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Erschienen in: CardioVascular and Interventional Radiology 11/2018

19.06.2018 | Clinical Investigation

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

verfasst von: Shahram Akhlaghpoor, Pooya Torkian, Jafar Golzarian

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 11/2018

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Abstract

Background

Large hepatic hemangiomas can cause symptoms such as pain and bleeding. No consensus currently exists on the optimal management of large and symptomatic hemangiomas. The purpose of this study was to evaluate the role of transarterial bleomycin–lipiodol embolization (B/LE) in the treatment of symptomatic large hepatic hemangioma.

Materials and Methods

We retrospectively reviewed 23 patients (29 hemangiomas) treated between July 2011 and August 2017. Transarterial B/LE was performed using 7–15 cc of Lipiodol mixed with 30–45 IU of bleomycin by standard three-way stopcocks. All patients were followed clinically and by imaging for an average of 7.5 months. Patterns of bleomycin–lipiodol distribution in the periphery of hemangiomas were categorized into four different grades. Technical success was defined as proper delivery of bleomycin–lipiodol into the hemangioma confirmed by post-embolization computed tomography. Clinical success was defined as more than 50% reduction of hemangioma volume and symptom improvement during follow-ups.

Results

Technical success and clinical success were 100 and 73.9% (17 patients), respectively. Six patients (26.08%) experienced transient post-embolization syndrome. Significant size reduction was seen in patients with grade 4 hemangioma border coverage (P = 0.042).

