Embolization of Liver Hemangiomas

In infants, the embolization of liver hemangiomas with congestive heart failure demonstrates therapeutic efficiency by the rapid resolution of heart failure. This is because of the collaterals between the hepatic artery and the hepatic veins. In adults, heart failure due to a giant hemangioma is very rare and the most common indication in adults is a kind of pain in the trunk. The expectation from the embolization of a liver hemangioma is the cessation of symptoms as a result of the shrinkage of the hemangioma. Although some authors (2-4) have reported satisfactory results with a significant decrease in the size of hemangiomas after embolization, others have found little or no effect on the symptoms (5, 6). After embolization, some amount of shrinkage almost always occurs in the hemangioma but this decrease in size may be far from the expectations of clinicians and patients. There are several reasons for this disappointment. First, although most patients wait for pain relief, the pain increases in the post-embolization period and some symptoms of the hemangioma may continue in the long term. Secondly, the amount of the decrease in the size of the hemangioma can be lower than expected. Whereas three-dimensional computed tomography calculations report a satisfactory decrease in the volume of hemangiomas after embolization (7), two-dimensional measurements usually fail to show any significant decrease in size (5). Thirdly, the shrinkage of a hemangioma after embolization is transient and it reaches its previous volume after a short period of time. It is, therefore, difficult to claim a clear therapeutic effect for the embolization of liver hemangiomas.