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Vol. 59. Issue 5.
Pages 414-421 (September - October 2017)
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Vol. 59. Issue 5.
Pages 414-421 (September - October 2017)
Original article
DOI: 10.1016/j.rxeng.2017.07.003
Role of selective intra-arterial embolization in benign liver tumors
Papel de la embolización selectiva intraarterial en los tumores hepáticos benignos
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M.D. Ferrer Puchola,
Corresponding author
mferrer@hospital-ribera.com

Corresponding author.
, C. La Parra Casadoa, A. Cervera Araeza, R. Sala Lópezb, E. Esteban Hernándeza, A. Cremades Mirac, R. Ramiro Gandiaa
a Servicio de Radiología, Hospital Universitario La Ribera, Alzira, Valencia, Spain
b Servicio de Cirugía General y Digestiva, Hospital Universitario La Ribera, Alzira, Valencia, Spain
c Servicio de Anatomía Patológica, Hospital Universitario La Ribera, Alzira, Valencia, Spain
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Table 1. Patients diagnosed with symptomatic benign tumors who required therapy.
Table 2. Classification of hepatocellular adenomas based on genomic analysis.a
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Abstract
Objective

To present cases of symptomatic benign liver tumors diagnosed and treated with intra-arterial embolization before surgery.

Material and methods

We present the cases of 7 patients diagnosed with symptomatic benign liver tumors that required treatment: 1 focal nodular hyperplasia, 2 giant cavernous hemangiomas, 1 hepatic adenomatosis, and 3 hepatic adenomas.

Once the feeding arteries were identified, tumors were embolized with polyvinyl alcohol particles (500μm–700μm) and then the feeding artery was plugged with coils if there was an arterial pedicle to ensure the total vascular exclusion of the tumor. The surgical intervention took place 4–7 days after embolization.

Results

All 7 patients were women (age range, 23–74 years); presurgical intra-arterial embolization was done in 6. In 1 patient with adenomatosis, embolization was done to control intraparenchymal hepatic hemorrhage. In the 6 patients who underwent surgery, the tumor was completely excised and no intraoperative bleeding events or postoperative complications occurred.

Conclusions

Provided there is a consensus among the multidisciplinary team, embolization is a useful option in the perioperative management of giant and/or symptomatic benign liver tumors.

Keywords:
Therapeutic embolization
Arterial embolization
Liver tumor
Treatment
Resumen
Objetivo

Presentar los casos de tumores hepáticos benignos sintomáticos diagnosticados y tratados con embolización intraarterial previa a la cirugía. Describimos la técnica y analizamos los resultados obtenidos.

Material y métodos

Presentamos 7 pacientes diagnosticadas de tumores benignos sintomáticos que requirieron tratamiento: 1 hiperplasia nodular focal, 2 hemangiomas cavernosos gigantes, 1 adenomatosis hepática y 3 adenomas hepáticos.

Una vez identificadas las arterias nutricias de cada tumor se embolizaron con partículas de PVA de 500 a 700 micras y posteriormente se cerró la arteria nutricia con coils si presentaban pedículo arterial para asegurar la exclusión vascular total del tumor. La intervención quirúrgica se realizó de 4 a 7 días después de la embolización.

Resultados

Los 7 casos eran mujeres con un rango de edad de 23 a 74 años. En 6 pacientes se realizó la embolización intraarterial prequirúrgica. En 1 caso, de adenomatosis, la embolización fue para control de una hemorragia intraparenquimatosa hepática. En las 6 pacientes intervenidas se realizó una exéresis tumoral completa y no tuvieron eventos hemorrágicos intraoperatorios ni ulteriores complicaciones.

Conclusiones

La embolización de los tumores hepáticos benignos gigantes y/o sintomáticos es una opción terapéutica útil para el manejo perioperatorio, siempre consensuado en un comité multidisciplinar.

Palabras clave:
Embolización terapéutica
Embolización arterial
Tumor hepático
Tratamiento

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