Clinical Image
Hepatic Giant Hemagiomas; Surgery or Endovascular Treatment?
H Timur Sindel*
Department of Radiology and Interventional Radiology, Akdeniz Üniversitiy, Antalya, Turkey
*Corresponding author: H Timur Sindel, Department of Radiology and Interventional Radiology, Akdeniz Üniversitiy, Antalya, Turkey
Published: 20 Dec 2017
Cite this article as: Sindel HT. Hepatic Giant Hemagiomas;
Surgery or Endovascular Treatment?.
Clin Surg. 2017; 2: 1831.
Clinical Image
Hemangiomas are the most common primary tumors of the liver, with a prevalence ranging from 3% up to 20% being reported in the literature [1-2]. Most lesions are asymptomatic and detected incidentally [1]. Lesions greater than 4 cm are called giant hemangiomas, in which case they might be symptomatic and thus require treatment [1,3]. When and how to treat hepatic hemangiomas is a controversial topic? With treatment generally being considered only in cases of symptomatic lesions, hemagiomas that are progressively growing or at high risk of bleeding [4]. Corticosteroids, radiotherapy, cytotoxic agents and surgery have been used for treatment, with surgical resection being the traditional treatment method [1,2,4]. But the resection complication rate is relatively high. Transcatheter Arterial Chemoembolisation (TACE) using bleomycin has been reported in the literature [1]. According to our studies, when minimally invasive endovascular treatment of giant hepatic hemangiomas is considered, TACE should be preferred over surgery.
Figure 1
Figure 1
Digital subtraction angiography image showing the sinusoids of multiple hemangiomas filled with
lipiodol-bleomycin mixture.
Figure 2
Figure3
Figure 3
Arterial phase CT image of hepatic hemangiomas 12 months after
TACE (same patient as Figure 2).
References
- Giavroglou C, Economou H, Ioannidis I. Arterial embolization of giant hepatic hemangiomas. Cardiovasc Intervent Radiol. 2003;26(1):92-6.
- Toro A, Mahfouz AE, Ardiri A, Malaguarnera M, Malaguarnera G, Loria F, et al. What is changing in indications and treatment of hepatic hemangiomas: A review. Ann Hepatol. 2014;13(4):327-39.
- 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.
- Srivastava DN, Gandhi D, Seith A, Pande GK, 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.