1.2 Treatment method Using Seldinger’s puncture technique, the right femoral artery was cannulated to perform abdominal trunk and superior mesenteric artery angiography to clarify the tumor site, size, number and blood supply vessels, and after combining with the preoperative imaging findings and matching the lesion site, the tumor blood supply arteries were super-selectively cannulated respectively, with the catheter tip as close to the edge of the tumor as possible. Then, under fluoroscopy, the fully emulsified Pingyangmycin -lipiodol emulsion (PLE) was slowly and intermittently pushed, and for those with rich blood supply, appropriate amount of gelatin sponge strip embolization was added after embolization, and postoperative CT and color ultrasound follow-up was performed for 1~24 months. The common dose of pinyamycin was 8~16mg, and the dosage of super-liquidated iodine oil was 4~10m1. The appearance of stagnation after embolization of the blood supply artery of the lesion or the appearance of small portal branches around the lesion was used as the standard for quantifying embolization. In this group, there were 26 cases with 1 embolization and 6 cases with 2 embolizations, and the interval was 1~2 months. 1.3 Postoperative follow-up :The liver ultrasound and flat-scan CT were generally reviewed at 6 and 12 months after embolization to observe the tumor size, blood flow signal with or without iodine oil deposition inside and at the edge of the lesion, and liver function and blood routine were also reviewed. 2.1 Postoperative embolic syndrome reaction All cases had postoperative right upper abdominal pain of varying degrees, which was tolerated in the majority of cases. 6 cases had nausea and vomiting, and 8 cases had transient hypothermia. The vast majority of patients had transient general discomfort lasting 2-3 d, and were reluctant to speak loudly. 2.2 Observation of efficacy: 32 patients who had been injected with PLE for one or two times, after 6 and 12 months of postoperative follow-up ultrasound and CT scan, saw the disappearance of blood flow signal around the tumor, good iodine oil deposition in the tumor, and signs of tumor shrinkage and iodine oil accumulation, including 25 cases with >50% tumor shrinkage and 5 cases with >30% tumor shrinkage, including 1 case with complete disappearance of tumor on ultrasound follow-up, and 1 case with no significant tumor shrinkage. Among 30 patients with clinical symptoms, 28 cases had disappeared and 1 case had reduced significantly, with a total effective rate of 96.7% (29/30); 3 Discussion 3.1 Imaging performance Hepatic cavernous hemangioma is the most common benign tumor of the liver, consisting of many dilated blood sinuses of different sizes, which are branching malformations of the hepatic artery, and the blood supply is all from the hepatic artery, not related to the portal vein [4]. The age of predilection is 30-50 years, and it is more common in women. It is often clinically asymptomatic, and larger tumors may present with epigastric discomfort, distension, and abdominal pain. Hepatic cavernous hemangioma is composed of dilated abnormal blood sinuses, and its vessel wall is a single layer of endothelial cells, lacking muscle layer and elastic layer, without neuromodulation, and the contrast agent entering the tumor disappears slowly [5], therefore, DSA manifests as “popcorn sign”, “cotton ball sign “, “hanging fruit on the tree sign” and “early exit and late return sign”, with time, the contrast agent gradually becomes lighter and spreads to the center of the ring and is deposited in the blood sinusoids, like snowflakes, showing the general morphology of the lesion, and sinusoidal staining is often maintained until The sinusoidal staining is often maintained until late in the hepatic parenchyma (10-15s) and continues unabated. If there is an arteriovenous to portal fistula, the portal vein appears abnormal. The rate of arteriovenous-portal fistula in hepatic cavernous hemangioma is very high, and Lawrence Ouyang showed arteriovenous-portal fistula in 73% of CHL by CT and DSA [6]. The incidence of arteriovenous-portal fistula in our group is 18.8% (6/32), and the problem of arteriovenous-portal fistula should be considered in CHL interventions. Embolization is feasible for small A to PV fistulas, i.e., 4 to 5 branches, without reflux hepatic hematoma, and the injection rate should be slow and moderate during embolization. In our case, there were 6 small A to PV fistulas, i.e., 4 to 5 branch fistulas, and the lesions were embolized satisfactorily after super-selective intubation of PLE, and the small portal branches adjacent to the lesions were also embolized, and the patients had no obvious clinical symptoms and good liver function after the operation. 3. 2 Mechanisms of embolization therapy The inhibitory and endothelial disrupting effects of pindamycin are used to cause progressive thrombosis and tissue fibrosis in the microvessels (or CHL sinusoids) of the target organ [7]. Pingyangmycin also has the advantages of milder action, less irritation and anti-infective properties as well as milder or less frequent adverse effects and complications than other embolic agents/sclerosing agents [8]. Super-liquefied iodine oil allows highly concentrated, slow release of pinyamycin in the blood sinusoids and acts as an X-ray impermeable vehicle facilitating release of embolic agents under imaging surveillance. Through the interventional treatment and effect observation of 32 cases of hepatic cavernous hemangioma, ultrasound or CT was reviewed within 3-6 months after embolization, and 31 cases had different degree of tumor diameter reduction during the observation period. There was no case of serious complication in this group, which indicates that PLE is effective and safe in treating symptomatic hepatic cavernous hemangioma. 3.3 Embolization dose and Pingyangmycin In terms of embolization dose, we believe that the amount of embolization dose should be related to the size of the tumor, and should also pay attention to the number of vascular beds of the lesion, and the embolization dose should be reduced accordingly if the lesion has few vascular beds. The dose of embolization should be totaled in order to avoid embolization of normal liver tissues due to excessive dosage; 10 cm in diameter or multiple larger lesions should be embolized in stages to alleviate the discomfort of patients after embolization. In addition, intermittent bolus injection under fluoroscopy is used to reduce embolization of normal liver tissue adjacent to the lesion by using the siphoning effect of hemangioma blood flow velocity greater than that of normal liver tissue. Pingyangmycin is an antitumor antibiotic of Streptomyces class. Experimental and clinical studies found that when the cumulative dosage of Pingyangmycin reached 450-500 mg, 30% of cocoa caused pulmonary fibrosis and interstitial fibrosis, and the literature reported that the dosage was 16-3 2 mg as appropriate. 3.4 Application of super-selective cannulation and rotational DSA: In the cannulation technique, super-selective cannulation should be advocated first. It has been reported in the literature that PLE was injected into the hepatic artery, and the degeneration and focal necrosis of liver tissue were seen in the surgical pathology 1 month later, indicating that PLE still has a killing effect on normal liver tissue. In addition, we should pay attention to the vascular variation and multiple arteries supplying blood, especially when the tumor is large, we should routinely do the imaging of the celiac artery and superior mesenteric artery, so as not to miss the branches of the blood supplying artery. Secondly, because conventional DSA can only image in one direction, the vascular distribution in anterior-posterior direction or the overlapping of the traveling vessels, a single coronal image makes it difficult for the operator to determine the source of the blood supplying artery and whether there are multiple blood supplying arteries, and the selective cannulation of each artery clearly prolongs the operation time and increases the possibility of vascular injury. In this case, rotational DSA imaging should be chosen. This method avoids the overlapping of vessels by rotating multi-directional imaging, thus can quickly and correctly determine the tumor supply arteries and greatly reduce repeated cannulation and trial injection.