Percutaneous Sclerotherapy with Bleomycin and Ethiodized Oil for Symptomatic Giant Hepatic Hemangioma: A 6-year Single-center Experience

Background: Giant hepatic hemangiomas (GHHs) can cause significant symptoms and complications, yet the optimal minimally invasive therapy remains debated. This study aimed to evaluate the safety and long-term efficacy of percutaneous sclerotherapy using bleomycin combined with ethiodized oil for symptomatic GHHs. Patients and Methods: In this retrospective single-center study, 120 patients with symptomatic GHHs (>5 cm) underwent ultrasound-guided percutaneous sclerotherapy between September 2019 and October 2024. A standardized mixture of bleomycin and ethiodized oil was injected intralesionally. Technical success, symptom severity (Visual Analog Scale [VAS]), and lesion dimensions were recorded at baseline and at 6 months, 1, 2, 3, 4, and 5 years postprocedure. The complications were classified according to the Society of Interventional Radiology guidelines. Results: A total of 135 sessions were performed (mean bleomycin dose 43.4 IU per session). Technical success was 100%. Mean VAS score decreased from 6.9 ± 2.1 preprocedure to 2.7 ± 1.8 at the last follow-up ( P < 0.001). Both major and minor lesion dimensions decreased significantly at all the follow-up intervals. No major complications occurred; minor transient symptoms were managed conservatively. Conclusion: Percutaneous sclerotherapy with bleomycin and ethiodized oil is a safe and effective option for symptomatic GHHs, producing durable symptom relief and lesion shrinkage during the long-term follow-up.