Ablative therapy for hepatic hemangioma

Various research and publications:

StudyN (Patients/Lesions)Size (mm)Treatment TypeEffectivenessComplications
Cui Y, Zhou LY, et al.12 (15)25–95RFA58.3% significant/complete relief, 38–79% volume reductionNone
Wen SQ, Wan M, et al.44 (50)50–100RFA86% complete effectClavien-Dindo
- Grade 1 (Hemoglobinuria, Hemolytic jaundice anemia, Elevated serum transaminase, Fever, Skin burns, Transient renal damage, Hydrothorax),
- Grade 3a (Pneumothorax, Liver abscess)
van Tilborg AA, Nielsen K, et al.4106–145RFA50% complete relief, 58–92% volume reductionSelf-limiting postprocedural pain lasting for 6 days (25%), Macroscopic hematuria lasting for 24 h (25%)
van Tilborg AAJM, Dresselaars HF, et al.215.7–25RFA50% complete relief, 56% and 32% reductionAKI, anemia (100%)
Park SY, Tak WY, et al.24 (25)40–150RFA71.4% complete relief, 92% complete effectAbdominal pain (16.7%), Fever (8.3%), Anemia (8.3%), Jaundice (12.5%), Ascites (4.2%)
Fan RF, Chai FL, et al.2728–100RFA52% complete relief, 100% complete effectPostoperative low-grade fever (48.1%), Elevated serum transaminase (48.1%)
Wu S, Gao R, et al.29150–200RFA99% complete effectClavien-Dindo
- Grade 1 (Hemoglobinuria, Anemia, Lung injury, SIRS, Postprocedural pain, Transient hepatic injury, Asymptomatic pleural effusion, Skin burn),
- Grade 2 (Esophageal injury, Myocardial dysfunction),
- Grade 2-3 (Diaphragmatic injury, AKI),
- Grade 3 (Symptomatic pleural effusion, Bleeding at electrode entry site, Rupture of hepatic hemangioma),
- Grade 4 (ARDS)
Qu C, Liu H, et al.1065–12.8RFA90.9%/65% complete relief, 86.5%/40.7% complete effectClavien-Dindo
- Grade 1 (Pleural effusion, Fever, Hemoglobinuria, Moderate anemia, Acute renal insufficiency, Jaundice),
- Grade 3 (Abdominal Hemorrhage)
Zhang X, Yan L, et al.66#40–100RFA76.5% complete relief, 94.4% complete effectFever (18.8%), Hemoglobinuria (3.1%), Transient renal damage (3.1%), Jaundice (3.1%)
Tang XY, Wang Z, et al.46 (47)50–96MWA91.5% complete effectMinor complications (fever, mild pain, transient hepatic dysfunction) 78.3%, Major complications (acute renal dysfunction, symptomatic pleural effusion, hyperbilirubinemia) 10.9%
Tang X, Ding M, et al.44106–145MWA50% complete relief, 93.2% complete effectClavien-Dindo
- Grade 1: Pain (22.7%), Excessive wound exudate (6.8%), Low-grade fever (4.5%), Coprostasis (13.6%), Stomach discomfort (4.5%), AKI (6.8%),
- Grade 3: Diaphragmatic hernia (2.3%)
Wang Z, Tang X, et al.12 (13)100–145MWA100% complete relief, 84.6% complete effectFever (15.4%), Constipation (30.8%), Slight wound pain (30.8%), Stomach discomfort (7.7%), High bilirubin (53.8%), Anemia (30.8%), Elevated serum transaminase (100%), Elevated serum creatinine (15.4%)
Liu F, Yu X, et al.40 (42)41–108MWA95% clinical effectiveness, 100% technical effectivenessFever (15%), Pleura effusion without drainage (5%), Hemoglobinuria at first urination after ablation (37.5%), AKI caused by massive heat-induced intravascular hemolysis (2.5%)
Shi Y, Song J, et al.8250–100MWA88.6% complete relief, 89.0% complete effect1. Major complications (9.8%): Diaphragmatic hernia (1.2% D), Symptomatic pleural effusion (2.4% C), Jaundice (2.4% C), Acute renal dysfunction (3.7% C)
2. Minor complications (43.9%): Fever (6.1% B), Abdominal pain (22% B), Both fever and pain (6.1% B), Other discomfort (9.8% A)
Kong J, Gao R, et al.144-MWA95.8% complete effectClavien-Dindo Grade 1: Hemoglobinuria (48.6%), SIRS (15.3%), Hemolytic jaundice (2.8%), Anemia (4.2%), Postprocedural pain (4.2%), Transient hepatic injury (4.2%), Asymptomatic pleural effusion (1.4%)
AKI: Acute Kidney Injury.
SIRS: Systemic Inflammatory Response Syndrome.
Clavien-Dindo Classification: Grades complications; higher grades indicate more severe complications.

