Preoperative arterial embolization of large liver hemangiomas

PURPOSE

We aimed to investigate the efficacy and safety of preoperative selective intra-arterial embolization (PSIAE) in the surgical treatment of large liver hemangiomas.

METHODS

Data of 22 patients who underwent resection of large liver hemangiomas were retrospectively analyzed. PSIAE was performed in cases having a high risk of severe blood loss during surgery (n=11), while it was not applied in cases with a low risk of blood loss (n=11).

RESULTS

A total of 19 enucleations and six anatomic resections were performed. Operative time, intraoperative bleeding amount, Pringle period, and blood transfusion were comparable between the two groups (P > 0.05, for all). The perioperative serum aspartate transaminase level was not different between groups (P = 1.000). Perioperative total bilirubin levels were significantly increased in the PSIAE group (P = 0.041). Postoperative hospital stay was longer in the PSIAE group. Surgical complications were comparable between groups (P = 0.476).

CONCLUSION

Patients who underwent PSIAE due to a high risk of severe blood loss during resection of large liver hemangiomas had comparable operative success as patients with a low risk of blood loss who were operated without PSIAE. Hence, PSIAE can be used for the control of intraoperative blood loss, especially in surgically difficult cases.Hepatic hemangiomas are the most common benign tumors of the liver. The incidence in autopsy series ranges from 0.4% to 7.3% (1). According to epidemiologic studies, estimated prevalence is 5% to 20% in the general population (2, 3). Most hepatic hemangiomas are less than 1 cm in diameter, and are usually followed without treatment in the absence of symptoms or complications. However, when they are large (>4 cm), patients may suffer from abdominal discomfort or pain caused by capsular stretch and experience early satiety from gastric compression. Additionally, spontaneous or traumatic rupture of a hemangioma is a mortal complication. In patients with large hemangiomas, consumptive coagulopathy with low platelet count and hypofibrinogenemia (Kasabach-Merritt syndrome) is also an important clinical problem.Management of patients with large hemangiomas of the liver has been controversial. Operative bleeding during enucleation or resection of a large liver hemangioma is an important cause of morbidity and mortality (4). However, preoperative embolization of large hemangiomas can reduce operative bleeding related with the hepatic arterial supply. Selective embolization through the left or right hepatic arteries is thought to reduce morbidity compared with nonselective embolization of the proper hepatic artery or ligation of the common hepatic artery (5).In the present study, the effect of preoperative selective intra-arterial embolization (PSIAE) of large hemangiomas on operative bleeding was evaluated retrospectively. Preoperative variables, complications, and the hospital course of patients were compared with the control group.