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Adjuvant intra-arterial chemotherapy for patients with resected colorectal liver metastases: a systematic review and meta-analysis. HPB (Oxford) 2022; 24:299-308. [PMID: 34895829 DOI: 10.1016/j.hpb.2021.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/18/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The practice of adjuvant hepatic arterial infusion chemotherapy (HAIC) for colorectal liver metastasis (CRLM) varies widely. This meta-analysis investigates the effectiveness of adjuvant HAIC and the influence of variations in HAIC treatment in patients with resected CRLM. METHODS PRISMA guidelines were followed for this study. The search was limited to comparative studies (HAIC vs non-HAIC) for overall survival. Subgroup meta-analyses using random-effects were performed for type of intra-arterial drug, method of catheter insertion, use of concomitant adjuvant systemic chemotherapy, and study design. RESULTS Eighteen eligible studies were identified. After excluding overlapping cohorts, fifteen studies were included in the quantitative analysis, corresponding to 3584 patients. HAIC was associated with an improved overall survival (pooled hazard ratio (HR) 0.77; 95%CI 0.64-0.93). Survival benefit of HAIC was most pronounced in studies using floxuridine (HR 0.76; 95%CI: 0.62-0.94), surgical catheter insertion with subcutaneous pump (HR 0.71; 95%CI: 0.61-0.84), and concomitant adjuvant systemic chemotherapy (HR 0.75; 95%CI: 0.59-0.96). The pooled HR of RCTs was 0.91 (95%CI 0.72-1.14), of which only 3 used floxuridine. CONCLUSION Adjuvant HAIC is a promising treatment for patients with resectable CRLM, in particular HAIC with floxuridine using a surgically placed catheter and a subcutaneous pump, and concomitant systemic chemotherapy.
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Baluchi I, Anani H, Hassanshahi G, Fatemi A, Khalilabadi RM. The effect of maslinic acid on apoptotic genes in u266 multiple myeloma cell line. GENE REPORTS 2019. [DOI: 10.1016/j.genrep.2019.100431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hepatic arterial infusion chemotherapy by the fixed-catheter-tip method: retrospective comparison of percutaneous left subclavian and femoral port-catheter system implantation. AJR Am J Roentgenol 2013; 202:211-5. [PMID: 24370146 DOI: 10.2214/ajr.12.10502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to retrospectively compare the subclavian and femoral approaches to a fixed-catheter-tip method of implantation of a port-catheter system for hepatic arterial infusion chemotherapy with respect to complications and dysfunctions. MATERIALS AND METHODS Between April 2006 and April 2012, 153 patients (104 men, 49 women; age range, 23-82 years; mean, 65 years) with unresectable malignant liver tumors underwent percutaneous implantation of indwelling port-catheter systems by the fixed-catheter-tip method via the left subclavian or femoral artery. The success of implantation and outcome of complications were investigated and compared between these approach routes. RESULTS The overall technical success rate of port-catheter system implantation with the fixed-catheter-tip method was 99% (152 of 153 patients). Seventy-five patients underwent implantation with a port-catheter system via the left subclavian artery, and 77 patients via the femoral artery. Catheter dislocation occurred in 3.9% of the patients; hepatic artery obstruction, 2.6%; catheter occlusion, 3.9%; bleeding at the puncture site, 3.9%; cerebral infarction, 1.3%; and infection related to port-catheter implantation, 2.6%. No significant differences in complications and port-catheter system dysfunction between the left subclavian and femoral approaches to port-catheter system implantation with the fixed-catheter-tip method were seen in any of the parameters. In addition, cerebral infarction occurred exclusively with the left subclavian approach, whereas infection occurred exclusively with the femoral approach. CONCLUSION Implantation of the port-catheter system with the fixed-catheter-tip method is equally feasible via both the left subclavian and the femoral approaches.
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Choi SY, Kim AH, Kim KA, Won JY, Lee DY, Lee KH. A simplified technique of percutaneous hepatic artery port-catheter insertion for the treatment of advanced hepatocellular carcinoma with portal vein invasion. Korean J Radiol 2010; 11:648-55. [PMID: 21076591 PMCID: PMC2974227 DOI: 10.3348/kjr.2010.11.6.648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 07/01/2010] [Indexed: 02/07/2023] Open
Abstract
Objective We assessed the outcomes of a simplified technique for the percutaneous placement of a hepatic artery port-catheter system for chemotherapy infusion in advanced hepatocellular carcinoma with portal vein invasion. Materials and Methods From February 2003 to February 2008, percutaneous hepatic artery port-catheter insertion was performed in 122 patients who had hepatocellular carcinoma with portal vein invasion. The arterial access route was the common femoral artery. The tip of the catheter was wedged into the right gastroepiploic artery without an additional fixation device. A side hole was positioned at the distal common hepatic artery to allow the delivery of chemotherapeutic agents into the hepatic arteries. Coil embolization was performed only to redistribute to the hepatic arteries or to prevent the inadvertent delivery of chemotherapeutic agents into extrahepatic arteries. The port chamber was created at either the supra-inguinal or infra-inguinal region. Results Technical success was achieved in all patients. Proper positioning of the side hole was checked before each scheduled chemotherapy session by port angiography. Catheter-related complications occurred in 19 patients (16%). Revision was achieved in 15 of 18 patients (83%). Conclusion This simplified method demonstrates excellent technical feasibility, an acceptable range of complications, and is hence recommended for the management of advanced hepatocellular carcinoma with portal vein thrombosis.
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Affiliation(s)
- Sun Young Choi
- Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do, Korea
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Yamagami T, Terayama K, Yoshimatsu R, Matsumoto T, Miura H, Nishimura T. Embolisation of the right gastric artery in patients undergoing hepatic arterial infusion chemotherapy using two possible approach routes. Br J Radiol 2010; 83:578-84. [PMID: 20442280 PMCID: PMC3473675 DOI: 10.1259/bjr/51736762] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 04/15/2009] [Accepted: 06/09/2009] [Indexed: 11/05/2022] Open
Abstract
We used a retrospective non-randomised study to investigate the clinical effect of selective embolisation of the right gastric artery before hepatic arterial infusion chemotherapy (HAIC) using a port-catheter system. We evaluated whether the hepatic artery or the left gastric artery is the better approach for selecting the right gastric artery. A total of 367 patients (244 men and 123 women; mean age, 64.1 years) with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system. In 294 of these patients, right gastric arterial embolisation with microcoils was attempted before placement of the port-catheter system to prevent gastric mucosal lesions. Approach was either through the hepatic artery (175 patients) or through the left gastric artery (119 patients), with success rates in catheterising the right gastric artery of 78.3% and 77.3%, respectively. If the attempt was unsuccessful, the catheter was redirected to the alternative approach, which increased the final success rate to 96.3%. Only seven patients experienced gastroduodenal mucosal lesions acutely after HAIC, as revealed by endoscopy. Embolisation of the right gastric artery is a feasible procedure that can reduce the incidence of gastric mucosal lesions associated with HAIC. Approach through either the hepatic artery or the left gastric artery is equally acceptable.
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Affiliation(s)
- T Yamagami
- Department of Radiology, Kyoto Prefectural University of Medicine, Kamigyo, Kyoto 602-8566, Japan.
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Brzezinski M, Luisetti T, London MJ. Radial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations. Anesth Analg 2009; 109:1763-81. [PMID: 19923502 DOI: 10.1213/ane.0b013e3181bbd416] [Citation(s) in RCA: 197] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Consistent anatomic accessibility, ease of cannulation, and a low rate of complications have made the radial artery the preferred site for arterial cannulation. Radial artery catheterization is a relatively safe procedure with an incidence of permanent ischemic complications of 0.09%. Although its anatomy in the forearm and the hand is variable, adequate collateral flow in the event of radial artery thrombosis is present in most patients. Harvesting of the radial artery as a conduit for coronary artery bypass grafting, advances in plastic and reconstructive surgery of the hand, and its use as an entry site for cardiac catheterization has provided new insight into the collateral blood flow to the hand and the impact of radial arterial instrumentation. The Modified Allen's Test has been the most frequently used method to clinically assess adequacy of ulnar artery collateral flow despite the lack of evidence that it can predict ischemic complications in the setting of radial artery occlusion. Doppler ultrasound can be used to evaluate collateral hand perfusion in an effort to stratify risk of potential ischemic injury from cannulation. Limited research has demonstrated a beneficial effect of heparinized flush solutions on arterial catheter patency but only in patients with prolonged monitoring (>24 h). Conservative management may be equally as effective as surgical intervention in treating ischemic complications resulting from radial artery cannulation. Limited clinical experience with the ultrasound-guided arterial cannulation method suggests that this technique is associated with increased success of cannulation with fewer attempts. Whether use of the latter technique is associated with a decrease in complications has not yet been verified in prospective studies. Research is needed to assess the safety of using the ulnar artery as an alternative to radial artery cannulation because the proximity and attachments of the ulnar artery to the ulnar nerve may potentially expose it to a higher risk of injury.