Conclusion

Transarterial B/LE is a safe and efficient alternative for controlling symptoms related to large hemangiomas.
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Literatur
1.
Zurück zum Zitat Grieco M, Miscall B. Giant hemangiomas of the liver. Surg Gynecol Obstet. 1978;147(5):783.PubMed Grieco M, Miscall B. Giant hemangiomas of the liver. Surg Gynecol Obstet. 1978;147(5):783.PubMed
2.
Zurück zum Zitat Karhunen P. Benign hepatic tumours and tumour like conditions in men. J Clin Pathol. 1986;39(2):183–8.CrossRef Karhunen P. Benign hepatic tumours and tumour like conditions in men. J Clin Pathol. 1986;39(2):183–8.CrossRef
3.
Zurück zum Zitat Magid D, Fishman EK, Kadir S, Cameron JL, Siegelman SS. CT evaluation of therapeutic embolization of hepatic hemangiomas. J Comput Assist Tomogr. 1983;7(6):1007–11.CrossRef Magid D, Fishman EK, Kadir S, Cameron JL, Siegelman SS. CT evaluation of therapeutic embolization of hepatic hemangiomas. J Comput Assist Tomogr. 1983;7(6):1007–11.CrossRef
4.
Zurück zum Zitat Jain V, Ramachandran V, Garg R, Pal S, Gamanagatti SR, Srivastava DN. Spontaneous rupture of a giant hepatic hemangioma—sequential management with transcatheter arterial embolization and resection. Saudi J Gastroenterol. 2010;16(2):116.CrossRef Jain V, Ramachandran V, Garg R, Pal S, Gamanagatti SR, Srivastava DN. Spontaneous rupture of a giant hepatic hemangioma—sequential management with transcatheter arterial embolization and resection. Saudi J Gastroenterol. 2010;16(2):116.CrossRef
5.
Zurück zum Zitat Sun J-H, Nie C-H, Zhang Y-L, Zhou G-H, Ai J, Zhou T-Y, et al. Transcatheter arterial embolization alone for giant hepatic hemangioma. PLoS ONE. 2015;10(8):e0135158.CrossRef Sun J-H, Nie C-H, Zhang Y-L, Zhou G-H, Ai J, Zhou T-Y, et al. Transcatheter arterial embolization alone for giant hepatic hemangioma. PLoS ONE. 2015;10(8):e0135158.CrossRef
6.
Zurück zum Zitat Gandolfi L, Leo P, Solmi L, Vitelli E, Verros G, Colecchia A. Natural history of hepatic haemangiomas: clinical and ultrasound study. Gut. 1991;32(6):677–80.CrossRef Gandolfi L, Leo P, Solmi L, Vitelli E, Verros G, Colecchia A. Natural history of hepatic haemangiomas: clinical and ultrasound study. Gut. 1991;32(6):677–80.CrossRef
7.
Zurück zum Zitat Erdogan D, Busch OR, Van Delden OM, Bennink RJ, Ten Kate FJ, Gouma DJ, et al. Management of liver hemangiomas according to size and symptoms. J Gastroenterol Hepatol. 2007;22(11):1953–8.CrossRef Erdogan D, Busch OR, Van Delden OM, Bennink RJ, Ten Kate FJ, Gouma DJ, et al. Management of liver hemangiomas according to size and symptoms. J Gastroenterol Hepatol. 2007;22(11):1953–8.CrossRef
8.
Zurück zum Zitat Li Y, Jia Y, Li S, Wang W, Wang Z, Wang Y, et al. Transarterial chemoembolization of giant liver haemangioma: a multi-center study with 836 cases. Cell Biochem Biophys. 2015;73(2):469–72.CrossRef Li Y, Jia Y, Li S, Wang W, Wang Z, Wang Y, et al. Transarterial chemoembolization of giant liver haemangioma: a multi-center study with 836 cases. Cell Biochem Biophys. 2015;73(2):469–72.CrossRef
9.
Zurück zum Zitat Bozkaya H, Cinar C, Besir FH, Parıldar M, Oran I. Minimally invasive treatment of giant haemangiomas of the liver: embolisation with bleomycin. Cardiovasc Intervent Radiol. 2014;37(1):101–7.CrossRef Bozkaya H, Cinar C, Besir FH, Parıldar M, Oran I. Minimally invasive treatment of giant haemangiomas of the liver: embolisation with bleomycin. Cardiovasc Intervent Radiol. 2014;37(1):101–7.CrossRef
