Complications and technical limitations of hepatic arterial infusion catheter placement for chemotherapy.
OBJECTIVE
To determine the rate of complications associated with hepatic arterial infusion (HAI) catheter placement, as well as technical success related to liver perfusion.


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.
Habbe
T G
TG
Department of Radiology, The University of Nebraska Medical Center, Omaha 68198-1045, USA.
McCowan
T C
TC
Goertzen
T C
TC
Leveen
R F
RF
Culp
W C
WC
Tempero
M A
MA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001916:Brachial Artery / Q000000981:diagnostic imaging; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000009:adverse effects; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D011877:Radionuclide Imaging