Transarterial Embolization in the Management of Bleeding from Liver Tumors: Experience of 15 Years

Abstract

Introduction: Spontaneous bleeding from liver nodules is a rare but potentially fatal condition. Transarterial embolization has emerged as an effective approach for the control of active bleeding in this setting.

Objective

To describe the experience of a tertiary hospital with the endovascular management of spontaneous active bleeding associated with liver nodules, focusing on clinical and technical outcomes.

Methods: A retrospective study of 28 consecutive cases treated with transarterial embolization, between January 2009 and December 2024. Demographic variables, nodule type, embolization technique, bleeding recurrence, and 30-day and 12-month mortality were analysed.

Results: The majority of patients were male (85,7%), with a mean age of 66 years (range: 9 to 94 years). The most frequent diagnosis was hepatocellular carcinoma (n=24), followed by hepatic adenoma (n=2) and hepatic metastasis (n=2). Embolization was performed with polyvinyl alcohol (PVA) particles in 16 cases, microcoils in 2 cases, a combination of PVA particles and microcoils in 9 cases, and a combination of PVA particles and cyanoacrylate:lipiodol in 1 case. There was one case of bleeding recurrence. No immediate complications related to the intervention were recorded. The 30-day mortality was 39% (n=11) and the 12-month mortality was 50% (n=14). All deceased patients had malignant tumours.

Conclusion: Embolization proved to be an effective approach in the control of spontaneous bleeding from liver nodules, with a low rate of bleeding recurrence and a good safety profile. The underlying pathology is crucial for the vital prognosis, which is guarded in oncological patients.