10.
Zurück zum Zitat Bozkaya H, Cinar C, Ünalp ÖV, Parildar M, Oran I. Unusual treatment of Kasabach–Merritt syndrome secondary to hepatic hemangioma: embolization with bleomycin. Wien Klin Wochenschr. 2015;127(11–12):488–90.CrossRef Bozkaya H, Cinar C, Ünalp ÖV, Parildar M, Oran I. Unusual treatment of Kasabach–Merritt syndrome secondary to hepatic hemangioma: embolization with bleomycin. Wien Klin Wochenschr. 2015;127(11–12):488–90.CrossRef
11.
Zurück zum Zitat Hall GW. Kasabach-Merritt syndrome: pathogenesis and management. Br J Haematol. 2001;112(4):851–62.CrossRef Hall GW. Kasabach-Merritt syndrome: pathogenesis and management. Br J Haematol. 2001;112(4):851–62.CrossRef
12.
Zurück zum Zitat Yoon SS, Charny CK, Fong Y, Jarnagin WR, Schwartz LH, Blumgart LH, et al. Diagnosis, management, and outcomes of 115 patients with hepatic hemangioma. J Am Coll Surg. 2003;197(3):392–402.CrossRef Yoon SS, Charny CK, Fong Y, Jarnagin WR, Schwartz LH, Blumgart LH, et al. Diagnosis, management, and outcomes of 115 patients with hepatic hemangioma. J Am Coll Surg. 2003;197(3):392–402.CrossRef
13.
Zurück zum Zitat Singh RK, Kapoor S, Sahni P, Chattopadhyay TK. Giant haemangioma of the liver: is enucleation better than resection? Ann Royal Coll Surg Eng. 2007;89(5):490–3.CrossRef Singh RK, Kapoor S, Sahni P, Chattopadhyay TK. Giant haemangioma of the liver: is enucleation better than resection? Ann Royal Coll Surg Eng. 2007;89(5):490–3.CrossRef
14.
Zurück zum Zitat Lerner SM, Hiatt JR, Salamandra J, Chen PW, Farmer DG, Ghobrial RM, et al. Giant cavernous liver hemangiomas: effect of operative approach on outcome. Arch Surg. 2004;139(8):818–23.CrossRef Lerner SM, Hiatt JR, Salamandra J, Chen PW, Farmer DG, Ghobrial RM, et al. Giant cavernous liver hemangiomas: effect of operative approach on outcome. Arch Surg. 2004;139(8):818–23.CrossRef
15.
Zurück zum Zitat Liu X, Yang Z, Tan H, Liu L, Xu L, Sun Y, et al. Characteristics and operative treatment of extremely giant liver hemangioma > 20 cm. Surgery. 2017;161(6):1514–24.CrossRef Liu X, Yang Z, Tan H, Liu L, Xu L, Sun Y, et al. Characteristics and operative treatment of extremely giant liver hemangioma > 20 cm. Surgery. 2017;161(6):1514–24.CrossRef
16.
Zurück zum Zitat Ho H-Y, Wu T-H, Yu M-C, Lee W-C, Chao T-C, Chen M-F. Surgical management of giant hepatic hemangiomas: complications and review of the literature. Chang Gung Med J. 2012;35(1):70–8.PubMed Ho H-Y, Wu T-H, Yu M-C, Lee W-C, Chao T-C, Chen M-F. Surgical management of giant hepatic hemangiomas: complications and review of the literature. Chang Gung Med J. 2012;35(1):70–8.PubMed
17.
Zurück zum Zitat Gao J, Ding X, Ke S, Xin Z, Ning C, Sha Q, et al. Radiofrequency ablation in the treatment of large hepatic hemangiomas: a comparison of multitined and internally cooled electrodes. J Clin Gastroenterol. 2014;48(6):540–7.PubMed Gao J, Ding X, Ke S, Xin Z, Ning C, Sha Q, et al. Radiofrequency ablation in the treatment of large hepatic hemangiomas: a comparison of multitined and internally cooled electrodes. J Clin Gastroenterol. 2014;48(6):540–7.PubMed
18.
Zurück zum Zitat Park SY, Tak WY, Jung MK, Jeon SW, Cho CM, Kweon YO, et al. Symptomatic-enlarging hepatic hemangiomas are effectively treated by percutaneous ultrasonography-guided radiofrequency ablation. J Hepatol. 2011;54(3):559–65.CrossRef Park SY, Tak WY, Jung MK, Jeon SW, Cho CM, Kweon YO, et al. Symptomatic-enlarging hepatic hemangiomas are effectively treated by percutaneous ultrasonography-guided radiofrequency ablation. J Hepatol. 2011;54(3):559–65.CrossRef
