Semptomatik Dev Hepatik Venöz Malformasyonların Tedavisinde Bleomisin-Lipiodol Embolizasyonunun Etkinliği

Öz

Amaç: 2018 ISSVA sınıflamasına göre, daha önce hepatik hemanjiyom olarak adlandırılan lezyonların büyük çoğunluğu günümüzde yavaş akımlı hepatik venöz malformasyonlar (HVM) olarak sınıflandırılmaktadır. Dev HVM’ler (>5 cm) belirgin semptomlara ve komplikasyonlara yol açabilmektedir. Bu çalışmada, semptomatik dev hepatik venöz malformasyonlu hastalarda bleomisin-lipiodol karışımı ile uygulanan transarteriyel kemoembolizasyonun (TACE) etkinlik ve güvenliğinin değerlendirilmesi amaçlandı.

Gereç ve Yöntemler: Bu retrospektif çalışmaya, Mayıs 2020 ile Mayıs 2022 tarihleri arasında tedavi edilen, 5 cm’den büyük HVM’ye sahip 38 semptomatik hasta (32 kadın, 6 erkek) dahil edildi. Tanı, kontrastlı bilgisayarlı tomografi ve/veya manyetik rezonans görüntülemedeki karakteristik bulgulara dayanılarak konuldu ve dijital substraksiyon anjiyografi ile desteklendi. Lezyon hacmi ve semptomlar işlem öncesinde ve tedaviden 11-13 ay sonra değerlendirildi. Teknik başarı, tüm besleyici arterlerin selektif embolizasyonu olarak; klinik başarı ise semptomlarda düzelme ile birlikte %50’den fazla hacim azalması olarak tanımlandı. Tedavi sonuçlarını değerlendirmek amacıyla uygun istatistiksel analizler yapıldı.

Bulgular: Tüm işlemler teknik olarak başarılıydı. Ortalama başlangıç lezyon hacmi 502,3 cm³ iken, bir yıllık takipte 138,4 cm³’e geriledi ve ortalama %72,4 küçülme sağlandı (p<0,001). Klinik başarı oranı %94,7 olarak bulundu. Ağrı Görsel Analog Skalası skorları 5,2’den 1,3’e düştü (p<0,001). Majör komplikasyon izlenmedi; üç hastada geçici post-embolizasyon sendromu gelişti. İlaç dağılım derecelendirmesi ile lezyon küçülmesi arasında anlamlı korelasyon saptandı (p=0,0059). Cinsiyet, yaş, lezyon lokalizasyonu ve ilaç dozu anlamlı prediktörler değildi.

Sonuç: Bleomisin-lipiodol ile uygulanan TACE, semptomatik dev HVM’lerde belirgin lezyon küçülmesi ve semptom gerilemesi sağlayan, minimal komplikasyon oranına sahip güvenli ve etkili bir minimal invaziv tedavi yöntemidir.

Anahtar Kelimeler

• Hemanjiyom
• Hepatik Venöz Malformasyon
• Trans-Arteryal Kemo-Embolizasyon
• Bleomisin
• Lipiodol

EFFICACY OF BLEOMYCIN-LIPIODOL EMBOLIZATION IN TREATING SYMPTOMATIC GIANT HEPATIC VENOUS MALFORMATIONS

Öz

Objective: According to the 2018 ISSVA classification, most lesions previously termed hepatic hemangiomas are now categorized as slow-flow hepatic venous malformations (HVMs). Giant HVMs (>5 cm) may cause significant symptoms and complications. To evaluate the efficacy and safety of transarterial chemoembolization (TACE) with a bleomycin-lipiodol mixture in patients with symptomatic giant hepatic venous malformations.

Material and Methods: This retrospective study included 38 symptomatic patients (32 women, 6 men) with HVMs larger than 5 cm, treated between May 2020 and May 2022. Diagnosis was established using characteristic findings on contrast-enhanced computed tomography and/or magnetic resonance imaging and was supported by digital subtraction angiography. Lesion volume and symptoms were assessed pre-procedure and at 11-13 months post-treatment. Technical success was defined as selective embolization of all feeding arteries, and clinical success as symptom improvement with >50% volume reduction. Appropriate statistical analyses were performed to evaluate treatment outcomes.

Results: All procedures were technically successful. Mean baseline lesion volume decreased from 502.3 cm³ to 138.4 cm³ at one-year follow-up, a mean shrinkage of 72.4% (p<0.001). Clinical success was achieved in 94.7% of cases. Pain Visual Analog Scale scores decreased from 5.2 to 1.3 (p<0.001). No major complications occurred; three patients experienced transient post-embolization syndrome. Drug distribution grading significantly correlated with lesion shrinkage (p=0.0059), while sex, age, lesion location, and drug dose were not significant predictors.

Conclusion: Bleomycin-lipiodol TACE is a safe and effective minimally invasive treatment for symptomatic giant HVMs, achieving substantial lesion shrinkage and symptom relief with minimal complications.

Anahtar Kelimeler

• Hemangioma
• Hepatic Venous Malformation
• Trans-Arterial Chemo-Embolization
• Bleomycin
• Lipiodol

Kaynakça

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