The Efficacy of Bleomycin Lipiodol in Reduction Size of Large Hepatic Hemangioma

Background: Hepatic hemangiomas are the most common benign tumors of the liver. Most hepatic hemangiomas are asymptomatic but can be symptomatic or sufficiently large for therapeutic intervention (usually considered if > 4–5 cm). Transarterial embolization (TAE) for hepatic hemangioma provides a minimally invasive option using bleomycin and lipiodol and is becoming more commonly used, but prospective studies evaluating its efficacy have been limited. Methods: A cohort prospective study was performed to investigate the effect of transcatheter arterial embolization on large hepatic hemangiomas (>5 cm) in 16 adult patients (15 females, 1 male; mean age 38 ± 7.7 years), who presented with symptomatic hepatic hemangiomas for 6 months or longer. All patients underwent TAE with a combination of 15 IU bleomycin and 10 mL lipiodol. Hemangioma size and volume were measured by triphasic CT imaging pre- and post-TAE at a mean follow-up of 9 months. Duration of symptom resolution and complications following TAE were also recorded. Results: Following the embolization, mean lesion diameters were significantly decreased by 25.75% (craniocaudal), 20.06% (transverse), and 24.1% (anteroposterior) (p < 0.001). The mean volumetric reduction was 65.2%. Every patient experienced clinical improvement of their pain, discomfort, and abdominal fullness. There were no major complications, transient post-embolization syndrome was self-limited. Conclusion: TAE with Bleomycin/Lipiodol seems to be a safe and effective minimally invasive approach for large symptomatic hepatic hemangiomas. The reduction in the size of the lesion, significant symptom relief, and durability, suggest its place in the management strategy as an alternative to surgery. Larger multicenter studies, with extended follow-up studies, would add further evidence to the results found in this review.