RF/RFA = Radiofrequency Ablation, PEI = percutaneous ethanol injection, PAI = Percutaneous acetic acid injection, OS = Overall survival, MWA = Microwave ablation, PLAT = Percutaneous Local ablative therapy, HCC = hepatocellular carcinoma

  1. Cui Y, Zhou LY, Dong MK, Wang P, Ji M, Li XO, et al. Ultrasonography guided percutaneous radiofrequency ablation for hepatic cavernous hemangioma. World J Gastroenterol 2003;9(9):2132–2134. doi:10.3748/ wjg.v9.i9.2132, PMID:12970923.
  2. Wen SQ, Wan M, Len KM, Hu QH, Xie XY, Wu Q, et al. Safety and Efficacy of Laparoscopic Radiofrequency Ablation for Hepatic Hemangiomas: A Multicenter Retrospective Study. Ann Hepatol 2018;17(2):268–273. doi:10.5604/01.3001.0010.8653, PMID:29469049.
  3. van Tilborg AA, Nielsen K, Scheffer HJ, van den Tol P, van Waesberghe JH, Sietses C, et al. Bipolar radiofrequency ablation for symptomatic giant (>10 cm) hepatic cavernous haemangiomas: initial clinical experience. Clin Radiol 2013;68(1):e9–e14. doi:10.1016/j.crad.2012.08.029, PMID:23146554.
  4. van Tilborg AAJM, Dresselaars HF, Scheffer HJ, Nielsen K, Sietses C, van den Tol PM, et al. RF Ablation of Giant Hemangiomas Inducing Acute Renal Failure: A Report of Two Cases. Cardiovasc Intervent Radiol 2016; 39(11):1644–1648. doi:10.1007/s00270-016-1415-1, PMID:27387187.
  5. Park SY, Tak WY, Jung MK, Jeon SW, Cho CM, Kweon YO, et al. Symptomatic-enlarging hepatic hemangiomas are effectively treated by percutaneous ultrasonography-guided radiofrequency ablation. J Hepatol 2011;54(3):559–565. doi:10.1016/j.jhep.2010.07.024, PMID:21115209.
  6. Fan RF, Chai FL, He GX, Wei LX, Li RZ, Wan WX, et al. Laparoscopic radiofrequency ablation of hepatic cavernous hemangioma. A preliminary experience with 27 patients. Surg Endosc 2006;20(2):281–285. doi:10.1007/ s00464-005-0184-8, PMID:16362478.
  7. Tang XY, Wang Z, Wang T, Cui D, Zhai B. Efficacy, safety and feasibil-ity of ultrasound-guided percutaneous microwave ablation for large hepatic hemangioma. J Dig Dis 2015;16(9):525–530. doi:10.1111/1751- 2980.12169, PMID:24945806.
  8. Tang X, Ding M, Lu B, Chi J, Wang T, Shi Y, et al. Outcomes of ultrasound-guided percutaneous microwave ablation versus surgical resection for symptomatic large hepatic hemangiomas. Int J Hyperthermia 2019; 36(1):632–638. doi:10.1080/02656736.2019.1624837, PMID:3124434.
  9. Wang Z, Tang X, Qi X, Shi Y, Chi J, Li P, et al. Feasibility, safety, and efficacy of ultrasound-guided percutaneous microwave ablation for giant hepatic hemangioma. Int J Hyperthermia 2018;35(1):246–252. doi:10.1080/0265 6736.2018.1493541, PMID:30130992.
  10. Liu F, Yu X, Liang P, Cheng Z, Han Z, Yu J. Ultrasonography-guided percutaneous microwave ablation for large hepatic cavernous haemangiomas. Int J Hyperthermia 2018;34(7):1061–1066. doi:10.1080/02656736.2017.139 2045, PMID:29025295.
  11. Wu S, Gao R, Yin T, Zhu R, Guo S, Xin Z, et al. Complications of Radiofrequency Ablation for Hepatic Hemangioma: A Multicenter Retrospective Analysis on 291 Cases. Front Oncol 2021;11:706619. doi:10.3389/ fonc.2021.706619, PMID:34395280.
  12. Qu C, Liu H, Li XQ, Feng K, Ma K. Percutaneous ultrasound-guided ‘threestep’ radiofrequency ablation for giant hepatic hemangioma (5–15 cm): a safe and effective new technique. Int J Hyperthermia 2020;37(1):212– 219. doi:10.1080/02656736.2020.1732484, PMID:32106730.
  13. Shi Y, Song J, Ding M, Tang X, Wang Z, Chi J, et al. Microwave ablation versus transcatheter arterial embolization for large hepatic hemangiomas: clinical outcomes. Int J Hyperthermia 2020;37(1):938–943. doi:10.1080/ 02656736.2020.1766122, PMID:32762267.
  14. Zhang X, Yan L, Li B, Wen T, Wang W, Xu M, et al. Comparison of laparoscopic radiofrequency ablation versus open resection in the treatment of symptomatic-enlarging hepatic hemangiomas: a prospective study. Surg Endosc 2016;30(2):756–763. doi:10.1007/s00464-015-4274-y, PMID:2612 3327.
  15. Kong J, Gao R, Wu S, Shi Y, Yin T, Guo S, et al. Safety and efficacy of microwave versus radiofrequency ablation for large hepatic hemangioma: a multicenter retrospective study with propensity score matching. Eur Radiol 2022;32(5):3309–3318. doi:10.1007/s00330-021-08425-4, PMID: 35091785.
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