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Affiliation(s)
- Marek Brzezinski
- Anesthesiology Service (129) VA Medical Center, 4150 Clement St., San Francisco, CA 94121, USA.
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Bacchetti S, Pasqual E, Crozzolo E, Pellarin A, Cagol PP. Intra-arterial hepatic chemotherapy for unresectable colorectal liver metastases: a review of medical devices complications in 3172 patients. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2009; 2:31-40. [PMID: 22915912 PMCID: PMC3417858 DOI: 10.2147/mder.s4036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Hepatic artery infusion (HAI) is indicated to treat unresectable colorectal hepatic metastases, with recent applications as a neoadjuvant or adjuvant treatment. Traditionally performed with the infusion of fluoropyrimidine-based chemotherapy, it has been now tested with oxaliplatin or irinotecan and associated with systemic chemotherapy. Methods To evaluate the impact of medical devices complications we carried out a search of the published studies on HAI in unresectable colorectal liver metastases. Complications were pooled according to the applied medical system: 1) surgical catheter, 2) radiological catheter, and 3) fully implantable pump. The surgical catheter is inserted into the hepatic artery from the gastro-duodenal artery. The radiological catheter is inserted into the hepatic artery through a percutaneous transfemoral or transaxillar access. The fully implantable pump is a totally internal medical device connected to the arterial hepatic catheter during laparotomy. Results The selection criteria were met in 47/319 studies. The complications of surgical and radiological medical devices connected to a port were found in 16 and 14 studies respectively. Meanwhile, complications with a fully implantable pump were reported in 17 studies. The total number of complications reported in studies evaluating patients with surgical or radiological catheter were 322 (322/948, 34%) and 261 (261/722, 36.1%) respectively. In studies evaluating patients with a fully implantable pump, the total number of complications was 237 (237/1502, 15.8%). In 18/319 studies the number of cycles was reported. The median number of cycles with surgically and radiologically implanted catheters was 8 and 6 respectively. The fully implantable pump allows a median number of 12 cycles. Conclusions The fully implantable pump, maintaining a continuous infusion through the system, allows the lowest risk for thrombosis and infection and the best median number of cycles of loco-regional chemotherapy in HAI.
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Affiliation(s)
- Stefano Bacchetti
- Department of Surgical Sciences, Faculty of Medicine and Surgery, University of Udine, Italy
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Yamagami T, Matsumoto T, Yoshimatsu R, Nishimura T. Dysfunction of a port-catheter system percutaneously implanted for hepatic arterial infusion chemotherapy due to a fibrin sheath. Clin J Gastroenterol 2009; 2:47-50. [PMID: 26191809 DOI: 10.1007/s12328-008-0046-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 09/12/2008] [Indexed: 11/25/2022]
Abstract
Catheter-related difficulties occurred with a port-catheter system percutaneously implanted by the fixed catheter tip technique for repeated hepatic arterial infusion chemotherapy (HAIC) for unresectable metastatic liver cancer. A side hole in the indwelling catheter opened into the common hepatic artery. Four years and 3 months later, an occluded hepatic artery was diagnosed by arteriography with contrast medium infused via the port. Conversely, celiac arteriography performed from a catheter newly inserted from the femoral artery showed no such occlusion. A new port-catheter system replaced the original one to continue HAIC. Examination revealed a fibrin sheath covering the withdrawn catheter.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Tomohiro Matsumoto
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Rika Yoshimatsu
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tsunehiko Nishimura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Stuart K. Liver-Directed Therapies for Colorectal Metastases. SEMINARS IN COLON AND RECTAL SURGERY 2008. [DOI: 10.1053/j.scrs.2008.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Use of N-butyl cyanoacrylate in implantation of a port-catheter system for hepatic arterial infusion chemotherapy with the fixed-catheter-tip method: is it necessary? AJR Am J Roentgenol 2008; 191:1523-9. [PMID: 18941095 DOI: 10.2214/ajr.07.3717] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the usefulness of N-butyl cyanoacrylate (NBCA) in addition to microcoils in the percutaneous implantation of a port-catheter system for repeated hepatic arterial infusion chemotherapy with the fixed-catheter-tip method. MATERIALS AND METHODS We retrospectively studied 166 consecutive patients with unresectable advanced liver cancer for whom a port-catheter system was percutaneously implanted with its tip fixed at the gastroduodenal artery with microcoils. In 107 patients, NBCA was also used for catheter tip fixation. We compared this group with a control cohort of 59 patients who did not receive NBCA. Outcomes, including rate of success in implantation, details of embolic agents for fixation, and occurrence of complications related to catheter placement that would prohibit continuation of chemotherapy if not corrected, were compared. RESULTS In all, port-catheter placement was successful. However, 38 complications occurred in 32 patients. Catheter dislocation occurred in nine. Hepatic artery obstruction or severe stenosis was seen in 10. Recanalization of a once-embolized gastroduodenal artery was found in two patients. The rate of dislocation did not differ significantly between patients in whom NBCA was and those in whom it was not used. However, hepatic artery obstruction appeared at a significantly higher rate, and recanalization of a gastroduodenal artery at a significantly lower rate, in patients in whom the catheter tip was fixed with NBCA. CONCLUSION The use of NBCA correlated with a higher rate of hepatic artery obstruction. The use of NBCA should not always be required in port-catheter implantation with the fixed-catheter-tip method.
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Garrot C, Stuart K. Liver-directed therapies for metastatic neuroendocrine tumors. Hematol Oncol Clin North Am 2007; 21:545-60; ix-x. [PMID: 17548039 DOI: 10.1016/j.hoc.2007.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neuroendocrine tumors, despite being indolent, frequently cause significant morbidity and mortality from hepatic metastatic lesions. It is possible to directly target these liver lesions with embolization/chemoembolization, radiofrequency ablation, or other therapies. The observational studies that exist seem to indicate a prolongation of survival. Liver-directed therapies are also able to decrease symptoms in most patients. The value of these therapeutic interventions therefore lies mainly in their palliative capabilities. Coupled with aggressive use of octreotide, local ablative techniques may frequently control symptoms of hormone excess and tumor bulk. Because of the possible adverse effects of these interventions, however, careful patient selection is essential to minimize the morbidity and mortality of the procedures.
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Affiliation(s)
- Crain Garrot
- Department of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02215, MA 01805, USA
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Yamagami T, Kato T, Hirota T, Yoshimatsu R, Matsumoto T, White RI, Nishimura T. Value of Micronester coils in port-catheter implantation for continuous hepatic arterial infusion chemotherapy with fixed catheter tip method. Eur Radiol 2007; 18:152-7. [PMID: 17619883 DOI: 10.1007/s00330-007-0706-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 04/28/2007] [Accepted: 06/04/2007] [Indexed: 10/23/2022]
Abstract
To retrospectively evaluate the use of Micronester coils in port-catheter implantation with the fixed catheter tip method in comparison with other previously used coils. The cohort of this study was 143 consecutive patients with unresectable advanced liver cancer for whom a port-catheter system was percutaneously implanted. In the most recent 32 patients, Micronester coils were used for catheter tip fixation. Details of embolic agents for fixation, persistent blood flow beyond the distal end of the indwelling catheter, and complications were compared between cases without and with Micronester coils. In all, percutaneous port-catheter placement was successful. Mean number of coils used for fixation was 4.2 without Micronester coils vs. 2.5 with Micronester coils. N-butyl cyanoacrylate (NBCA)-Lipiodol was additionally used for catheter tip fixation in 85.6% of 111 procedures without Micronester coils and in 50% of 32 using Micronester coils. The gastroduodenal artery beyond the distal end was not detected at the final examination after any procedure. Catheter dislocation occurred in five and hepatic arterial obstruction or severe stenosis in eight. The number of coils used and necessity of NBCA-Lipiodol could be decreased with usage of Micronester coils without decreasing fixation ability compared to other coils.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
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Nagaoka S, Itano S, Nagamatsu H, Akiyoshi J, Kurogi J, Tajiri N, Kajiwara M, Sata M. Temporary indwelling catheter system via the left brachial artery: evaluation in 83 patients with hepatic tumors. AJR Am J Roentgenol 2007; 188:652-8. [PMID: 17312050 DOI: 10.2214/ajr.05.0693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate retrospectively the usefulness and complications associated with a temporary indwelling catheter system through the brachial artery for patients with liver tumors. CONCLUSION The temporary indwelling catheter system via the left brachial artery can be used not only for CO2-enhanced sonographically guided aspiration biopsy, radiofrequency ablation, and percutaneous ethanol injection, but also for short-term hepatic arterial infusion chemotherapy and transcatheter arterial chemoembolization.
