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. 2023 Jul 25;59(8):1358.
doi: 10.3390/medicina59081358.

Safety and Feasibility of Transarterial Bleomycin-Lipiodol Embolization in Patients with Giant Hepatic Hemangiomas

Arkadiusz Kacała  1 , Mateusz Dorochowicz  2 , Dariusz Patrzałek  3 , Dariusz Janczak  3 , Maciej Guziński  1
Affiliations

Safety and Feasibility of Transarterial Bleomycin-Lipiodol Embolization in Patients with Giant Hepatic Hemangiomas

Arkadiusz Kacała et al. Medicina (Kaunas). .

Abstract

Giant hepatic hemangiomas present a significant clinical challenge, and effective treatment options are warranted. This study aimed to assess the safety and feasibility of transarterial bleomycin-lipiodol embolization in patients with giant hepatic hemangiomas. A retrospective analysis was conducted on patients with giant hepatic hemangiomas (>5 cm). Transarterial chemoembolization (TACE) was performed using 7-20 cc of lipiodol mixed with 1500 IU of bleomycin. Safety outcomes, including post-embolization syndrome (PES), hepatic artery dissection, systemic complications, and access site complications, were evaluated. Radiation doses were also measured. Feasibility was assessed based on the achieved hemangioma coverage. Seventy-three patients (49 female, 24 male) with a mean age of 55.52 years were treated between December 2014 and April 2023. The average hospitalization duration was 3.82 days, and 97.3% of lesions were limited to one liver lobe. The average bleomycin dose per procedure was 1301.5625 IU, while the average lipiodol dose was 11.04 cc. The average radiation dose was 0.56 Gy. PES occurred after 45.7% of TACE procedures, with varying severity. Complications such as hepatic artery dissection (three cases), access site complications (two cases), and other complications (one case) were observed. No treatment-related mortality occurred. Hemangioma coverage exceeding 75% was achieved in 77.5% of cases. The study results suggest that transarterial bleomycin-lipiodol embolization is a safe and feasible treatment option for a heterogeneous group of patients with giant hepatic hemangiomas. This approach may hold promise in improving outcomes for patients with this challenging condition.

Keywords: bleomycin; giant hepatic hemangiomas; lipiodol; transarterial bleomycin–lipiodol embolization; transarterial chemoembolization (TACE).

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Giant hepatic hemangioma in the right liver lobe—abdomen CT scan. (a)—pre-contrast CT, (b)—post-contrast CT.
Figure 2
Figure 2
Illustration of common hepatic artery dissection. (a)—common hepatic artery before embolization, (b)—common hepatic artery after embolization.
Figure 3
Figure 3
Illustration of drug coverage grade according to hemangioma border coverage. (A): Grade 1. less than 25%, (B): Grade 2. 25–50%, (C): Grade 3. 50–75%, (D): Grade 4. more than 75%.
Figure 4
Figure 4
Illustration of complete drug coverage—Grade 4. (a)—hemangioma before embolization, (b)—hemangioma after embolization.
See this image and copyright information in PMC

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