19.
Zurück zum Zitat Hinshaw JL, Laeseke PJ, Weber SM, Lee FT Jr. Multiple-electrode radiofrequency ablation of symptomatic hepatic cavernous hemangioma. Am J Roentgenol. 2007;189(3):W146–9.CrossRef Hinshaw JL, Laeseke PJ, Weber SM, Lee FT Jr. Multiple-electrode radiofrequency ablation of symptomatic hepatic cavernous hemangioma. Am J Roentgenol. 2007;189(3):W146–9.CrossRef
20.
Zurück zum Zitat Yamamoto T, Kawarada Y, Yano T, Noguchi T, Mizumoto R. Spontaneous rupture of hemangioma of the liver: treatment with transcatheter hepatic arterial embolization. Am J Gastroenterol. 1991;86(11):1645–9.PubMed Yamamoto T, Kawarada Y, Yano T, Noguchi T, Mizumoto R. Spontaneous rupture of hemangioma of the liver: treatment with transcatheter hepatic arterial embolization. Am J Gastroenterol. 1991;86(11):1645–9.PubMed
21.
Zurück zum Zitat Tegtmeyer CJ, Smith TH, Shaw A, Barwick KW, Kattwinkel J. Renal infarction: a complication of gelfoam embolization of a hemangioendothelioma of the liver. Am J Roentgenol. 1977;128(2):305–7.CrossRef Tegtmeyer CJ, Smith TH, Shaw A, Barwick KW, Kattwinkel J. Renal infarction: a complication of gelfoam embolization of a hemangioendothelioma of the liver. Am J Roentgenol. 1977;128(2):305–7.CrossRef
22.
Zurück zum Zitat Srivastava D, Gandhi D, Seith A, Pande G, Sahni P. Transcatheter arterial embolization in the treatment of symptomatic cavernous hemangiomas of the liver: a prospective study. Abdom Imaging. 2001;26(5):510–4.CrossRef Srivastava D, Gandhi D, Seith A, Pande G, Sahni P. Transcatheter arterial embolization in the treatment of symptomatic cavernous hemangiomas of the liver: a prospective study. Abdom Imaging. 2001;26(5):510–4.CrossRef
23.
Zurück zum Zitat Huang X-Q, Huang Z-Q, Duan W-D, Zhou N-X, Feng Y-Q. Severe biliary complications after hepatic artery embolization. World J Gastroenterol. 2002;8(1):119.CrossRef Huang X-Q, Huang Z-Q, Duan W-D, Zhou N-X, Feng Y-Q. Severe biliary complications after hepatic artery embolization. World J Gastroenterol. 2002;8(1):119.CrossRef
24.
Zurück zum Zitat Mahajan D, Miller C, Hirose K, McCullough A, Yerian L. Incidental reduction in the size of liver hemangioma following use of VEGF inhibitor bevacizumab. J Hepatol. 2008;49(5):867–70.CrossRef Mahajan D, Miller C, Hirose K, McCullough A, Yerian L. Incidental reduction in the size of liver hemangioma following use of VEGF inhibitor bevacizumab. J Hepatol. 2008;49(5):867–70.CrossRef
25.
Zurück zum Zitat Lee M, Choi J-Y, Lim JS, Park M-S, Kim M-J, Kim H. Lack of anti-tumor activity by anti-VEGF treatments in hepatic hemangiomas. Angiogenesis. 2016;19(2):147–53.CrossRef Lee M, Choi J-Y, Lim JS, Park M-S, Kim M-J, Kim H. Lack of anti-tumor activity by anti-VEGF treatments in hepatic hemangiomas. Angiogenesis. 2016;19(2):147–53.CrossRef
26.
Zurück zum Zitat Jin S, Shi X-J, Sun X-D, Wang S-Y, Wang G-Y. Sclerosing cholangitis secondary to bleomycin-iodinated embolization for liver hemangioma. World J Gastroenterol. 2014;20(46):17680.CrossRef Jin S, Shi X-J, Sun X-D, Wang S-Y, Wang G-Y. Sclerosing cholangitis secondary to bleomycin-iodinated embolization for liver hemangioma. World J Gastroenterol. 2014;20(46):17680.CrossRef
27.