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Affiliation(s)
- Sakae Nagaoka
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Asahimachi 67, Kurume, Fukuoka 830-0011, Japan.
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Yoshimatsu R, Yamagami T, Katou T, Hirota T, Matsumoto T, Nishimura T. Percutaneous transluminal angioplasty using a pull-through technique for hepatic arterial occlusion at the time of port-catheter implantation. Br J Radiol 2007; 80:e33-7. [PMID: 17495052 DOI: 10.1259/bjr/36527189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We report a successful percutaneous transluminal angioplasty using a pull-through technique for the treatment of a hepatic arterial occlusion caused by iatrogenic subintimal dissection during the percutaneous placement of a port-catheter system.
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Affiliation(s)
- R Yoshimatsu
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
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Yamagami T, Iida S, Kato T, Takegi H, Nishimura T. Percutaneous transluminal angioplasty for hepatic arterial occlusion following hepatic arterial infusion chemotherapy. ACTA ACUST UNITED AC 2006; 50:82-6. [PMID: 16499737 DOI: 10.1111/j.1440-1673.2005.01534.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We report a case in which hepatic arterial occlusion developed during repeated hepatic arterial infusion chemotherapy through an implanted port-catheter system for advanced malignant hepatic neoplasia. After successful recanalization of the hepatic artery by using percutaneous transluminal angioplasty, another port-catheter system was placed percutaneously by interventional radiology techniques, allowing the continuation of hepatic arterial infusion chemotherapy.
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Affiliation(s)
- T Yamagami
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Franklin M, Trevino J, Hernandez-Oaknin H, Fisher T, Berghoff K. Laparoscopic hepatic artery catheterization for regional chemotherapy. Surg Endosc 2006; 20:554-8. [PMID: 16508811 DOI: 10.1007/s00464-005-0486-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2005] [Accepted: 11/25/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Metastatic disease isolated to the liver is present at the time of diagnosis in 20-30% of patients with colorectal cancer. Only 10% of patients are eligible for resection. Systemic chemotherapy remains the primary treatment modality for such patients. The morbidity associated with regional chemotherapy is largely a result of the laparotomy required to place a hepatic arterial infusion pump in these debilitated patients. We discuss the main advantages of laparoscopic approach in comparison to both open procedure and percutaneous hepatic artery catheterization. MATERIAL AND METHODS From November 1993 to April 2004, 27 patients (16 males, 11 females) underwent laparoscopic placement of a hepatic artery catheter. The mean age was 64.9 years (46 to 82 years). 24 patients (88.8%) had bilobar disease precluding surgical resection of the liver metastases. There were four cases of non-colon cancers, all with liver metastases. RESULTS LHAC alone averaged 45-55 minutes. Mean blood loss of 151 cc (20-300 cc). Postoperatively, 16 patients (59.2%) had hepatic intra-arterial chemotherapy in the recovery room as a preplanned protocol. Average hospital stay was 8.4 days (3-25 days). Median follow-up period of 8.1 months. 22 patients with residual hepatic disease, in whom chemotherapy was successfully instituted, showed regression of their metastases, in 18 patients, CEA had improved at their one-month follow-up visit. Three complications: one catheter thrombosis, one partial catheter occlusion and one eroded catheter into the duodenum one year after. CONCLUSIONS In experienced hands, laparoscopic hepatic artery catheterization is a safe, feasible and minimally invasive technique for those patients with metachronous liver malignancies.
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Affiliation(s)
- M Franklin
- Laparoscopic Surgery, Texas Endosurgery Institute, San Antonio, TX 78222, USA.
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Tsurumaru D, Hidaka H, Takeuchi K, Kuroiwa T. Duodenal Perforation Caused by an Indwelling Catheter during Hepatic Arterial Infusion Chemotherapy. J Vasc Interv Radiol 2005; 16:1041-2. [PMID: 16002518 DOI: 10.1097/01.rvi.0000163319.75381.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Yamagami T, Kato T, Iida S, Hirota T, Nishimura T. Management of End Hole in Placement of Port-Catheter System for Continuous Hepatic Arterial Infusion Chemotherapy Using the Fixed Catheter Tip Method. AJR Am J Roentgenol 2005; 184:1332-9. [PMID: 15788620 DOI: 10.2214/ajr.184.4.01841332] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to compare persistent hepatofugal blood flow in the gastroduodenal artery after implanting a port-catheter system for repeated hepatic arterial infusion chemotherapy using either the original or the modified fixed catheter tip method. With the original method the lumen of the catheter tip is closed with a microcoil; with the modified method it is left open. Persistent hepatofugal blood flow can induce reactive gastric or duodenal mucosal lesions. MATERIALS AND METHODS A port-catheter system with the catheter tip fixed to the gastroduodenal artery by embolic agents was percutaneously implanted in 156 patients (102 men, 54 women; mean age, 63.2 years) with unresectable liver cancer. In 98 patients the original method was used, and in 58 patients the modified method was used. Existence of persistent blood flow beyond the indwelling catheter tip as shown on arteriography via the port performed immediately and 2-10 days after port-catheter placement was compared between these two groups. RESULTS In all cases, percutaneous port-catheter placement was successfully performed. In one (1.0%) of 98 procedures involving the original method, the gastroduodenal artery was detected on arteriography just after implantation, compared with 23 (39.7%) of 58 procedures using the modified method. However, arteriography performed 2-10 days (mean, 5.02 days) after implantation detected the gastroduodenal artery in only one case. CONCLUSION This retrospective study indicates that closure of the end hole appears to occur spontaneously shortly after implantation. Thus, such closure is not always necessary to avoid persistent hepatofugal blood flow in the gastroduodenal artery.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii, Kawaramachi-Hirokoji, Kamigyo, Kyoto 602-8566, Japan.
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Hirota T, Yamagami T, Tanaka O, Iida S, Kato T, Nishimura T. Catheter Redundancy in the Aortic Arch Increases the Risk of Stroke in Left Subclavian Arterial Port–Catheter Systems. J Vasc Interv Radiol 2005; 16:471-6. [PMID: 15802446 DOI: 10.1097/01.rvi.0000152387.43037.33] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The stroke rate after left subclavian arterial port-catheter placement was compared in two groups: one with minimal redundancy of the catheter and one with pronounced redundancy in the aortic arch designed to minimize the likelihood of catheter dislocation. MATERIALS AND METHODS One hundred forty-eight patients (102 men, 46 women; age range, 26-83 years; mean age, 64.3 years) with inoperable advanced liver cancers underwent percutaneous implantation of port-catheter systems via the left subclavian artery. In 33 patients, a pronounced redundancy of the catheter was intentionally looped in the aortic arch. Redundancy was intentionally avoided in the remaining 115 patients. The rates of brain infarction complications in these two groups were retrospectively compared. RESULTS Among the 33 patients with pronounced redundant catheter looping, brain infarctions occurred in four cases (12.1%). In contrast, brain infarctions occurred in only three of the 115 patients with minimal redundant catheter looping (2.6%). The frequency of brain infarction complications was significantly higher in the patients with pronounced redundant catheter looping in the aortic arch than in patients with minimal pronounced redundant catheter looping (P = .044, Fisher exact test). CONCLUSION Catheter redundancy in the aortic arch increases the risk of stroke in patients undergoing implantation of port-catheter systems via a left subclavian arterial approach for repeated hepatic arterial infusion chemotherapy.
