Management of Liver Hemangioma Using Trans-Catheter Arterial Embolization

Abstract

Background:Hemangioma, a congenital vascular malformation, is the most common benign liver lesion that is usually remain stable subsequently requiring not treatment; however, complications such as abdominal pain or fullness, coagulation disturbances, and inflammatory syndrome may occur, demanding a specific treatment of hemangioma.Objectives:To assess the safety, feasibility and efficacy of trans-catheter arterial embolization (TAE) for the treatment of Liver hemangiomaPatients and Methods:TAE was performed on 20 patients with liver hemangioma. The embolic agent used was polyvinyl alcohol (PVA) particles (300-400 micron, Jonson and Johnson Cordis, USA). All patients were followed up for 6 months. Imaging was carried out and patients were also evaluated symptomatically through telephone interview by a physician.Results:Twenty patients aged from 21 to 63 years (mean: 46.8, SD: 10.26) were included in this study. Post embolization syndrome, including abdominal pain, fever, and leukocytosis occurred in one patient 1 week after TAE and lasted for 3 days. No serious adverse event and TAE-related death was observed. None of the patient underwent another intervention including surgery. During follow up interval, decreased episode of abdominal pain was documented in all patients who had pain. Tumor enlargement was also stopped during the follow up. The average diameter of tumors was 97.00 mm (range: 25-200 SD: 47.85) and 88.95 mm (range: 23-195 SD: 43.27) before and after embolization, respectively. Comparison of images before and after TAE revealed statistically significant decrease in the size of lesion (P value: 0.004, t: 3.31).Conclusions:Our findings indicate that TAE is a safe and efficient procedure for the treatment of liver hemangioma. Further studies with larger sample sizes are required to support therapeutic effects of TAE.

Preoperative Trans-Arterial Embolization and Surgical Resection for Giant Liver Hemangioma: A Multidisciplinary Approach

“…The diameter of the hemangiomas also decreased from a mean of 9.7cm to 3cm. These results were compatible with study by Firouznia et al [18]. Risks associated with TAE include pain, inoperability, non-target embolization, bile duct injury, pyrexia, leukocytosis, and nausea [15,19,34,35].…”

“…For this reason, surgical resection remains an attractive option if the hemangioma is deeply located in the liver parenchyma, occupies an entire lobe, or does not have a free surface from Glisson's capsule [13]. Trans-arterial embolization has been proposed as a treatment option in giant symptomatic hemangiomas, both alone and in combination with resection [15][16][17][18][19][20][21][22]. In a study of 98 patients with a hemangioma > 5cm, TAE monotherapy resulted in resolution of pain and distension in 87% of patients with baseline symptoms, with partial reduction in the other 13% [22].…”

“…Although traditionally treated with surgical resection or enucleation alone, recent treatment modalities include trans-arterial embolization (TAE), radiotherapy, radiofrequency ablation, transplant, chemotherapy, or multi-modal therapy [13]. Trans-arterial embolization has been proposed as a treatment option in giant symptomatic hemangiomas, both alone and in combination with resection [15][16][17][18][19][20][21][22][23].…”

Hepatic artery embolization for treating giant hemangioma of liver: an experience from a tertiary level hospital in India

“…[13][14][15] Zeng Q et al , Firouznia K et al and Panis Y, et al found that significant reduction in tumour size of all patients and symptomatic relief in almost all patients. [16][17][18] In present study, we found significant reduction in tumour size and symptomatic relief in all 28 patients. Present study is comparable with studies done by Firouznia K et al and others.…”

Hepatic Hemangioma Rupture Caused by Blunt Trauma

“…TAE as an alternative to surgical resection is controversial because of its complications, including postembolization pain, nausea, biliary tree damage, infection, liver abscess, and sepsis. However, owing to technical improvements and fewer complication rates, TAE has also been safely and effectively used as a single therapy in recent research [5][6][7]. If vital signs were stable, TAE without surgery would have been attempted in our case.…”