Salvage of ineffective transarterial embolization with liver resection in a patient with repeated hepatic angiosarcoma bleeding

Rupture with internal bleeding is not an uncommon complication of hepatic angiosarcomas that causes high morbidity and mortality. Transarterial embolization (TAE) may be effective for the temporary hemostasis of ruptured tumors. However, the blood supply of an angiosarcoma can also originate in the portal vein, and repeated internal bleeding may stem from this source. Elective liver resection following initial TAE is the standard curative treatment and is the only effective method for preventing further internal bleeding. High-risk liver resection is the only other choice for rescuing patients with fatal bleeding that cannot be controlled by TAE. We report a 66-year-old female patient with angiosarcoma who presented with repeated bleeding and developed hemorrhagic shock after the first episode of TAE. Following two more episodes of TAE, the patient developed internal bleeding with shock, but angiography revealed no arterial bleeding. Bleeding from the portal vein was highly suspected. To prevent further recurrent bleeding, salvage liver resection was subsequently performed under conditions of poor liver reserve. During the 4-month follow-up period until the patient died, no recurrent bleeding was noted. In conclusion, TAE is only a temporary treatment for internal bleeding from a ruptured hepatic angiosarcoma. Recurrent, potentially fatal bleeding may be caused by supplemental vascularization of the portal vein. Surgical tumor resection is necessary for the curative treatment of hepatic angiosarcomas and the prevention of repeated internal bleeding.