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Affiliation(s)
- Tatsuya Hirota
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
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Yamagami T, Kato T, Iida S, Hirota T, Nishimura T. Efficacy of the Left Gastric Artery as a Route for Catheterization of the Right Gastric Artery. AJR Am J Roentgenol 2005; 184:220-4. [PMID: 15615978 DOI: 10.2214/ajr.184.1.01840220] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our aim was to evaluate the efficacy of the left gastric artery as a route for embolization of the right gastric artery before port-catheter implantation for hepatic artery infusion chemotherapy. MATERIALS AND METHODS In 88 patients (61 men and 27 women; mean age, 63.4 years; range, 25-83 years) with unresectable advanced liver cancer, retrograde catheterization of the right gastric artery through the left gastric artery was performed to embolize the right gastric artery. RESULTS The right gastric artery was successfully catheterized and embolized in 79 patients (89.8%). In two of the nine patients in whom the procedure was not successful, we found that no right gastric artery existed after we succeeded in retrograde advancement of the microcatheter toward the hepatic site. The only procedure-related complication was misplacement of a microcoil into the hepatic artery site in two patients. CONCLUSION The left gastric artery is an appropriate route for selective embolization of the right gastric artery as preparation for long-term hepatic artery infusion chemotherapy.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto 602-8566, Japan.
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Watanabe M, Takita W, Tsuchiya M, Otsuka Y, Tamura A, Kaneko H, Kobayashi K. Hepatic arterial cannulation using the side holed catheter. J Surg Oncol 2005; 91:145-9. [PMID: 16028290 DOI: 10.1002/jso.20283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hepatic arterial infusion chemotherapy (HAIC) has been recognized as one of the effective treatments for patients with hepatic metastatic tumor. However it is difficult to perform HAIC in the long term without complications. This report describes the laparotomic approach using the side holed catheter, which is a novel method of implanting a catheter-port system. METHODS AND RESULTS We designed a new anti-thrombotic catheter for HAIC. This catheter is tapered from 5F (diameter of shaft) to 3.3F (diameter at tip), and a side hole is opened 7 cm from the tip of catheter. This catheter is inserted from the gastroduodenal artery to the common hepatic artery (CHA), and the tip is put in the aorta or in the splenic artery. The side hole is adjusted distal to the CHA. In our surgical department, our new catheter was inserted in four patients at the time of their abdominal surgery. The cannulation was performed successfully in all patients. In two of them, HAIC was finished without problems at 6 months after starting, and two were still treated by HAIC at 9 and 8 months after starting. CONCLUSIONS Initial results from a study of a new method of implanting a catheter-port system in the hepatic artery using the new tapering side hole catheter suggest that this method may enable operators to avoid complicated selective coiling and may lower the incidence of hepatic artery occlusion in patients receiving long-term HAIC.
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Affiliation(s)
- Masashi Watanabe
- Department of Gastrointestinal Surgery (Omori), Toho University School of Medicine, 6-11-1 Ota-ku, Tokyo, Japan.
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Oberfield RA, Sampson E, Heatley GJ. Hepatic artery infusion chemotherapy for metastatic colorectal cancer to the liver at the lahey clinic: comparison between two methods of treatment, surgical versus percutaneous catheter placement. Am J Clin Oncol 2004; 27:376-83. [PMID: 15289731 DOI: 10.1097/01.coc.0000071465.29907.a5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study updates our experience with hepatic artery infusion chemotherapy for colorectal liver metastases at the Lahey Clinic. It compares surgical versus percutaneous catheter methods, employing an external pump. The surgical series (SS) consisted of 58 patients (1970-1995) treated with floxuridine (FUDR), 20 mg/d for 4 to 5 weeks (modified in 1985; 2-week cycles). Percutaneous series (PS) consisted of 42 patients (1976-1995) treated with fluorouracil (5-FU), 20 mg/d for 10 days followed by a floxuridine (FUDR) schedule as with SS. Analysis consisted of tumor response, survival, and toxicity data between the two methods. Response rates showed no significant difference, SS (34%) and PS (48%) (P = 0.22). There were no significant differences in survival from treatment until death in SS (n = 58) of 13 months versus PS (n = 42) of 10.6 months (P = 0.39), from diagnosis until death, SS being 28.4 months versus PS of 26.4 months (P = 0.71) and from metastases until death, SS being 17.4 months versus PS of 22.2 months (P = 0.35). Hepatic toxicity was similar, but there was increased bone marrow toxicity, mucositis, and diarrhea for the PS. Response rates are similar for both our SS and PS and to that reported in recently randomized surgical trials. Hepatic artery infusion chemotherapy with FUDR by percutaneous catheter placement may be as effective as surgical catheter placement for colorectal liver metastases, but further study is needed.
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Affiliation(s)
- Richard A Oberfield
- Department of Medical Oncology, Lahey Clinic Medical Center, Burlington, Massachusetts 01805, USA.
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Yamagami T, Kato T, Iida S, Hirota T, Nishimura T. Interventional Radiologic Treatment for Hepatic Arterial Occlusion after Repeated Hepatic Arterial Infusion Chemotherapy via Implanted Port–Catheter System. J Vasc Interv Radiol 2004; 15:633-9. [PMID: 15178726 DOI: 10.1097/01.rvi.0000127896.85305.ba] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The present study evaluated the feasibility of interventional radiologic treatments for hepatic arterial occlusion after hepatic arterial infusion chemotherapy (HAIC) via an implanted port-catheter system. Treatment for hepatic arterial occlusion was attempted in seven patients with unresectable liver cancer. In six, the obstructed hepatic artery was recanalized. In three patients, the recanalized hepatic artery again became obstructed. However, by performing additional interventional radiologic procedures, secondary patency of the hepatic artery was successfully obtained in two patients. In conclusion, when hepatic arterial occlusion occurs, HAIC can be resumed in the attempt to recanalize the hepatic artery.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
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Yamagami T, Kato T, Iida S, Tanaka O, Nishimura T. Value of Transcatheter Arterial Embolization with Coils and n-Butyl Cyanoacrylate for Long-term Hepatic Arterial Infusion Chemotherapy. Radiology 2004; 230:792-802. [PMID: 14739309 DOI: 10.1148/radiol.2303021564] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the value of transcatheter arterial embolization (TAE) of splanchnic arterial branches to allow continuous application of repeat hepatic arterial infusion chemotherapy (HAIC). MATERIALS AND METHODS In 128 patients with unresectable advanced liver cancer, percutaneous implantation of a port catheter system and TAE of splanchnic arteries with coils and/or n-butyl cyanoacrylate (NBCA) were performed. Parameters included (a) methods selected for catheter placement; (b) embolic materials used (coils and/or NBCA, number of coils, administration rate of NBCA-iodized oil) for TAE of splanchnic arteries, details of embolized arteries, and frequency of recanalization; (c) ability to prevent gastrointestinal symptoms by avoiding inflow of anticancer drugs into extrahepatic adjacent organs and to maintain distribution of contrast agents in liver, as well as management of difficulties encountered; (d) complications related to catheter system implantation or to long-term HAIC and management of such complications; and (e) final success in performing scheduled HAIC while maintaining distribution over liver via a single route without gastrointestinal symptoms caused by inflow of anticancer drugs. Fisher exact test was used to compare recanalization rate between coil-embolized and NBCA- or NBCA-coil-embolized arteries, and frequency of heterogeneously poor distribution was compared between patients with single and those with multiple hepatic arteries. RESULTS Embolization was successful during first catheterization in 326 arteries and during follow-up in 10. In 119 (93.0%) of 128 patients, repeat HAIC was effective until death or the time of this writing (observation period, 2-47 months). HAIC was continued in two patients, although anticancer drugs did not distribute to all liver tumors. Arteries once embolized with coils alone spontaneously recanalized at a significantly higher rate than those with NBCA (eight of 192 vs one of 144, P =.048). Rate of heterogeneously poor distribution was significantly higher in those with two or more hepatic arteries than in those with one (seven of 17 vs nine of 111, P =.001). CONCLUSION TAE for various splanchnic organs is useful for efficient performance of long-term HAIC.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto 602-8566, Japan.
