Safety and Efficacy of Transarterial Chemoembolization Using Bleomycin-Lipiodol Emulsion for the Treatment of Symptomatic Giant Hepatic Hemangiomas: A Retrospective Study

Giant hemangioma (>5 cm) often presents with dyspeptic symptoms or rupture and warrants appropriate management. The purpose of this study was to assess the efficacy, changes in size, and symptoms of giant hepatic hemangioma treated with transarterial chemoembolization (TACE) with bleomycin-lipiodol emulsion (B/LE). A retrospective analysis was conducted in seven patients (16 giant hemangiomas) treated between 2012 and 2023. TACE was performed using B/LE at a dose of 1 mL/cm of hemangioma. Multiple sessions were planned in patients based on predefined criteria. Follow-up was done by imaging and clinical evaluation at 1 month, 3 months, 6 months, 1 year, and then annually till 5 years after the last session of embolization. Technical success and clinical success were 100% without any severe complications. The volume and maximum dimension of lesions showed significant reduction (p < 0.001) on post-embolization images. Larger lesions (>11 cm) showed a significantly higher percentage reduction than smaller hemangiomas (<11 cm; p = 0.017). Similarly, lesions larger than 1,000 cc showed a higher percentage reduction compared to lesions smaller than 1,000 cc; however, the difference was not statistically significant (p = 0.129). A significant decrease in size, complete resolution of symptoms, and minimal complications were seen after TACE using B/LE, with a significantly higher percentage decrease in larger sized hemangiomas. However, large multicentric prospective studies or randomized controlled trials are needed for wider applicability.