta-regression. Int J Hyperthermia 2023; 40: 2146214. DOI: 10.1080/02656736. 2022.2146214.
 
22.
Ji J, Gao J, Zhao L, Tu J, Song J, Sun W. Computed tomography-guided radiofrequency ablation following transcatheter arterial embolization in treatment of large hepatic hemangiomas. Medicine (Baltimore) 2016; 95: e3402. DOI: 10.1097/MD.0000000000003402.
 
23.
Kacała A, Dorochowicz M, Patrzałek D, Janczak D, Guziński M. Safety and feasibility of transarterial bleomycin–lipiodol embolization in patients with giant hepatic hemangiomas. Medicina (Kaunas) 2023; 59: 1358. DOI: 10.3390/medicina59081358.
 
24.
Li Y, Jia Y, Li S, Wang W, Wang Z, Wang Y, et al. Transarterial chemoembolization of giant liver haemangioma: a multi-center study with 836 cases. Cell Biochem Biophys 2015; 73: 469-472.
 
25.
Karhunen P. Benign hepatic tumors and tumour-like conditions in men. J Clin Pathol 1986; 39: 183-188.
 
26.
Idée JM, Guiu B. Use of lipiodol as a drug-delivery system for transcatheter arterial chemoembolization of hepatocellular carcinoma: a review. Crit Rev Oncol Hematol 2013; 88: 530-549.
 
27.
Sun JH, Nie CH, Zhang YL, Zhou GH, Ai J, Zhou TY, et al. Trans­catheter arterial embolization alone for giant hepatic hemangioma. PLoS One 2015; 10: e0135158. DOI: 10.1371/journal.pone.0135158.
 
28.
Anderson SW, Kruskal JB, Kane RA. Benign hepatic tumors and iatrogenic pseudotumors. Radiographics 2009; 29: 211-229.
 
29.
Perkins AB, Imam K, Smith WJ, Cronan JJ. Color and power Doppler sonography of liver hemangiomas: a dream unfulfilled? J Clin Ultrasound 2000; 28: 159-165.
 
30.
Yamashita Y, Ogata I, Urata J, Takahashi M. Cavernous hemangioma of the liver: pathologic correlation with dynamic CT findings. Radio­logy 1997; 203: 121-125.
 
31.
McFarland EG, Mayo-Smith WW, Saini S, Hahn PF, Goldberg MA, Lee MJ. Hepatic hemangiomas and malignant tumors: improved differentiation with heavily T2-weighted conventional spin-echo MR imaging. Radiology 1994; 193: 43-47.
 
32.
Lee MG, Baker ME, Sostman HD, Spritzer CE, Paine S, Paulson EK, Keogan MT. The diagnostic accuracy/efficacy of MRI in differentiating hepatic hemangiomas from metastatic colorectal/breast carcinoma: a multiple reader ROC analysis using a jackknife technique. J Comput Assist Tomogr 1996; 20: 905-913
 
33.
Herman P, Costa ML, Machado MA, Pugliese V, D’Albuquerque LA, Machado MC, et al. Management of hepatic hemangiomas: a 14-year experience. J Gastrointest Surg 2005; 9: 853-859.
 
34.
Erdogan D, Busch OR, van Delden OM, Bennink RJ, ten Kate FJ, Gouma DJ, van Gulik TM. Management of liver hemangiomas according to size and symptoms. J Gastroenterol Hepatol 2007; 22: 1953-1958.
 
35.
Ribeiro MA Jr, Papaiordanou F, Gonçalves JM, Chaib E. Spontaneous rupture of hepatic hemangiomas: a review of the literature. World J Hepatol 2010; 2: 428-433.
 
36.
Yamamoto T, Kawarada Y, Yano T, Noguchi T, Mizumoto R. Spontaneous rupture of hemangioma of the liver: treatment with transcatheter hepatic arterial embolization. Am J Gastroenterol 1991; 86: 1645-1649.
 
37.
Chen ZY, Qi QH, Dong ZL. Etiology and management of hemmorrhage in spontaneous liver rupture: a report of 70 cases. World J Gastroenterol 2002; 8: 1063-1066.
 
38.
Jain V, Ramachandran V, Garg R, Pal S, Gamanagatti SR, Srivastava DN. Spontaneous rupture of a giant hepatic hemangioma – sequential management with transcatheter arterial embolization and resection. Saudi J Gastroenterol 2010; 16: 116-119.
 
39.
Schnelldorfer T, Ware AL, Smoot R, Schleck CD, Harmsen WS, Nagorney DM. Management of giant hemangioma of the liver: resection versus observation. J Am Coll Surg 2010; 211: 724-730.
 
40.
Ohishi H, Uchida H, Yoshimura H, Ohue S, Ueda J, Katsuragi M, et al. Hepatocellular carcinoma detected by iodized oil. Use of anticancer agents. Radiology 1985; 154: 25-29.
 
41.
Yedibela S, Alibek S, Müller V, Aydin U, Langheinrich M, Lohmüller C, et al. Management of hemangioma of the liver: surgical therapy or observation? World J Surg 2013; 37: 1303-1312.
 
42.
Schnelldorfer T, Ware AL, Smoot R, Schleck CD, Harmsen WS, Nagorney DM. Management of giant hemangioma of the liver: resection versus observation. Am Coll Surg 2010; 211: 724-730.
 
43.
Yuan B, Zhang J, Duan F, Wang MQ. Medium and long-term outcome of superselective transcatheter arterial embolization with lipiodol–bleomycin emulsion for giant hepatic hemangiomas: results in 241 patients. J Clin Med 2022; 11: 4762. DOI: 10.3390/jcm11164762.
 
44.
Jin S, Shi XJ, Sun XD, Wang SY, Wang GY. Sclerosing cholangitis secondary to bleomycin-iodinated embolization for liver hemangioma. World J Gastroenterol 2014; 20: 17680-17685.
 
45.
Özden İ, Poyanlı A, Önal Y, Demir AA, Hoş G, Acunaş B. Superselective transarterial chemoembolization as an alternative to surgery in symptomatic/enlarging liver hemangiomas. World J Surg 2017; 41: 2796-2803.
 
46.
Xu H, Yu X, Hu J. The risk assessment and clinical research of bile duct injury after transcatheter arterial chemoembolization for hepatocellular carcinoma. Cancer Manag Res 2021; 13: 5039-5052.
 
47.
Miyayama S, Yamashiro M, Okuda M, Yoshie Y, Nakashima Y, Ikeno H, et al. Main bile duct stricture occurring after transcatheter arterial chemoembolization for hepatocellular carcinoma. Cardiovasc. Interv Radiol 2010; 33: 1168-1179.
 
48.
Dhamija E, Paul SB, Gamanagatti SR, Acharya SK. Biliary complications of arterial chemoembolization of hepatocellular carcinoma. Diagn Interv Imaging 2015; 96: 1169-1175.
 
49.
Boulin M, Adam H, Guiu B, Aho LS, Cercueil JP, Di Martino C, et al. Predictive factors of transarterial chemoembolisation toxicity in unresectable hepatocellular carcinoma. Dig Liver Dis 2014; 46: 358-362.
 
50.
Thompson CM, Saad NE, Quazi RR, Darcy MD, Picus DD, Menias CO. Management of iatrogenic bile duct injuries: role of the interventional radiologist. Radiographics 2013; 33: 117-134.
 
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