title: Supplementary inferior phrenic artery embolization in the interventional treatment of hemoptysis.
abstract: BACKGROUND
  Transcatheter bronchial artery embolization (BAE) is widely used for the treatment of hemoptysis and the immediate success rate is high, but there are still some hemorrhage recurrences. One of the common reasons for failure of BAE is collateral branches as blood supply. The inferior phrenic artery (IPA) is one of the most common collateral branches that is scarcely reported. Our purpose was to observe manifestations of IPA supplying to hemoptysis and evaluate the efficacy and safety of IPA embolization.
  
  
  METHODS
  Angiography during interventional treatment of 178 hemoptysis patients in the past 7 years confirmed that IPA hemorrhage resulted in hemoptysis in 25 patients (26 - 67 years old) who had: lung cancer (11 patients), bronchiectasis (11 patients), chronic lung inflammation (2 patients), and pulmonary tuberculosis (1 patient). Among the 25 patients, 7 patients had twice interventional operations within one week and 6 patients still experienced intraoperative hemoptysis after conventional embolization of the bronchial artery, the internal thoracic artery, and the intercostal artery, then had the second interventional operation immediately. The total number of cases were 191. Selective embolization of the IPA was performed using polyvinyl alcohol microspheres, gelatin sponge particles, and microcoil. The safety and clinical significance of IPA embolization were evaluated. The Pearson chi(2) test and Fisher's exact probability test were used in this study.
  
  
  RESULTS
  Selective IPA angiography showed increased diameter of the IPA, disorganization of the branches, and varying degrees of angiogenesis. In 11 cases, contrast material was seen in vessels supplying the tumor and in the tumor. In 9 cases, contrast material had leaked into the area supplied by the IPA; in 8 cases, non-specific flake-like deposits of contrast material were seen; and in 14 cases, abnormal communication or shunt was visualized. Lesions were closely related to the pleura in 25 patients. Fifteen lesions were close to the diaphragmatic pleura, seven close to the mediastinal pleura, and three close to the lateral pleura of the lower lung. Eleven cases had inferior thoracic pleural thickening and adhesions. The IPA was embolized in 25 cases, and the success rate of hemostasis was 100%. The IPA was not embolized in the other 166 cases, and the success rate of hemostasis was 92.17 %. In the 25 cases with IPA embolization, the involvement of the IPA in the blood supply of the hemoptysis was correlated with the duration of the disease (P = 0.0344). The involvement of IPA in the blood supply of the hemoptysis was not correlated with the characteristic of the lung lesions (benign or malignant) (P = 1.0000). Duration of follow-up was 8 months to 5 years. Hemoptysis recurred in four patients 1, 2, 3, and 6 months after interventional operation, respectively, and was controlled by conservative treatment. Twenty-one patients had no recurrence of hemoptysis.
  
  
  CONCLUSIONS
  Bleeding from the IPA can result in hemoptysis and failure of BAE in the treatment of hemoptysis. If IPA hemorrhage contributes to hemoptysis, supplementary IPA embolization may be a safe and effective treatment.
authors.affiliation: Department of Interventional Radiology, Chinese People's Liberation Army General Hospital, Beijing, China.
authors.forename: Feng-yong
authors.initials: FY
authors.lastname: Liu
authors.forename: Mao-qiang
authors.initials: MQ
authors.lastname: Wang
authors.forename: Qing-sheng
authors.initials: QS
authors.lastname: Fan
authors.forename: Feng
authors.initials: F
authors.lastname: Duan
authors.forename: Zhi-jun
authors.initials: ZJ
authors.lastname: Wang
authors.forename: Peng
authors.initials: P
authors.lastname: Song