Transarterial Bleomycin–Lipiodol Embolization (B/LE) for Symptomatic Giant Hepatic Hemangioma

Akhlaghpoor, Shahram; Torkian, Pooya; Golzarian, Jafar

doi:10.1007/s00270-018-2010-4

Cited by 31 publications

(35 citation statements)

References 37 publications

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“…Substances used for TAE are, for example, metallic coils, polyvinyl alcohol, Gelfoam particles, and liquid agents such as N-butyl-2-cyanoacrylate and bleomycin-lipiodol [36][37][38]. A recent study including 23 patients and 29 HHs treated with TAE using bleomycin-lipiodol showed a 50% reduction in the hemangioma volume in 17 of 23 patients [39].…”

Section: Nonsurgical Managementmentioning

confidence: 99%

Benign Liver Tumors

et al. 2020

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Background: Due to the frequent use of medical imaging including ultrasonography, the incidence of benign liver tumors has increased. There is a large variety of different solid benign liver tumors, of which hemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA) are the most frequent. Advanced imaging techniques allow precise diagnosis in most of the patients, which reduces the need for biopsies only to limited cases. Patients with benign liver tumors are mostly asymptomatic and do not need any kind of treatment. Symptoms can be abdominal pain and pressure effects on adjacent structures. The 2 most serious complications are bleeding and malignant transformation. Summary: This review focuses on hepatic hemangioma (HH), FNH, and HCA, and provides an overview on clinical presentations, surgical and interventional treatment, as well as conservative management. Treatment options for HHs, if indicated, include liver resection, radiofrequency ablation, and transarterial catheter embolization, and should be carefully weighed against possible complications. FNH is the most frequent benign liver tumor without any risk of malignant transformation, and treatment should only be restricted to symptomatic patients. HCA is associated with the use of oral contraceptives or other steroid medications. Unlike other benign liver tumors, HCA may be complicated by malignant transformation. HCAs have been divided into 6 subtypes based on molecular and pathological features with different risk of complication. Key Message: The vast majority of benign liver tumors remain asymptomatic, do not increase in size, and rarely need treatment. Biopsies are usually not needed as accurate diagnosis can be obtained using modern imaging techniques.

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Section: Nonsurgical Managementmentioning

confidence: 99%

Benign Liver Tumors

et al. 2020

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“…Multiple reasons for treatment, present in 39/231 patients (16.9%), always included symptoms. Three studies stated that the indication for treatment was either symptoms, fear of future bleeding, patients’ desire for treatment or tumour size, but did not specify how many patients underwent treatment for each indication [ 51 , 52 , 54 ]. Details are tabulated in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

“…Biopsy was occasionally used in case of unsure diagnosis or if the study was conducted before widespread availability of CT and MRI [ 16 , 31 , 38 , 48 , 51 ]. Lipiodolization was performed with either pingyangmycin or bleomycin [ 8 , 31 , 38 , 45 , 47 , 50 , 52 – 54 ]. TAE/TACE procedures usually included the use of gelfoam [ 41 , 43 , 44 , 46 , 48 , 49 ].…”

Section: Resultsmentioning

confidence: 99%

Transarterial (Chemo-)Embolization and Lipiodolization for Hepatic Haemangioma

Furumaya

Rosmalen

Takkenberg

et al. 2019

Cardiovasc Intervent Radiol

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Background Transarterial (chemo-)embolization/lipiodolization (TAE/TAL) might be an attractive minimally invasive alternative to surgery in the treatment of symptomatic hepatic haemangioma. This review assesses the efficacy and safety of TAE/TAL as primary treatment for symptomatic hepatic haemangioma. Methods A systematic search of the literature was performed by two reviewers following the PRISMA guidelines. Cohort studies and case reports were identified; outcomes of cohort studies were reported. The primary efficacy outcome was tumour size before and after TAE/TAL. Improvement of symptoms and quality of life (QoL) were secondary outcomes; the primary safety outcome was complications. The Downs and Black statement was used for quality assessment. Results Eighteen cohort studies were identified, including 1284 patients. TAE/TAL led to a decrease in tumour size in 1100/1223 (89.9%) patients and to improvement or disappearance of symptoms in 1080/1096 (98.5%) patients. A significant decrease in tumour size from 9.79 ± 0.79 cm to 4.00 ± 1.36 cm ( p < 0.001) was shown. Grade 3 complications occurred in 37/1284 (2.9%) patients. Surgical treatment was necessary in 35/1284 (2.7%) of patients. Conclusion TAE/TAL appears to be a promising and safe treatment to decrease tumour size of hepatic haemangioma. The technique might also provide partial relief of symptoms, although no randomized clinical trials or prospective studies using validated QoL questionnaires are available. TAE/TAL may be considered as a viable alternative to resection. Electronic supplementary material The online version of this article (10.1007/s00270-019-02169-x) contains supplementary material, which is available to authorized users.

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“…In addition, it has a sclerosing effect on endothelial cells with a nonspecific inflammatory reaction. 9 Bleomycin has been used in the treatment of symptomatic hepatic haemangioma 10 and focal nodular hyperplasia 11 as a vascular endothelial sclerosing agent during TAE. This has been demonstrated to be safe and efficient with good long-term symptomatic control and reduction in lesion size.…”

Section: Introductionmentioning

confidence: 99%