Transarterial embolization for Focal Nodular Hyperplasia (FNH)

Indications1. Unresectable lesions with/without symptoms
2. Patients unfit for surgery
3. Necessity of sparing normal hepatic parenchyma
4. Multiple FNHs
5. Patient refusal to undergo surgery
6. Pediatric patients
Additional Uses1. Bridge therapy to surgery in selected cases for size reduction and pain control
2. Emergency method to arrest hemorrhage from ruptured FNH
Surgery vs. TAETAE avoids general anaesthesia, has shorter hospital stay, and lower morbidity/mortality rates compared to surgery
Choice of Embolization Material1. Polyvinyl alcohol (PVA) particles (depending on size of feeding vessel 100-300µm, 300-500µm, 500-700µm)
2. Ethiodized oil (lipiodol) emulsions
3. Bleomycin with other embolic agents (like PVA and lipiodol) - adding to the sclerosing and embolic effects. Superior to PVA alone
4. Pingyangmycin lipiodol emulsion and polyvinyl alcohol
Bleomycin
(Cautious use due to side effects)		1. Associated complications include
- Sclerosing cholangitis
- Interstitial pneumonia
- Pulmonary fibrosis
2. Microcatheters improve precise deposition of embolization particles in small feeding arteries (selective and superselective TAE)
Mechanism of Action1. PVA causes permanent occlusion of hepatic arterioles
2. Lipiodol reduces blood flow temporarily and has tumoricidal activity
Complications1. Post-Embolization Syndrome (PES)
2. Liver or gallbladder infarction
3. Pneumonia
4. Pleural effusion
Local RecurrenceRare (in presence of multiple feeders)
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