Zurück zum Zitat Sainsbury DC, Kessell G, Fall AJ, Hampton FJ, Guhan A, Muir T. Intralesional bleomycin injection treatment for vascular birthmarks: a 5-year experience at a single United Kingdom unit. Plast Reconstr Surg. 2011;127(5):2031–44.CrossRef Sainsbury DC, Kessell G, Fall AJ, Hampton FJ, Guhan A, Muir T. Intralesional bleomycin injection treatment for vascular birthmarks: a 5-year experience at a single United Kingdom unit. Plast Reconstr Surg. 2011;127(5):2031–44.CrossRef
28.
Zurück zum Zitat Favoulet P, Cercueil JP, Faure P, Osmak L, Isambert N, Beltramo JL, et al. Increased cytotoxicity and stability of Lipiodol-pirarubicin emulsion compared to classical doxorubicin–Lipiodol: potential advantage for chemoembolization of unresectable hepatocellular carcinoma. Anticancer Drugs. 2001;12(10):801–6.CrossRef Favoulet P, Cercueil JP, Faure P, Osmak L, Isambert N, Beltramo JL, et al. Increased cytotoxicity and stability of Lipiodol-pirarubicin emulsion compared to classical doxorubicin–Lipiodol: potential advantage for chemoembolization of unresectable hepatocellular carcinoma. Anticancer Drugs. 2001;12(10):801–6.CrossRef
29.
Zurück zum Zitat de Baere T, Dufaux J, Roche A, Counnord J-L, Berthault M-F, Denys A, et al. Circulatory alterations induced by intra-arterial injection of iodized oil and emulsions of iodized oil and doxorubicin: experimental study. Radiology. 1995;194(1):165–70.CrossRef de Baere T, Dufaux J, Roche A, Counnord J-L, Berthault M-F, Denys A, et al. Circulatory alterations induced by intra-arterial injection of iodized oil and emulsions of iodized oil and doxorubicin: experimental study. Radiology. 1995;194(1):165–70.CrossRef
30.
Zurück zum Zitat Ahrar K, Gupta S. Hepatic artery embolization for hepatocellular carcinoma: technique, patient selection, and outcomes. Surg Oncol Clin N Am. 2003;12(1):105–26.CrossRef Ahrar K, Gupta S. Hepatic artery embolization for hepatocellular carcinoma: technique, patient selection, and outcomes. Surg Oncol Clin N Am. 2003;12(1):105–26.CrossRef
31.
Zurück zum Zitat Idée J-M, Guiu B. Use of Lipiodol as a drug-delivery system for transcatheter arterial chemoembolization of hepatocellular carcinoma: a review. Crit Rev Oncol Hematol. 2013;88(3):530–49.CrossRef Idée J-M, Guiu B. Use of Lipiodol as a drug-delivery system for transcatheter arterial chemoembolization of hepatocellular carcinoma: a review. Crit Rev Oncol Hematol. 2013;88(3):530–49.CrossRef
32.
Zurück zum Zitat Ouyang Y, Ouyang X-H, Yu M, Gu S-B. Frequency of arteriovenous shunts in hepatic cavernous hemangiomas in adults as seen on selective arteriography and postembolization radiography. Cardiovasc Intervent Radiol. 2001;24(3):161–7.CrossRef Ouyang Y, Ouyang X-H, Yu M, Gu S-B. Frequency of arteriovenous shunts in hepatic cavernous hemangiomas in adults as seen on selective arteriography and postembolization radiography. Cardiovasc Intervent Radiol. 2001;24(3):161–7.CrossRef
33.
Zurück zum Zitat Chung JW, Park JH, Han JK, Choi BI, Han MC, Lee H-S, et al. Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization. Radiology. 1996;198(1):33–40.CrossRef Chung JW, Park JH, Han JK, Choi BI, Han MC, Lee H-S, et al. Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization. Radiology. 1996;198(1):33–40.CrossRef
34.
Zurück zum Zitat Ryder S, Rizzi P, Metivier E, Karani J, Williams R. Chemoembolisation with lipiodol and doxorubicin: applicability in British patients with hepatocellular carcinoma. Gut. 1996;38(1):125–8.CrossRef Ryder S, Rizzi P, Metivier E, Karani J, Williams R. Chemoembolisation with lipiodol and doxorubicin: applicability in British patients with hepatocellular carcinoma. Gut. 1996;38(1):125–8.CrossRef