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Hama Y, Makita K, Kusano S. J-tipped guidewire as a target for puncture of the subclavian artery in the placement of a reservoir port and catheter system. Eur Radiol 2003; 14:817-21. [PMID: 14605841 DOI: 10.1007/s00330-003-2131-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2003] [Revised: 07/08/2003] [Accepted: 10/01/2003] [Indexed: 11/26/2022]
Abstract
The aim of this study was to verify the feasibility of using a J-tipped guidewire as a target for puncture of the subclavian artery in the placement of a reservoir port and catheter system (RPCS). Twenty-five patients with various hepatic malignancies underwent percutaneous implantation of an RPCS through the left subclavian artery for regional chemotherapy. To successfully puncture the left subclavian artery, a J-tipped guidewire was used as a target with fluoroscopic guidance. Technical success and complication rates, and numbers of puncture failures, were retrospectively analyzed. Implantation of the RPCS was successful in all patients. Eight (32%) patients had minor complications and no patient had major complications. The number of puncture failures per patient was 0 to 1 (mean=0.32). The J-tipped guidewire is a safe and appropriate target for puncture of the subclavian artery in the placement of an RPCS.
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Affiliation(s)
- Yukihiro Hama
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-0042 Saitama, Japan.
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Shiozawa S, Tsuchiya A, Endo S, Kato H, Katsube T, Kumazawa K, Naritaka Y, Ogawa K. Transradial approach for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma: comparison with conventional transfemoral approach. J Clin Gastroenterol 2003; 37:412-7. [PMID: 14564191 DOI: 10.1097/00004836-200311000-00013] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We evaluated the clinical usefulness and safety of transradial approach for transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) compared with that of conventional transfemoral approach. The two groups (radial group, n = 177; femoral group, n = 150) of cases were retrospectively compared with regard to the successful rate of angiography or TACE, time required for catheterizaiton and complications. Hepatic angiography and TACE were completed in 174 (98.3%) of 177 cases in the radial group. There was no intergroup difference of time required for catheterization. Minor complications (dull pain, numbness) occurred in 8 (4.6%) patients in the radial group, and there were lower complications in the radial group compared to the femoral group. TACE by our new transradial approach was found to have therapeutic efficacy with lower complications comparable to that of the conventional transfemoral approach.
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Affiliation(s)
- Shunichi Shiozawa
- Department of Surgery, Tokyo Women's Medical University, Daini Hospital, Japan.
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Abstract
The dual vascular supply of the liver affords a unique opportunity to explore intraarterial therapies for hepatic malignancies. Chemoembolization is a well-established technique combining intra-arterial chemotherapy with delivery of embolic agents in order to achieve an antitumor effect due to a high local concentration and prolonged dwell time of the drug, along with select ischemia. Many tumors, such as hepatocellular carcinoma, colorectal cancer, and neuroendocrine tumors, cause symptoms and death by local growth and destruction of the liver. While there are other methods capable of controlling small or isolated hepatic neoplasms, none are suitable for the majority of these patients. Chemoembolization can produce significant results in terms of tumor shrinkage in many of these patients, and there are studies to suggest a survival advantage in hepatocellular carcinoma. Toxicity, however, may be substantial, and patient selection is crucial in order to achieve the optimal benefit of this powerful technique for individual populations.
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Affiliation(s)
- Keith Stuart
- Gastrointestinal and Hepatobiliary Oncology Program, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
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Tanaka T, Arai Y, Inaba Y, Matsueda K, Aramaki T, Takeuchi Y, Kichikawa K. Radiologic placement of side-hole catheter with tip fixation for hepatic arterial infusion chemotherapy. J Vasc Interv Radiol 2003; 14:63-8. [PMID: 12525587 DOI: 10.1097/01.rvi.0000052292.26939.59] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate the technical outcome of radiologic catheter placement with use of a side-hole catheter with distal fixation for hepatic arterial infusion chemotherapy. MATERIALS AND METHODS Between January 1993 and September 1999, 426 patients were referred to our department to undergo intraarterial infusion chemotherapy for unresectable malignant liver tumors. A subclavian artery was exposed under local anesthesia and a catheter was inserted. After inserting the tip of the side-hole catheter into the gastroduodenal artery, splenic artery, or peripheral branch of the hepatic artery, the catheter tip was fixed to the vessel with use of coils and a mixture of n-butyl cyanoacrylate (NBCA) and iodized oil. The proximal end of the catheter was connected to an implanted port, and the port system was embedded subcutaneously. RESULTS Placement was successful in 425 of 426 patients (99.8%) in a mean time of 76 minutes. Catheter dislodgement was noted in 12 patients (2.8%). Cumulative patency rates of the hepatic artery calculated according to the Kaplan-Meier method for the entire group were 91.0%, 81.4%, and 58.1% at 6 months and 1 and 2 years, respectively. Complications related to catheter placement were observed in nine cases and included dysfunction of the implanted system (n = 3), significant bleeding around the implanted port (n = 2), improper infusion of NBCA and iodized oil (n = 2), and cerebral infarction (n = 2). CONCLUSION Radiologic catheter placement via a subclavian artery with side-hole catheter placement with distal fixation for hepatic arterial infusion chemotherapy is a highly successful procedure with a reduced risk of catheter dislodgment and arterial occlusion.
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Affiliation(s)
- Toshihiro Tanaka
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, Nagoya, Japan
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Yamagami T, Iida S, Kato T, Tanaka O, Hirota T, Nakamura T, Nishimura T. Using n-butyl cyanoacrylate and the fixed-catheter-tip technique in percutaneous implantation of a port-catheter system in patients undergoing repeated hepatic arterial chemotherapy. AJR Am J Roentgenol 2002; 179:1611-7. [PMID: 12438064 DOI: 10.2214/ajr.179.6.1791611] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the usefulness of adding n-butyl cyanoacrylate to microcoils to fix the catheter tip in percutaneous implantation of a port-catheter system for hepatic arterial-infusion chemotherapy. SUBJECTS AND METHODS Ninety-three patients (64 men and 29 women; age range, 38-83 years; mean age, 62.2 years) with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system with the catheter tip fixed at the gastroduodenal artery with microcoils and a mixture of n-butyl cyanoacrylate and iodized oil. The rates of successful implantation and complications closely associated with this technique and management of the complications were reviewed. RESULTS Percutaneous port-catheter placement was successfully performed in all patients. However, in eight patients, complications occurred: hepatic arterial obstruction (n = 5, 5.4%); catheter dislocation (n = 2, 2.2%); recanalization of the gastroduodenal artery (n = 1, 1.1%); or movement of n-butyl cyanoacrylate (n = 1, 1.1%). In five of the eight patients with complications, hepatic arterial-infusion chemotherapy was continued either after observation of the patient to ensure that stability had been established or after treatment using comparatively easy interventional techniques. In three (3.2%) of the 93 patients, planned hepatic arterial-infusion chemotherapy could not be performed because of complications associated with the technique. CONCLUSION Fixation of the catheter tip in the gastroduodenal artery using a combination of microcoils and a mixture of n-butyl cyanoacrylate and iodized oil is a useful and safe technique in percutaneous port-catheter placement for repeated hepatic arterial infusion chemotherapy.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-0841, Japan
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Yamagami T, Nakamura T, Iida S, Kato T, Nishimura T. Embolization of the right gastric artery before hepatic arterial infusion chemotherapy to prevent gastric mucosal lesions: approach through the hepatic artery versus the left gastric artery. AJR Am J Roentgenol 2002; 179:1605-10. [PMID: 12438063 DOI: 10.2214/ajr.179.6.1791605] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate whether the hepatic artery or the left gastric artery is the better route of approach for selective embolization of the right gastric artery before hepatic arterial infusion chemotherapy using a port-catheter system. SUBJECTS AND METHODS Eighty-six patients (56 men, 30 women; mean age, 62.1 years) with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system. In the 75 patients who had not undergone gastrectomy, right gastric artery embolization was performed before port-catheter system placement to prevent gastric mucosal lesions. In 43 patients, the approach for embolization was through a microcatheter inserted from the hepatic artery site, and in the remaining 32 patients, the approach was from the left gastric artery. The success rates of these two groups were compared. RESULTS Embolization was successfully accomplished at the first attempt in 72.1% of the 43 patients in whom the microcatheter was inserted from the hepatic artery site. In contrast, in 93.8% of 32 patients, embolization was successfully performed through the left gastric artery. The success rate of embolization was significantly higher in the latter group (p = 0.0173, chi-square test). A second attempt in which the catheter was redirected to another approach, performed on the same day in a majority of patients, resulted in successful embolization in an additional eight patients, with a final success rate of 92.0%. CONCLUSION Embolization of the right gastric artery using microcoils through a microcatheter advanced through the left gastric artery may be the preferred method for the preparation of repeated hepatic artery infusion.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan
