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Arch Hellen Med, 26(5), September-October 2009, 625-633


The role of intra-arterial embolization in the treatment of giant hepatic hemangioma

"Euroclinic" Hospital of Athens, Athens, Greece

Hepatic cavernous hemangiomas are usually discovered incidentally. They almost always remain stable and usually cause no complications. Rarely giant hemangiomas might cause symptoms, such as intense and debilitating pain or complications, such as hemorrhage, inflammation, Kasabach-Merritt syndrome etc., in which case treatment is indicated. Surgical resection of the hemangioma should, according to the latest bibliography, be reserved for absolute indications, in the absence of which aggressive therapy is best avoided. Such indications include severe complications, unremitting pain, sudden increase in tumor size (a rare occurrence) and non-definite diagnosis (suspicion of malignancy). Arterial embolization is a technique which is widely used, easy to perform and safe, with very few serious complications. The goal of embolization is to occlude the feeding vessel, causing shrinkage and fibrosization of the tumor. The indications are similar to those for surgical treatment: unremitting pain, sudden increase in tumor size, other complications and unfeasibility (for any reason) of surgical resection. It is also used preoperatively in cases of Kasabach-Merritt syndrome with hemorrhage. The results of embolization (reduction of tumor size and pain remission) are not consistent, with various studies showing different success rates. The possible complications are minimized and the results are better with careful planning of the procedure and appropriate choice of embolic material.

Key words: Hepatic cavernous hemangioma, Intra-arterial embolization, Kasabach-Merritt syndrome.

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