Percutaneous Sclerotherapy for Large Hepatic Hemangiomas

Abstract Background: Hepatic venous malformation (HVM), otherwise known as hepatic hemangioma, is considered the most common benign liver tumor. These liver tumors are common and are estimated to occur in up to 20% of the population. Although this tumor originates from a vascular malformation, its underlying pathophysiology remains poorly understood. Patients & Methods: This study is a prospective study – one arm clinical trial. In this study, 14 patients with large symptomatic or asymptomatic significantly growing hepatic hemangioma (more than 5 cm) will undergo percutaneous sclerotherapy by bleomycin with a follow up study by contrast enhanced cross-sectional imaging after 3 months. This study was conducted in an Interventional Radiology Unit in university hospital over the period from March 2024 to September 2024. The main source of data for this study will be patients with large symptomatic hepatic hemangiomas referred to IR unit. Results: Percutaneous transhepatic sclerotherapy with a bleomycin–lipiodol mixture is a minimally invasive, effective alternative to surgery for large symptomatic hepatic hemangiomas, achieving 45–80% size reduction and durable symptom relief with minimal complications. Compared to resection, it offers shorter procedures, faster recovery, fewer complications, and lower costs. Our study observed a statistically significant reduction in the lesion's largest dimension, Just three months after the injection procedure, with the mean decreasing to 7.99 ± 3.18 cm compared to 11.13 ± 3.2 cm in the pre-injected lesions, median to 7.75 cm (IQR: 6.5–10), and the range narrowing to 3.5–16 cm compared to 6-17 cm in the pre-injected lesions. With reduction in the lesion's largest dimension of 10% to 41% and reduction in volume (yet only obtained in 3 patients) of 45% to 68.8%, with follow-up only after 3 months. Conclusion: Percutaneous transhepatic sclerotherapy with bleomycin–lipiodol is a safe, effective, minimally invasive option for symptomatic giant hepatic hemangiomas, achieving significant lesion reduction and symptom relief with minimal complications. Despite promising outcomes, limitations include small sample sizes, short follow-up, and single-center data, highlighting the need for larger, multicenter prospective trials to validate long-term efficacy.