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Franklin ME, Gonzalez JJ. Laparoscopic placement of hepatic artery catheter for regional chemotherapy infusion: technique, benefits, and complications. Surg Laparosc Endosc Percutan Tech 2002; 12:398-407. [PMID: 12496545 DOI: 10.1097/00129689-200212000-00003] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Approximately 15% to 18% of patients diagnosed with colorectal cancers present with metastases confined to the liver. Although many may undergo a liver resection procedure, some will not be candidates for surgery or will have recurrence of liver disease within the first 2 years after liver metastasis resection. For this subset of patients, regional hepatic chemotherapy, including intra-arterial chemotherapy, has been shown to improve control of the disease and, in some cases, prolong survival. With the advent of laparoscopic surgery and its application to more and more advanced procedures, the possibility of laparoscopic placement of a chemotherapy infusion catheter in the hepatic artery with all the advantages of a minimally invasive approach appears to be a viable alternative in our hands. From November 1993 through February 2002, 20 patients (12 male, 8 female) successfully underwent laparoscopic placement of a hepatic artery infusion catheter at the Texas Endosurgery Institute. Correct placement of the catheter was confirmed by methylene blue injections via the hepatic artery catheter at the time of surgery. Chemotherapy was generally initiated in the immediate postoperative period. Mean age was 68.3 years (range, 46-82). Twelve of the patients (60%) had previously undergone abdominal surgery. There were 27 major laparoscopic procedures performed at the time of hepatic artery catheter placement. There were no conversions to an open procedure. Mean operative time was 186 minutes (range, 125-280), and mean blood loss was 132 mL (range, 20-300). These values include the 27 major concurrent laparoscopic procedures performed at the time of catheter placement, including 18 cholecystectomies, 7 colectomies, and 2 liver resections. Median hospital stay was 3 days (range, 3-25), with a median return to regular diet of 3 days. There were no intraoperative complications and no deaths secondary to catheter placement. There were 2 late complications, for an overall rate of 10%. For all 17 patients with residual hepatic disease whose chemotherapy was successfully instituted, regression of the metastases was evident by abdominal computed tomographic criteria and CEA levels. Laparoscopic hepatic artery catheterization is both feasible and safe. It incurs all the benefits of a minimally invasive procedure and can be performed at the time of laparoscopic colectomy to avoid the necessity of a second procedure.
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Affiliation(s)
- Morris E Franklin
- Department of Surgery, University Texas Health Care Center at San Antonio, USA.
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Hirota T, Yamagami T, Tanaka O, Iida S, Kato T, Nakamura T, Ishihara K, Nishimura T. Brain infarction after percutaneous implantation of port-catheter system via the left subclavian artery. Br J Radiol 2002; 75:799-804. [PMID: 12381688 DOI: 10.1259/bjr.75.898.750799] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to evaluate the incidence of brain infarction after percutaneous implantation of a port-catheter system via the left subclavian artery for hepatic arterial infusion chemotherapy. In 90 patients with inoperable liver cancer, a port-catheter system was implanted via the left subclavian artery. In 5 patients (5.6%) brain infarction occurred after port-catheter implantation. In one patient (1.1%) thrombi formed around the catheter, as confirmed by autopsy. The risk of brain infarction should be taken into consideration when a trans-left subclavian arterial access route is used for the percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy.
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Affiliation(s)
- T Hirota
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo, Japan
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Clark TWI, Bilo JM, Beecroft JR. Arterial port catheter system placement using a translumbar aortic route. Invest Radiol 2002; 37:7-12. [PMID: 11753148 DOI: 10.1097/00004424-200201000-00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Implantable ports for arterial infusion hold promise in a growing number of clinical applications, including regional chemotherapy and gene therapy. Percutaneous placement of arterial infusion ports has been described clinically; however, existing sites of access pose unique anatomic challenges. The feasibility of translumbar aortic placement of a port-catheter system for long-term arterial infusion was assessed. MATERIALS AND METHODS Eight swine underwent placement of a percutaneously implantable arterial port-catheter system using a translumbar aortic approach for catheter placement. The tip of the catheter was positioned in the left or right hepatic artery and the port reservoir implanted in the paraspinal subcutaneous tissues. Patency and position of the port-catheter system were assessed at 7 to 10 days and 28 days. The insertion procedure was modified in two animals by introducing tissue adhesive around the catheter to prevent dislodgment. RESULTS Immediate technical success was achieved in 6 of 8 animals (75%). Catheters were dislodged into the aorta in two animals on the day of the procedure, extravascular in four animals and intra-aortic in one animal by day 10. One animal died at 21 days of sepsis. The port-catheter systems remained functional at 28 days with catheters positioned within the left or right hepatic artery in three animals, including two animals in which the catheter had been fixated within the paraspinal soft tissues with tissue adhesive. CONCLUSIONS A translumbar aortic route for percutaneous placement of arterial infusion port-catheter systems is feasible in swine and holds potential as an ancillary access site in a clinical setting if the obstacle of catheter fixation can be overcome.
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Inaba Y, Arai Y, Matsueda K, Takeuchi Y, Aramaki T. Right gastric artery embolization to prevent acute gastric mucosal lesions in patients undergoing repeat hepatic arterial infusion chemotherapy. J Vasc Interv Radiol 2001; 12:957-63. [PMID: 11487676 DOI: 10.1016/s1051-0443(07)61576-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The purpose of the study was to investigate the technical outcome and clinical effect of right gastric artery (RGA) embolization to prevent acute gastric mucosal lesions caused by influx of anticancer agents into the RGA in patients undergoing repeat hepatic arterial infusion chemotherapy (HAIC). MATERIALS AND METHODS In 217 patients with malignant hepatic tumors, we attempted RGA embolization with use of metallic coils and/or a mixture of n-butyl cyanoacrylate (n-BCA) and iodized oil, along with the embolization of the gastroduodenal artery. After this procedure, an infusion catheter was placed radiologically and HAIC was performed. We then evaluated the technical outcome and clinical effect of RGA embolization. RESULTS RGA embolization was technically successful in 201 of 217 patients (93%). Major complications--nausea, epigastric pain, and fever--were noted in 12%, 4%, and 2% of successful cases, respectively, and were treated conservatively. Recanalization occurred in 4% (nine of 201) of the patients. Eventually, sufficient RGA embolization was achieved in 192 patients. The incidence of acute gastric mucosal lesions confirmed endoscopically was only 3% (five of 192) in patients with sufficient RGA embolization, whereas it was 36% (nine of 25) in patients without sufficient RGA embolization, with a significant difference (P <.01). CONCLUSION RGA embolization is a highly feasible procedure that can reduce the incidence of acute gastric mucosal lesions associated with HAIC.
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Affiliation(s)
- Y Inaba
- Department of Diagnostic Radiology, Aichi Cancer Center, 1-1 Kanokoden Chikusa-ku, Nagoya 464-8681, Japan.
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Tanaka T, Inaba Y, Arai Y, Matsueda K, Aramaki T, Dendo S. Case report: Hepatic arterial occlusion following infusion catheter placement: recanalization using the Palmaz stent. Br J Radiol 2001; 74:448-51. [PMID: 11388994 DOI: 10.1259/bjr.74.881.740448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report two cases in which hepatic arterial occlusion developed soon after percutaneous catheter placement for hepatic arterial infusion chemotherapy in malignant hepatic neoplasms. A replaced hepatic artery and a proper hepatic artery, respectively, became occluded in these cases. In both, because the tip of a side-holed catheter for arterial infusion was fixed in place, we performed recanalization without removing the indwelling catheter. Despite the presence of the catheter, a stent could be inserted into the occluded portion of the hepatic artery. Recanalization of the hepatic artery was achieved with stent placement, and continuation of hepatic arterial infusion became possible.