35.
Zurück zum Zitat Chung J, Yu J, Chung J, Kim J, Kim K. Haemodynamic events and localised parenchymal changes following transcatheter arterial chemoembolisation for hepatic malignancy: interpretation of imaging findings. Br J Radiol. 2010;83(985):71–81.CrossRef Chung J, Yu J, Chung J, Kim J, Kim K. Haemodynamic events and localised parenchymal changes following transcatheter arterial chemoembolisation for hepatic malignancy: interpretation of imaging findings. Br J Radiol. 2010;83(985):71–81.CrossRef
36.
Zurück zum Zitat Kim HK, Chung Y-H, Song B-C, Yang SH, Yoon H-K, Yu E, et al. Ischemic bile duct injury as a serious complication after transarterial chemoembolization in patients with hepatocellular carcinoma. J Clin Gastroenterol. 2001;32(5):423–7.CrossRef Kim HK, Chung Y-H, Song B-C, Yang SH, Yoon H-K, Yu E, et al. Ischemic bile duct injury as a serious complication after transarterial chemoembolization in patients with hepatocellular carcinoma. J Clin Gastroenterol. 2001;32(5):423–7.CrossRef
37.
Zurück zum Zitat Yu J-S, Kim KW, Park M-S, Yoon S-W. Bile duct injuries leading to portal vein obliteration after transcatheter arterial chemoembolization in the Liver: CT findings and initial observations. Radiology. 2001;221(2):429–36.CrossRef Yu J-S, Kim KW, Park M-S, Yoon S-W. Bile duct injuries leading to portal vein obliteration after transcatheter arterial chemoembolization in the Liver: CT findings and initial observations. Radiology. 2001;221(2):429–36.CrossRef
38.
Zurück zum Zitat Shea W Jr, Demas BE, Goldberg HI, Hohn DC, Ferrell LD, Kerlan RK. Sclerosing cholangitis associated with hepatic arterial FUDR chemotherapy: radiographic-histologic correlation. Am J Roentgenol. 1986;146(4):717–21.CrossRef Shea W Jr, Demas BE, Goldberg HI, Hohn DC, Ferrell LD, Kerlan RK. Sclerosing cholangitis associated with hepatic arterial FUDR chemotherapy: radiographic-histologic correlation. Am J Roentgenol. 1986;146(4):717–21.CrossRef
39.
Zurück zum Zitat Zeng Q, Li Y, Chen Y, Ouyang Y, He X, Zhang H. Gigantic cavernous hemangioma of the liver treated by intra-arterial embolization with pingyangmycin-lipiodol emulsion: a multi-center study. Cardiovasc Intervent Radiol. 2004;27(5):481–5.CrossRef Zeng Q, Li Y, Chen Y, Ouyang Y, He X, Zhang H. Gigantic cavernous hemangioma of the liver treated by intra-arterial embolization with pingyangmycin-lipiodol emulsion: a multi-center study. Cardiovasc Intervent Radiol. 2004;27(5):481–5.CrossRef
40.
Zurück zum Zitat López-Benítez R, Richter GM, Kauczor H-U, Stampfl S, Kladeck J, Radeleff BA, et al. Analysis of non-target embolization mechanisms during embolization and chemoembolization procedures. Cardiovasc Intervent Radiol. 2009;32(4):615–22.CrossRef López-Benítez R, Richter GM, Kauczor H-U, Stampfl S, Kladeck J, Radeleff BA, et al. Analysis of non-target embolization mechanisms during embolization and chemoembolization procedures. Cardiovasc Intervent Radiol. 2009;32(4):615–22.CrossRef
Metadaten
Titel
Transarterial Bleomycin–Lipiodol Embolization (B/LE) for Symptomatic Giant Hepatic Hemangioma
verfasst von
Shahram Akhlaghpoor
Pooya Torkian
Jafar Golzarian
Publikationsdatum
19.06.2018
Verlag
Springer US
Erschienen in
CardioVascular and Interventional Radiology / Ausgabe 11/2018
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-018-2010-4

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