An implantable pump for long-term intravascular drug infusion

A totally implantable infusion pump has been developed that can provide chronic, continuous, low-rate drug infusions in ambulatory patients. The device relies on vapor pressure for its power source, and thus needs no recharging other than periodic drug refills. It is implanted surgically under the skin of the chest or abdomen, with the delivery cannula placed in an appropriate blood vessel. Pumps implanted in this way have delivered heparin, 5-fluorodeoxyuridine, or other drugs in patients; some outpatients have received continuous intravenous heparin infusions for more than 4 years.

Totally implanted drug delivery system for hepatic arterial chemotherapy

A totally implanted drug delivery system for hepatic arterial chemotherapy was evaluated in 13 patients with metastatic (11 colon and one carcinoid) or primary (one hepatoma) cancer of the liver. During laparotomy, a Silastic catheter was positioned in the hepatic artery for infusion to the entire liver arterial vasculature as ascertained by low-flow radionuclide angiography with 99Tc-macroaggregated albumin. The catheter was connected to a subcutaneously implanted model 400 Infusaid pump (Metal Bellows Corp, Sharon, MA). Each pump had a 50-ml volume and a set rate (3--6 ml/day) and required refill every 8--16 days. A side port bypassed the pumping mechanism and allowed direct catheter injection for nuclide angiography, for bolus drug administration, or for clearing of a blocked catheter. Pump refills and side port injections were performed by percutaneous injection. The 13 patients in this ongoing study received a median of 6 months (range, 4.5--17) of continuous hepatic arterial infusion. The pump performed reliably with stable (+/- 10%) flow rates and only one malfunction in 2800 cumulative days of use. Flow distribution determined by low-flow radionuclide angiography did not change in 12 patients. Patient acceptance was excellent, with the ability to participate fully in normal daily activities. Eleven patients showed partial hepatic tumor regressions documented by physical examination and nuclide liver scans. All patients were treated with 5-fluorodeoxyuridine. Two patients failed 5-fluorodeoxyuridine therapy and subsequently responded briefly to dichloromethotrexate. This implanted system should facilitate future investigation of regional chemotherapy using these and other agents.

[Intra-arterial infusion in the treatment of severe forms of occlusive vascular diseases of the lower limbs]

The clinico-instrumental investigation of results of intraarterial infusions of acetylcholine chloride in 82 patients with obliterating lesions of the vessels of lower extremities has revealed high therapeutic effect of the drug. The treatment allowed avoiding amputation of the extremity in the overwhelming majority of patients with serious degrees of ischemia.

Spontaneous cervical carotid artery dissection: outpatient treatment with continuous heparin infusion using a totally implantable infusion device

The authors report a patient with spontaneous high cervical internal carotid artery dissection and a severe reversible ischemic deficit. Successful treatment consisted of 5 months of continuous intravenous heparin using an implantable infusion device. The details of this therapy are described, and alternative therapeutic modalities are discussed.

[Percutaneous removal of intravascular fragments from infusion, angiography and cerebrospinal fluid drainage catheters with the loop-snare technic]

Intravascular loss of catheter fragments (for infusion, angiographic, or CSF shunting purposes) represents a serious complication. There is a high morbidity rate and even mortality when the foreign body remains within the vascular system. Nonsurgical percutaneous removal of 16 catheter fragments from the venous side and 1 Gianturco coil from the abdominal aorta by use of a catheter sheath introducer system and the loop-snare technique is reported. If there is no local thrombosis, fragment recovery is relatively easy. Surgical intervention should be resorted to only when percutaneous removal turns out to be impossible.

Transbrachial hepatic arterial chemotherapy using an implanted infusion pump

Two patients with hepatic metastases from colonic cancer were treated with hepatic arterial FUDR using an innovative drug infusion system. The two patients reported underwent transbrachial hepatic artery catheterization with a 5 French polyethylene catheter. This catheter was amputated just distal to its exit from the brachial artery and attached to a totally implantable, percutaneously refillable drug infusion pump placed in the infraclavicular position. The patients received FUDR at flow rates of 3--4 ml/day. The pumps were refilled weekly by percutaneous injection. One patient was treated for seven weeks, and another for ten weeks without technical difficulties. This innovative approach offers marked improvement in comfort and convenience for patients who are candidates for long-term hepatic artery chemotherapy, and avoids the morbidity of laparotomy for direct hepatic arterial catheterization.

A simple double channel swivel for infusions of fluids into unrestrained animals

The construction of a double channel swivel for infusing two fluids separately into an unrestrained animal is described. The swivel is constructed of readily available, inexpensive materials and does not require any machining of parts. These swivels have been found to last for 720 hr without leakage.

The implantable infusion pump: a new concept in drug delivery

Several of our most useful drugs cannot be administered orally. This paper is a summary of our work with a new drug delivery system: a totally implantable, continuous infusion pump, with a self-contained inexhaustible power source. Currently, after bench tests and animal experimentation, we have initiated clinical series utilizing this device to treat individuals with refractory thromboembolic conditions by intravenous heparin, and patients with localized solid tumors by intra-arterial chemotherapy. The use of this device for the infusion of insulin in the management of diabetes mellitus is yet in the laboratory stage of development. In addition to improving dy-today diabetic control and obviating the need for daily insulin injections, this pump offers an ideal opportunity to test whether optimal blood glucose control can significantly prevent or delay the onset of the crippling vascular complications of diabetes. The potential uses of this device, in many fields, are myriad.

Continuous long-term intra-arterial infusion in the unrestrained rabbit

A technique for the catheterization and intra-arterial infusion of the common carotid artery of the rabbit utilized a simple swivel apparatus, an acrylic head mount, and a silicone rubber sleeve. This method was used for continuous intra-arterial infusion in 29 unrestrained rabbits for periods up to 61 days.