Tratamento endovascular de hemangiomas hepáticos gigantes: uma revisão sistemática com metanálise
Endovascular treatment of giant hepatic hemangiomas: a systematic review and meta-analysis
Sofia Malosso Tronconi; João Felipe Federici de Almeida; Ana Terezinha Guillaumon
Resumo
Palavras-chave
Abstract
Giant hepatic hemangiomas are benign vascular lesions that may cause abdominal pain, compression of adjacent structures, bleeding, and thrombotic complications. Management of symptomatic cases is challenging, especially for larger lesions. This systematic review and meta-analysis evaluated the efficacy and safety of endovascular treatment through transarterial embolization, focusing on the embolization agents employed, reductions in tumor diameter, and associated complications. The results showed significant reductions in mean hemangioma diameter, with low rates of severe complications. This treatment emerges as a promising minimally invasive option for symptomatic or unresectable cases.
Keywords
References
1 Zaydfudim VM, Broelsch RBA. Management of liver hemangioma. In: Cameron JL, Cameron AM, eds. Current surgical therapy. 13th ed. Philadelphia: Elsevier; 2023. p. 363-8.
2 Mannelli L, Lomas DJ, Kosmin OK. The liver and spleen. In: Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM, eds. Grainger & Allison’s Diagnostic Radiology. 7th ed. Philadelphia: Elsevier; 2021. p. 598-665.
3 Sallee K. Giant hemangioma. J Diagn Med Sonogr. 2004;20(6):422-5.
4 Feng ZH, Chen XF, Jiang JS. Giant hepatic hemangioma. Clin Gastroenterol Hepatol. 2024;22(10):A24-5.
5 Paasch C, Hillner B, Strik M, Siegel R. Giant liver hemangioma. Tagliche Praxis. 2016;56(4):607-12.
6 van Malenstein H, Maleux G, Monbaliu D, et al. Giant liver hemangioma: the role of female sex hormones and treatment. Eur J Gastroenterol Hepatol. 2011;23(5):438-43.
7 European Association for the Study of the Liver. EASL clinical practice guidelines on the management of benign liver tumours. J Hepatol. 2016;65(2):386-98.
8 Reading NG, Forbes A, Nunnerley HB, Williams R. Hepatic haemangioma: a critical review of diagnosis and management. Q J Med. 1988;67(253):431-45. PMid:3065812.
9 Hoekstra LT, Bieze M, Erdogan D, Roelofs JJTH, Beuers UHW, van Gulik TM. Management of giant liver hemangiomas: an update. Expert Rev Gastroenterol Hepatol. 2013;7(3):263-8.
10 Giulianotti PC, Bustos R, Valle V, Aguiluz G, Pavelko Y, Fernandes E. Robot-assisted enucleation of gigantic liver hemangiomas: case series of 3 patients. Int J Surg Case Rep. 2019;60:244-8.
11 Farhat W, Ammar H, Said MA, et al. Surgical management of giant hepatic hemangioma: a 10-year single center experience. Ann Med Surg (Lond). 2021;69:102542.
12 Veerankutty FH, Rather SA, Yeldho V, Zacharia BM, Tu SA, B V. Totally laparoscopic resection of an extremely giant hepatic hemangioma. Surg J (N Y). 2019;5(3):e110-2.
13 Borisov AE, Zemlianoĭ VP, Borisova NA, Nepomniashchaia SL. Surgical strategy in liver hemangiomas. Vestn Khir Im I I Grek. 2001;160(2):99-103. PMid:11496505.
14 Bandeira Ferraz ÁA, Antunes Sette MJ, Maia M, et al. Liver transplant for the treatment of giant hepatic hemangioma. Liver Transpl. 2004;10(11):1436-7.
15 Shankar S, Rammohan A, Kulaseharan VH, Kanagavelu R, Reddy MS, Rela M. Liver transplantation for rapidly progressive giant hepatic hemangioma with diffuse hemangiomatosis. Exp Clin Transplant. 2021;19(10):1106-9.
16 García Espinosa I, García-Juárez F, Páez-Zayas V, Pérez-Hernández J, Higuera-de-la-Tijera F. Symptomatic giant cavernous hemangioma as an indication for liver transplantation. Ann Hepatol. 2022;27:100844.
17 Zhao Y, Li XP, Hu YY, Jiang JC, Zhao LJ. Liver transplantation for giant hemangioma of the liver: a case report and review of the literature. Front Med (Lausanne). 2022;9:985181.
18 Zhao Y, Legan CE. Liver transplantation for giant hemangioma complicated by Kasabach-Merritt syndrome: a case report and literature review. Am J Case Rep. 2022;23:e936042.
19 Lee JH, Yoon CJ, Kim YH, et al. Living-donor liver transplantation for giant hepatic hemangioma with diffuse hemangiomatosis in an adult: a case report. Clin Mol Hepatol. 2018;24(2):163-8.
20 Sun JH, Nie CH, Zhang YL, et al. Transcatheter arterial embolization alone for giant hepatic hemangioma. PLoS One. 2015;10(8):e0135158.
21 Maker AV, Al Rameni D, Prabhakar N. Combining on-table embolization with immediate resection to safely excise giant hepatic hemangiomas. J Gastrointest Surg. 2021;25(6):1651-3.
22 Roche A, Doyon D, Harry G, Weingarten A, Edouard A. Hepatic arterial embolisation: 35 cases. Nouv Presse Med. 1978;7(8):633-7. PMid:643591.
23 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.
