Nine patients (45.0%) were treated with TAE, and procedural failure occurred in one case. The reported bleeding arteries were the intercostal, inferior phrenic, bronchial, hepatic, and superficial cervical arteries. These arteries were related to the locations of contrast extravasation. The patients who exhibited bleeding in 2 cases with direct diaphragmatic invasion involved bleeding from the hepatic arteries. To identify the bleeding arteries, CT angiography can be helpful. A gelatin sponge was most commonly used, and other embolic agents, including ethanol, lipiodol, and polyvinyl alcohol particles were also used. Other treatment modalities, including chemotherapy, surgery, and radiofrequency ablation have been adopted. However, there are too few cases to analyze and more cases are needed for further evaluation.
Regarding the outcomes, 45% of patients died within a month, 80% died within 6 months, and only 20% of cases survived for more than 6 months. Most deaths within a day were caused by shock, and the causes of deaths from several days to 6 months included respiratory failure, hepatic failure, multiple organ failure, and cancer death. The outcomes of 8 patients undergoing successful TAE varied greatly; the survival time ranged from 40 days to more than 15 months. One patient who received combined TAE and surgery even survived for more than 2 years.
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