9 - Diagnosis and Treatment of Hepatic Venous Malformations

Purpose: To determine the role of ethanol endovascular therapy in the management of liver "hemangioma" (venous malformation of the liver). Currently, only surgical lobectomy with its attendant severe morbidity is the only other treatment option.

Materials and Methods: 28 patients underwent 221 treatments by direct puncture into the venous malformation involving single and multiple lobes of the liver. 7 males and 21 females with age range of 24 years – 72 years, mean age, 55 years. Patients underwent arteriography and direct puncture repair of the malformations in the liver; all patients had follow-up performed by CT and MR imaging. Early in the series one patient developed a fever and was placed on antibiotics. Currently all patients are placed on Flagyl and Levoquin for 7 days.

Results: Reduction in the vein malformation within the liver was noted in all patients. More importantly, their pain symptoms resolved. 1 patient's intractable hiccups resolved. 1 patient developed a left foot drop due to pressure on the sciatic nerve because she was thin and laying on a hard angiographic table. This completely resolved. 1 patient developed a fever and was successfully treated with antibiotic therapy. Patients were followed-up by CT and MR imaging documenting the shrinkage of single and multiple lesions (follow-up range: 13 – 52 months; mean: 37 months). 3 of 28 patients had minor abdominal and right shoulder pain post-procedure.

Conclusion: Direct puncture ethanol endovascular therapy is efficacious in the management of liver venous malformations just as it is efficacious in venous malformations in other anatomic areas. We recommend covering patients with antibiotics (Flagyl and Levoquin, unless allergic) due to the potential of bacterial seeding of the malformation from the portal system. This procedure is well-tolerated by patients compared to current treatment by liver resections/lobectomy/bile leaks/bile strictures/death that are noted to occur with surgery.