24 Xie CM, Hu YF, Duan RQ, Liu JW. Clinical application of pingyangmycin lipiodol emulsion arterial embolization in the treatment of hepatic hemangioma. Zhongguo Jieru Yingxiang Yu Zhiliaoxue. 2006;3(5):329-32.
25 Li L, Yan L, Chen X. The side effect and complication of intraarterial phosphorus-32 glass microspheres for patients with advanced hepatoma. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi. 1997;14(4):376-9. PMid:11367632.
26 Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71):n71.
27 Zhao D, Xie L, Makamure J, et al. Transcatheter arterial embolization with bleomycin-lipiodol of hepatic hemangiomas: safety, efficacy and predictors of response. Cardiovasc Intervent Radiol. 2024;47(7):931-42.
28 Yuan B, Zhang JL, Duan F, Wang MQ. Medium and long-term outcome of superselective transcatheter arterial embolization with lipiodol–bleomycin emulsion for giant hepatic hemangiomas: results in 241 patients. J Clin Med. 2022;11(16):4762.
29 Shi Y, Song J, Ding M, et al. Microwave ablation versus transcatheter arterial embolization for large hepatic hemangiomas: clinical outcomes. Int J Hyperthermia. 2020;37(1):938-43.
30 Kirnap M, Boyvat F, Boyacioglu S, Hilmioglu F, Moray G, Haberal M. The effect of bleomycin embolization on symptomatic improvement and hemangioma size among patients with giant liver hemangiomas. Int J Surg Open. 2018;12:12-6.
31 Firouznia K, Ghanaati H, Alavian SM, et al. Management of liver hemangioma using trans-catheter arterial embolization. Hepat Mon. 2014;14(12):e25788.
32 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.
33 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.
34 Li Y, Jia Y, Li S, et al. Transarterial chemoembolization of giant liver haemangioma: a multi-center study with 836 cases. Cell Biochem Biophys. 2015;73(2):469-72.
35 Kurniawan J, Teressa M, Budiman RA, Matondang SB. Transarterial embolization with bleomycin–lipiodol emulsion: a successful minimal invasive approach for giant liver hemangioma. Clin J Gastroenterol. 2024;17(3):511-4.
36 Zhang L, Shi H, Zheng C, Liang B. Bleomycin-ethiodized oil transarterial embolization of a giant hepatic hemangioma. J Vasc Interv Radiol. 2023;34(3):514-5.
37 Ketchum WA, Lin-Hurtubise KM, Ochmanek E, Ishihara K, Rice RD. Management of symptomatic hepatic “mega” hemangioma. Hawaii J Med Public Health. 2019;78(4):128-31. PMid:30972235.
38 Giavroglou C, Economou H, Ioannidis I. Arterial embolization of giant hepatic hemangiomas. Cardiovasc Intervent Radiol. 2003;26(1):92-6.
39 Althaus S, Ashdown B, Coldwell D, Helton WS, Freeny PC. Transcatheter arterial embolization of two symptomatic giant cavernous hemangiomas of the liver. Cardiovasc Intervent Radiol. 1996;19(5):364-7.
40 Panis Y, Fagniez P, Cherqui D, Roche A, Schaal JC, Jaeck D. Successful arterial embolisation of giant liver haemangioma. HPB Surg. 1993;7(2):141-6.
41 Özden İ, Poyanlı A, Önal Y, Demir AA, Hoş G, Acunaş B. Superselective transarterial chemoembolization as an alternative to surgery in symptomatic/enlarging liver hemangiomas. World J Surg. 2017;41(11):2796-803.
42 Jiang XY, Xu K. The middle-long term effect of TAE with pingyangmycin-lipiodol emulsion for hepatic hemangioma. J Interv Radiol. 2012;21(1):31-4.
43 Li J, Zhang S, Ning C, Li G, Guo S. Efficacy of radiofrequency ablation vs. transcatheter arterial embolization for hepatic hemangiomas. Eur J Gastroenterol Hepatol. 2024;36(6):750-7.
44 Kacała A, Dorochowicz M, Korbecki A, et al. Transarterial bleomycin–lipiodol chemoembolization for the treatment of giant hepatic hemangiomas: an assessment of effectiveness. Cancers (Basel). 2024;16(2):380.
45 Özgür Ö, Sindel HT. Giant hepatic hemangioma treatment with transcatheter arterial embolisation and transcatheter arterial chemoembolisation: comparative results. Turk J Med Sci. 2021;51(6):2943-50.
46 Crawford D, Naidu S, Patel I, Knuttinen G, Alzubaidi S, Oklu R. Bland embolization of benign liver tumors: review of the literature and a single center experience. J Clin Med. 2021;10(4):4058.
47 Jia Y, Jia J, Zhao Y. Pingyangmycin-regulated expressions of adhesion molecules in human venous malformation endothelial cells. J Huazhong Univ Sci Technolog Med Sci. 2012;32(5):760-6.
48 Bennett JM, Reich SD. Drugs five years later: bleomycin. Ann Intern Med. 1979;90(6):945-8.
49 Castiglione D, Galia M, Falsaperla D, Libra F, Basile A. The “flowering” sign. Abdom Radiol (NY). 2024;49(9):3294-6.
50 Kacała A, Dorochowicz M, Patrzałek D, Janczak D, Guziński M. Safety and feasibility of transarterial bleomycin–lipiodol embolization in patients with giant hepatic hemangiomas. Medicina (Kaunas). 2023;59(8):1358.
Submitted date:
05/23/2025
Accepted date:
08/25/2025


