Medium and Long-Term Outcome of Superselective Transcatheter Arterial Embolization with Lipiodol–Bleomycin Emulsion for Giant Hepatic Hemangiomas: Results in 241 Patients

Abstract

Purpose: To evaluate the medium and long-term efficacy of superselective transcatheter arterial embolization (TAE) with lipiodol–bleomycin emulsions (LBE) for giant hepatic hemangiomas. Methods: A total of 241 patients who had underwent TAE with LBE for hepatic hemangiomas from January 2010 to December 2016 were retrospectively reviewed. Blood tests were performed 3 and 7 days after TAE and procedural-related complications were recorded. The patients were followed up by enhanced CT or MRI imaging at 6, 12, 36, and 60 months post-TAE, respectively. Technical success of TAE was defined as successful embolization of all identifiable arteries supplying to the hemangiomas. Clinical success was defined as improvement of the abdominal symptoms and indications on the imaging examinations that the hemangiomas had decreased by more than 50% in maximum diameter. Results: TAE was performed successfully in all patients without serious complications. Improvement of the abdominal symptoms was recorded in 102/102 cases (100%). The reduction rate of the tumor maximum diameter with >50% at 6, 12, 36, and 60 months was 88.1% (190/210), 86.7% (170/196), 85.2% (124/142), and 86.5% (45/52), respectively. There was a significant change from pre-TAE to follow-up values in maximum diameter (p < 0.05). Conclusion: TAE with LBE was feasible and effective for giant hepatic hemangiomas. The reductions of the tumor maximum diameter with >50% at medium (≥3 years) and long-term (≥5 years) follow-up were satisfactory, with 85.2% and 86.5%, respectively.

Efficacy of radiofrequency ablation vs. transcatheter arterial embolization for hepatic hemangiomas

“…Despite the super-selective nature of embolization, there may still be a small amount of BLE retained in normal liver tissue. Research suggests that the elevation of ALT and AST after RFA and TACE is temporary and returns to normal within 1-2 weeks [12,17,19]. In the RFA group, hemolytic jaundice may occur after surgery, which is attributed to the destruction of red blood cells during the RFA process.…”

“…The higher incidence rate of procedure-related complications in the RFA group in our center is mainly due to the higher number of patients with temporary liver injury (23 out of 39, 59.0%) compared to the TACE group (12 out of 43, 27.9%). However, both temporary liver injuries in the RFA group and the TACE group can self-recover within 1-2 weeks [12,17,19]. Procedure-related complications in the TACE group included liver abscess, cholangitis, cholecystitis, and pulmonary fibrosis.…”

“…There were no reported deaths, and no severe complications occurred. In 2022, Yuan B [19] also considered TAE combined with BLE as a safe and effective method to improve abdominal symptoms caused by HH. It demonstrated reliable medium-term (≥3 years) and long-term (≥5 years) clinical and radiological success rates.…”

“…The determination of the time of efficacy assessment of RFA and TACE in this study was based on previous studies. On the one hand, research suggests that the period of tumor shrinkage following TACE for treating HH occurs primarily within the first 12 months postoperatively, with minimal changes observed beyond 12 months [19,29]. On the other hand, although there hasn't been explicit research on the contraction period of HH treated with RFA, relevant study [30] data suggests that the most significant volume changes occur within the first 12 months following thermal ablation.…”

“…For IE in HH treatment, drugs can be categorized into iodized oil (Lipiodol)-based strategies like L+Bleomycin (BLE), L+Pingyangmycin (PYG), or L+Ethanol, as well as non-iodized oil strategies like polyvinyl alcohol (PVA). Some studies [18,19] have shown that IE using L+BLE, L+PYG, or L+ethanol is safe and effective, while PVA-based transcatheter arterial embolization (TAE) has shown limited effectiveness in reducing hemangioma size. Long-term follow-up studies, such as those by Liu et al [20], found that the long-term effective rates of TAE for LHH and GHH were 45.9% and 12.5%, respectively.…”