Efficacy and safety of bleomycin–lipiodol transarterial chemoembolization in giant hepatic hemangiomas: Insights from a single-center experience

BACKGROUND This study aimed to evaluate the efficacy and safety of bleomycin–lipiodol transarterial chemoembolization in the treatment of giant hepatic hemangiomas based on data from our center and to assess volumetric changes in non-target hemangiomas, as well as the contribution of a coil-assisted superselective approach to procedural safety. METHODS Retrospective data from 23 patients who underwent bleomycin–lipiodol transarterial chemoembolization for the treatment of giant hepatic hemangiomas between October 2018 and December 2024 were analyzed. Target hemangioma volumes were calculated before the procedure and at 6 months of follow-up. Clinical success was defined as ≥ 50% volume reduction on ultrasonography at 6 months. Non-target hemangiomas were evaluated at mid- and long-term follow-up. Detachable mechanical coil embolization was performed for 4 patients to prevent reflux and vasospasm in the non-lesional parenchyma. Complications were classified according to Cardiovascular and Interventional Radiological Society of Europe standards. RESULTS The mean age of the patients was 51.2 ± 8.6 years, and 19 (82.6%) were female. No major complications or mortality were observed; minor complications occurred in 3 patients (13%). At 6 months, the mean volume reduction rate was 54.2 ± 11.3% (p < 0.001). Clinical success was achieved in 20 cases (87.0%). Volume reduction increased with longer follow-up, reaching 83% at 24 months and 94% at ≥ 36 months. Among 10 patients with multiple hemangiomas, non-target lesions demonstrated an average 85% reduction in volume in mid- to long-term follow-up evaluations. CONCLUSION Bleomycin–lipiodol transarterial chemoembolization is a safe and effective treatment for giant hepatic hemangiomas, achieving high efficacy with low morbidity. The treatment provides significant volume reduction not only in target lesions but also in non-target hemangiomas, suggesting a potential locoregional or diffuse pharmacological effect beyond the directly embolized area. Coil-assisted superselective embolization substantially enhances procedural safety. Bleomycin, embolization, eemangioma, lipiodol, liver