Internal Mammary Artery Embolization for Hemoptysis

Abstract

The internal mammary artery contributes to the perfusion of lesions responsible for hemoptysis when the basic lesion involves the pulmonary parenchyma adjacent to the anterior pleural surface. Initial distal occlusion of the internal mammary artery may improve the efficacy of embolization of this artery for hemoptysis.

Hemoptysis: Bronchial and Nonbronchial Systemic Arteries at 16–Detector Row CT

“…In the presence of pleural thickening, nonbronchial systemic feeder vessels that arise from the various arteries (eg, the intercostal artery, branches of the subclavian and axillary arteries, internal mammary artery, or inferior phrenic artery) may develop along the pleural surface and become enlarged as a result of the inflammatory process, and they can be a major source of massive hemoptysis (6,7,(17)(18)(19)(20)(21). In a previous study (6), the sensitivity, specificity, and accuracy of conventional CT in the depiction of a nonbronchial systemic artery were 80%, 84%, and 84%, respectively.…”

Added Benefit of Thoracic Aortography After Transarterial Embolization in Patients with Hemoptysis

“…Morphologically, their courses are not parallel to those of bronchi, and they may pass through the pulmonary ligaments or adherent pleura. Systemic collateral arteries may include a wide spectrum of arteries within or near the thorax, such as the intercostal [13], thyrocervical [14], internal mammary [15,16], thoracodorsal, and lateral thoracic arteries and other branches of the subclavian artery [8]. Even intraabdominal arteries, including the inferior phrenic arteries, may also provide nonbronchial collateral supplies for the lung lesions that cause hemoptysis [10,12].…”

“…Reduced pulmonary circulation in the lesions of inflammatory lung diseases leads to systemic pulmonary anastomosis accompanied by a compensatory increase in systemic circulation, resulting in the rupture of systemic arteries [11]. In addition to the bronchial arteries, many systemic arteries constitute various nonbronchial systemic collaterals that also contribute to hemoptysis [7,8,[12][13][14][15][16].…”

Complications of Embolization

“…Otherwise, the use of coils for bronchial embolization is not recommended as they may produce an overly proximal occlusion, preventing the performance of a repeat procedure should the hemoptysis recur. 57,62 Sometimes, the recurrence is due to the presence of nonbronchial systemic feeder vessels that must be searched for. 54,57,62 …”

“…57,62 Sometimes, the recurrence is due to the presence of nonbronchial systemic feeder vessels that must be searched for. 54,57,62 …”