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Affiliation(s)
- T Tanaka
- Department of Diagnostic Radiology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
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Herrmann KA, Waggershauser T, Heinemann V, Reiser M. Interventional radiological procedures in impaired function of surgically implanted catheter-port systems. Cardiovasc Intervent Radiol 2001; 24:31-6. [PMID: 11178710 DOI: 10.1007/s002700001714] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE System-related complications in surgically implanted catheter-port systems (CPS) for intraarterial (i.a.) chemotherapy are well known. In most cases of complications, the treatment must be interrupted and the catheter-port system must be repaired surgically. We describe microinvasive interventional radiological procedures to correct some dysfunctions of CPS. METHODS Five patients with repetitive dysfunction of CPS were treated with interventional techniques. Two patients presented with perfusion impairment, one patient had a pseudoaneurysm of the hepatic artery, and two patients presented with catheter displacement. Radiological interventions included mechanical recanalization with a guidewire, vascular stenting, and correction of catheter dislocation with a goose-neck snare. RESULTS In all cases, correct function of the CPS was restored. No intervention-related complications occurred and surgery was avoided. Chemotherapy could be continued for a period of 4--10 months. CONCLUSION For some system-related complications, minimally invasive radiological interventions can be used to restore the function of CPS for i.a. chemotherapy.
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Affiliation(s)
- K A Herrmann
- Institute of Clinical Radiology, Ludwig Maximilians University of Munich, Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany.
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Herrmann KA, Waggershauser T, Sittek H, Reiser MF. Liver intraarterial chemotherapy: use of the femoral artery for percutaneous implantation of catheter-port systems. Radiology 2000; 215:294-9. [PMID: 10751501 DOI: 10.1148/radiology.215.1.r00ap14294] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To provide intraarterial chemotherapy of the liver in 30 outpatients with colorectal cancer metastases and other malignancies, 32 catheter-port systems were implanted percutaneously via the femoral artery. Mean patency was 229 days. Percutaneous placement was feasible and safe. Compared with surgical placement, the overall complication rate (12%) was comparable or less.
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Affiliation(s)
- K A Herrmann
- Institute of Clinical Radiology, Ludwig-Maximilians-University of Munich, Grosshadern Marchioninistr 15, D-81377 Munich, Germany.
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Seki H, Kimura M, Yoshimura N, Yamamoto S, Ozaki T, Sakai K. Hepatic arterial infusion chemotherapy using percutaneous catheter placement with an implantable port: assessment of factors affecting patency of the hepatic artery. Clin Radiol 1999; 54:221-7. [PMID: 10210340 DOI: 10.1016/s0009-9260(99)91155-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the factors affecting patency of the hepatic artery during hepatic arterial infusion chemotherapy (HAIC) with an implantable port system inserted percutaneously. PATIENTS AND METHODS Ninety patients with malignant hepatic tumours were given HAIC using percutaneous catheter placement. An end-hole catheter was inserted into the hepatic artery (conventional method) in 41 patients. An end-closed and side-hole catheter was used in 49 patients, in which the catheter tip was fixed in the gastroduodenal artery and the side hole was placed in the common hepatic artery (fixed catheter-tip method). The patency of the hepatic artery was evaluated with computed tomography (CT) arteriography using the implantable port system and angiography. Then, the factors affecting hepatic arterial patency were analysed. RESULTS Hepatic arterial occlusion was observed in 15 patients (17%). The overall patency of the hepatic artery was 86.9%, 78.4% and 51.5% at 6 months, 1 year and 2 years, respectively. The patency rate of the hepatic artery was significantly higher in patients with catheter placement using fixed catheter-tip method than those using conventional method (P = 0.01), and in patients without transcatheter arterial chemoembolization (TACE) prior to catheter placement than those with prior TACE (P = 0.01). When the variables affecting patency of the hepatic artery were studied together by multivariate analyses, the important factors were the method of catheter placement and the presence or absence of prior TACE. CONCLUSION We consider that it is important for long-term patency of the hepatic artery during HAIC to use fixed catheter-tip method for percutaneous catheter placement instead of conventional method, and to select patients without prior TACE.
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Affiliation(s)
- H Seki
- Department of Radiology, Niigata University School of Medicine, Japan
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Castaing D, Azoulay D, Fecteau AH, Bismuth H. Implantable hepatic arterial infusion device: placement without laparotomy via an intercostal artery. J Am Coll Surg 1998; 187:565-8. [PMID: 9809576 DOI: 10.1016/s1072-7515(98)00212-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- D Castaing
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France
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Habbe TG, McCowan TC, Goertzen TC, Leveen RF, Culp WC, Tempero MA. Complications and technical limitations of hepatic arterial infusion catheter placement for chemotherapy. J Vasc Interv Radiol 1998; 9:233-9. [PMID: 9540905 DOI: 10.1016/s1051-0443(98)70262-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To determine the rate of complications associated with hepatic arterial infusion (HAI) catheter placement, as well as technical success related to liver perfusion. MATERIALS AND METHODS The authors reviewed 44 patients who underwent 106 HAI catheter placements, including 15 men and 29 women with an average age of 55 years (range, 32-82 years). One to nine placements were performed per patient with 61 (58%) via the left brachial artery, 40 (38%) via the right femoral artery, and five (4%) via the left femoral artery. Chemoinfusion lasted 4 days, with initial catheter placement assessed on technetium-99m macroaggregated albumin (MAA) perfusion scans, as well as daily abdominal radiographs. RESULTS One hundred attempted hepatic arterial catheter placements were completed. Liver perfusion was global in 66 (66%) cases, in the right lobe only in 28 (28%) cases, and in the left lobe only in six (6%) cases. Eight (8%) had gastrointestinal (GI) tract perfusion; this was eliminated in seven cases (7%) after catheter repositioning. Forty-six (43%) placement attempts required embolization of 62 GI vessels to preclude GI chemoinfusion. Complications included one cerebrovascular accident (related to removal of a left brachial catheter), eight brachial artery thromboses (four that required emergent thrombectomy), six hepatic arterial dissections, four hepatic arterial thromboses, and four catheter malfunctions. CONCLUSIONS HAI catheter placement via the left brachial artery has increased complications. Nearly one-half of placements required embolization of GI vessels to preclude GI perfusion. Global perfusion is possible in two-thirds of cases.
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Affiliation(s)
- T G Habbe
- Department of Radiology, The University of Nebraska Medical Center, Omaha 68198-1045, USA
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Hutson DG, Nunez AA, Tabbara M, Ginzburg E. A technique for prolonged arterial infusions of fibrinolytic agents in the immediate postoperative period through a cutaneous venostomy. Ann Vasc Surg 1997; 11:546-9. [PMID: 9302070 DOI: 10.1007/s100169900089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Prolonged use of fibrinolytic agents post thrombectomy is limited by present techniques that require arterial puncture and indwelling arterial catheters. This limitation can be avoided by attaching a short segment of saphenous vein to the arteriotomy used for the thrombectomy and bringing this out to the skin as a "venostomy"; thus providing ready access to the vascular tree for arteriography, prolonged infusion of thrombolytic agents, or selective catheter placement. In delayed thrombectomies (Categories 2 & 3 as described by the Ad Hoc Committee on Reporting Standards, J Vasc Surg 1986;4:80-94), extending the use of these agents may represent the only hope for limb salvage.
