Diagnosis and Embolization of Hemoptysis Associated with the Inferior Phrenic Artery: A Single-Center Study

The Inferior phrenic artery (IPA) is a key but often overlooked non-bronchial systemic artery involved in causing hemoptysis.

To analyze the digital subtraction angiography (DSA) characteristics of IPA involvement in cases of hemoptysis and evaluate the safety and efficacy of polyvinyl alcohol (PVA) particle embolization.

A retrospective analysis examined clinical data from 819 patients with IPA involvement, selected from 2296 patients who undergoing bronchial artery embolization (BAE) due to the hemoptysis. DSA assessed blood supply from the IPA to the lesion and systemic-to-pulmonary shunts. Hemoptysis recurrence was monitored after embolizing the diseased artery with PVA, and postoperative adverse events were recorded.

In the study, 36% of patients with hemoptysis had abnormal IPA, with basal pulmonary segment lesions in 95% of cases, primarily due to pulmonary infection. IPAs mostly originated from the abdominal aorta or the celiac artery and were hypertrophy and tortuous. In 80% of cases, there were connections with pulmonary arteries. Hemoptysis recurred in 26 patients within a month post-procedure, achieving a 97% clinical success rate. Significant predictors of recurrence included postoperative platelet, preoperative prothrombin time (PT), intraoperative PVA particle size, and postoperative antibiotic administration.

IPA can contribute to hemoptysis. When basal pulmonary segment involved, it's crucial to evaluate IPA and consider PVA particle embolization for safe treatment. In patients with IPA-associated hemoptysis, the combination of PVA particles (100-300 µm) in IPA embolization and avoiding the routine antifungal prophylaxis in patients without clear indication for antifungal therapy are vital for minimizing recurrence hemoptysis.