Technical considerations and complications associated with the placement of 180 implantable hepatic arterial infusion devices.
BACKGROUND
Treatment regimens with hepatic arterial chemotherapy infusion are being investigated in an attempt to improve survival and quality of life for patients with primary and metastatic liver malignancies. The successful delivery of chemotherapeutic drugs through an implantable hepatic arterial infusion device depends on the surgeon's understanding of hepatic arterial anatomy, the proper cannulation technique, and the operative measures necessary to prevent misperfusion of drug.


METHODS
Between January 1, 1987, and December 31, 1991, we placed implantable hepatic arterial infusion devices in 180 patients. The records of these patients were review to determine (1) the incidence and surgical management of variant hepatic arterial anatomy and (2) the complications associated with surgical placement of these devices.


RESULTS
Variant hepatic arterial anatomy requiring ligation of the variant vessel or nonstandard cannulation was seen in 66 patients (36.7%). Treatment response rates and duration of treatment were no different for these 66 patients than for the 114 patients with standard hepatic arterial anatomy (p = 0.94). There were no operative deaths in this series. Operative or early postoperative (within 30 days) complications occurred in 10 patients (5.5%). However, late complications or device-related malfunctions developed in 52 patients (28.8%).


CONCLUSIONS
An understanding of regional arterial anatomy is required to surgically place a catheter to achieve bilobar hepatic arterial perfusion and avoid gastroduodenal misperfusion of drug. Placement of hepatic arterial infusion devices has a low rate of early morbidity, but surgeons should be aware of late complications that may develop in patients undergoing hepatic arterial chemotherapy infusion through an implantable device.
Curley
S A
SA
Department of Surgery, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Chase
J L
JL
Roh
M S
MS
Hohn
D C
DC
D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D006499:Hepatic Artery / Q000033:anatomy & histology*; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects; D008113:Liver Neoplasms / Q000188:drug therapy*; D008722:Methods