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Affiliation(s)
- D G Hutson
- University of Miami School of Medicine, Department of Surgery, FL 33101, USA
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Matsuda T, Yamagishi H, Jin MB, Kobayashi Y, Sonoyama T, Oka T. Laparotomy versus interventional radiological procedures for the implantation of arterial infusion devices. Surg Today 1997; 27:398-402. [PMID: 9130340 DOI: 10.1007/bf02385701] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although there have been numerous reports on implantable infusion devices for chemotherapy of patients with malignancy, we occasionally face problems with this therapy due to trouble with implantation. We performed a retrospective review of 81 implantations in 77 patients, who were treated with intraarterial chemotherapy via implanted devices from 1985 to 1993. They were divided into two groups according to the procedures: the operative procedure group (group A, n = 41) and the interventional radiological procedure group (group B, n = 36). Both groups were then analyzed regarding the respective complications. We experienced 25 complications: (a) 9 obstructions of the catheter, (b) 4 infections, (c) 4 dislocations of the catheter, (d) 3 hematomas, (e) 3 breakdowns of the device, (f) 1 pneumothorax, and (g) 1 hepatic artery occlusion. The results of a comparison of the complication rate between groups A and B were (a) 14.0%:8%, (b) 4%:0%, (c) 0%:10%, (d) 4%:2%, (e) 7%:0%, (f) 0%:2%, and (g) 2%:0%, respectively. A statistically significant difference was observed for (b) and (c) (P < 0.05). Infection occurred mainly in the cirrhotic cases of group A, but not in group B. In addition, one case fell into fatal sepsis. Based on the above findings, the interventional radiological procedure is thus considered to be the appropriate method for the prevention of infection in the case of a compromised host.
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Affiliation(s)
- T Matsuda
- Second Department of Surgery, Kyoto Prefectural University of Medicine, Japan
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Vauthey JN, Marsh RDW, Cendan JC, Chu NM, Copeland EM. Arterial therapy of hepatic colorectal metastases. Br J Surg 1996; 83:447-55. [PMID: 8665231 DOI: 10.1002/bjs.1800830405] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Considerable experience of the treatment of irresectable hepatic colorectal metastases has accumulated over the past three decades. In this review, the rationale for hepatic artery treatment of colorectal metastases to the liver is presented and various access techniques and chemotherapeutic agents for infusion are discussed. Randomized trials of hepatic artery chemotherapy (HAC) are analysed, and the promising results of recent studies combining less toxic and more effective agents are summarized. Continuous infusion pumps provide the most reliable and long-lasting access for HAC. Appropriate surgical techniques and medical management can minimize complications. Although tumour progression is best controlled by HAC, a clear-cut survival advantage has yet to be demonstrated. While hepatic artery infusion chemotherapy cannot yet be recommended outside investigational protocols, the experience gained so far should stimulate further studies.
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Affiliation(s)
- J N Vauthey
- Department of Surgery, College of Medicine, University of Florida, Gainesville 32610-0286, USA
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Carrington BM, Thomas NB, Johnson RJ. Selective splenic arteriography for interleukin-2 administration: radiologic complications from the initial 113 procedures. Eur J Radiol 1992; 14:13-7. [PMID: 1563397 DOI: 10.1016/0720-048x(92)90054-d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A retrospective analysis was performed of the safety and efficacy of selective splenic artery catheterization for infusion of the immunotherapeutic agent interleukin-2 (IL-2). Fifty-one patients with metastatic melanoma had 103 successful catheterizations out of 113 attempts (91%). In nine patients preferential contrast flow was obtained into the splenic artery. When satisfactorily placed, the catheter position remained stable during the period of infusion in 98% of examinations. The incidence of major arteriographic complications was 4.5% and of minor complications 8.9%. The main problems encountered were thrombosis (3.6%) or persistent bleeding/hematoma formation (2.7%), in a patient population at high risk of malignant coagulopathy. Subintimal contrast injection occurred in five examinations (4.5%).
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Affiliation(s)
- B M Carrington
- Department of Diagnostic Radiology, Christie Hospital and Holt Radium Institute, Manchester, U.K
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Nagata Y, Kumada K, Abe M, Ono K, Ozawa K, Hayashido M. Continuous intra-arterial infusion therapy: an alternative approach to the femoral artery. Br J Surg 1990; 77:584-5. [PMID: 2162232 DOI: 10.1002/bjs.1800770539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Y Nagata
- Department of Radiology, Kyoto University Hospital, Japan
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Curley SA, Hohn DC, Roh MS. Hepatic artery infusion pumps: cannulation techniques and other surgical considerations. LANGENBECKS ARCHIV FUR CHIRURGIE 1990; 375:119-24. [PMID: 2139485 DOI: 10.1007/bf00713397] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Long term hepatic artery chemotherapy for metastatic disease to the liver has been made practical by technologic advances in pumps and catheters. The surgical placement of these pumps and catheters can be associated with a significant morbidity unless careful attention is given to variations in hepatic arterial anatomy and to eliminating collateral arterial supply to the distal stomach and duodenum. Gastroduodenal devascularization should be performed in all patients and should be confirmed both with intra-operative fluorescein injection and postoperative scintigraphy scanning. Routine cholecystectomy avoids the complication of chemical cholecystitis. Exact placement of the catheter tip at the junction of the gastroduodenal artery and the hepatic artery with fixation of the catheter in this position by placement of bidirectional ligatures around the catheter bead will reduce the incidence of hepatic artery thrombosis and catheter migration. Intrahepatic arterial collateralization in most patients allows for ligation of variant lobar vessels with total liver perfusion through the remaining lobar arterial supply. This again can be confirmed intra-operatively with fluorescein injection and postoperatively with scintigraphy scanning. Strict attention to these technical details will allow continued use of this important therapeutic modality in the treatment of hepatic metastases and by minimizing surgical complications will encourage continued trials to improve the efficacy of long term hepatic arterial chemotherapy.
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Affiliation(s)
- S A Curley
- University of Texas M.D. Anderson Cancer Center, Houston
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Yamashita Y, Takahashi M, Bussaka H, Fukushima S, Kawaguchi T, Nakano M. Intraarterial infusion of 5-fluoro-2-deoxyuridine-C8 dissolved in a lymphographic agent in malignant liver tumors. A preliminary report. Cancer 1989; 64:2437-44. [PMID: 2555039 DOI: 10.1002/1097-0142(19891215)64:12<2437::aid-cncr2820641207>3.0.co;2-h] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The drug 5-fluoro-2-deoxyuridine-C8 (FUdR-C8), one of the lipophilic prodrugs of FUdR, was dissolved in an oily lymphographic agent (Lipiodol Ultra Fluid, Andre Gelbe Laboratory, Paris, France; Ethiodol, Savage Laboratories, Melville, NY) and used for the intraarterial treatment of malignant liver tumors. From August 1985 to June 1988, 33 patients with hepatocellular carcinoma and 13 patients with metastatic liver tumors were treated with this agent at the Kumamoto University Hospital and its affiliated hospitals. The response rate (complete remission [CR] and partial remission [PR]) was 27.6% for hepatocellular carcinomas and 46.1% for metastatic liver tumors. The cumulative 1-year survival rate was 55.1% for hepatocellular carcinomas and 70.0% for metastatic liver tumors. More than a 50% decrease in the tumor marker level was observed in ten of 21 patients with hepatocellular carcinoma and in two of eight patients with metastatic liver tumors. The side effects, which were transient and controlled with conservative treatment, included fever, abdominal pain, nausea, vomiting, and acute gastritis.
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Affiliation(s)
- Y Yamashita
- Department of Radiology, Kumamoto University School of Medicine, Japan
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Abstract
Hepatic artery embolization has become a standard treatment for liver hemorrhage from a variety of lesions, including trauma, pseudoaneurysms, hematobilia, and arteriovenous fistulas. Embolization is also useful in properly selected cases of bleeding secondary to portal hypertension. It is valuable for many primary and secondary neoplasms when the lesion is unresectable and either there is no other effective treatment or other treatment has failed. Hypovascular tumor deposits have poor response rates, and the author no longer embolizes such lesions, whereas the benefits can be dramatic in the case of a hormone-secreting tumor. Hemorrhage from a tumor can also be controlled.
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Affiliation(s)
- M E Clouse
- Department of Radiology, Harvard Medical School, Boston, Massachusetts
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49
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Schlag P, Herfarth C. Liver Infusion Chemotherapy. Surg Oncol 1989. [DOI: 10.1007/978-3-642-72646-0_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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50
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Nerenstone SR, Ihde DC, Friedman MA. Clinical trials in primary hepatocellular carcinoma: current status and future directions. Cancer Treat Rev 1988; 15:1-31. [PMID: 2834053 DOI: 10.1016/0305-7372(88)90007-2] [Citation(s) in RCA: 166] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- S R Nerenstone
- Division of Cancer Treatment, National Cancer Institute, Bethesda, Maryland 20892
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