Analysis of efficacy and safety of transarterial embolization sequential microwave ablation for hepatic hemangioma

To evaluate the efficacy and safety of transarterial embolization (TAE) sequential microwave ablation (MWA) for hepatic hemangioma (HH).

This single-center retrospective study included 122 patients with 134 HHs treated from 2013 to 2024. TAE was followed by CT-guided MWA after 3-14 days. Technical efficacy was defined as ≥50% HH volume reduction at 6 months post-ablation. Hemoglobinuria within 24 h after MWA was analyzed as a safety outcome. Correlation analysis was used to avoid simultaneous inclusion of highly correlated tumor burden and ablation-related variables. Tumor volume and ablation time were selected as representative variables. Generalized estimating equation (GEE) logistic regression accounted for within-patient clustering. Receiver operating characteristic (ROC) analysis was exploratory.

Technical success and technical efficacy were 100% and 87.3%, respectively. At 6 months after ablation, median maximum diameter decreased from 7.5 to 5.0 cm and median volume from 138.9 to 40.0 cm³ (both p < 0.001). The 30-day complication rate was 52.2%, with no major complications. Hemoglobinuria occurred in 36.6% and resolved within 24 h. In multivariable GEE analysis, ablation time remained associated with hemoglobinuria (OR = 1.096, 95% CI: 1.045-1.149, p < 0.001), whereas tumor volume was not significant. ROC analysis showed good exploratory discrimination for ablation time (AUC = 0.824), with an exploratory cutoff of 28.5 min.

TAE sequential MWA effectively reduces HH volume with acceptable safety. Hemoglobinuria was common but transient and had no clear adverse clinical consequences. Ablation time may serve as an exploratory reference for short-term postoperative monitoring.