Purpose: To find the aggregated effectiveness and safety profiles of transarterial embolization (TAE) and percutaneous sclerotherapy (PS) in patients with hepatic venous malformations (HVMs).

Materials and methods: A comprehensive search encompassing PubMed, Scopus, and Web-of-Science databases was undertaken to identify original articles reporting on the safety or effectiveness of TAE or PS in adult patients with HVMs up to March 2025. Effect sizes for continuous outcomes were assessed using mean difference (MDs) and ratio of means (ROM), while proportions for dichotomous outcomes were pooled using logit transformation. The random-effects model was used for meta-analysis in the R software.

Results: Thirty-seven observations from 35 studies (N = 2,592 patients; mean age, 45.3 years; 64.5% female) were included, with 29 evaluating TAE and 8 assessing PS. Both TAE and PS significantly reduced lesion volume (TAE vs PS MD, 193.20 mL [ROM, 2.29] vs 455.91 mL [ROM, 3.73]) and diameter (TAE vs PS MD, 4.15 cm [ROM, 1.81] vs 4.04 cm [ROM, 1.72]). The indirect comparison showed no statistically significant difference between the 2 interventions for either volume (P = .097) or diameter (P = .72) reduction after the procedure. Clinical response rate was 86.3% in TAE and 85.9% in PS (P = .89). Major adverse events were low and comparable (TAE vs PS, 3.8% vs 3.0%). TAE had higher rates of liver enzyme elevation (44.9%), while PS had no reported cases. TAE was associated with longer hospital stays (mean, 1.19 days vs near-zero for PS) and higher costs ($2,424 vs $893; P < .0001).

Conclusions: Both techniques are equally effective, but PS is associated with fewer postprocedural liver enzyme derangement, shorter hospitalization, and reduced cost.