Hepatic artery access ports: recognizing and avoiding the problems.
BACKGROUND
Regional approaches to the management of hepatic tumours are appropriate in some clinical situations and include hepatic arterial chemotherapy (HAC) and selective internal radiation therapy (SIRT). Both require access to the hepatic artery, which is conveniently achieved with a subcutaneously placed port. Placement and use of these ports may be associated with a variety of technical problems which can impact adversely on the outcome of the treatment. The present paper outlines the problems related to port usage for regional hepatic therapies, with emphasis on the technical aspects of insertion and interpretation and management of subsequent problems.


METHODS
Hepatic artery port placement was attempted in 129 patients for use with either SIRT and/or HAC. Ports were used or flushed at monthly intervals.


RESULTS
Successful port insertion was achieved in 127 patients, of whom 87 received HAC alone, seven received SIRT alone, 28 patients received both and in five patients the port was never used. Methylene blue injection was used to identify anomalous arterial anatomy, which was found in 26 of 95 patients (27%), and significant extrahepatic 'access', which was seen in 25 patients (26%) after initial placement. Forty-six instances of technical problems preventing continued use of the port occurred in 43 patients after a median of 4 (0-36) cycles of chemotherapy, including hepatic artery thrombosis (n = 26), catheter blockage (n = 4), duodenal fistula (n = 3), gastrointestinal (GI) bleeding (n = 3), side-effects (n = 3), access problems (n = 3), extravasation (n = 3) and infection (n = 1).


CONCLUSIONS
Methods used to identify, manage and in some instances prevent the occurrence of these problems are discussed.
Wickremesekera
J K
JK
Wakefield Gastroenterology Centre, Wakefield Hospital, Wellington, New Zealand.
Cannan
R J
RJ
Stubbs
R S
RS
D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000145:classification; D003097:Collateral Circulation; D004378:Duodenal Diseases / Q000209:etiology; D004868:Equipment Failure; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000209:etiology; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D007202:Indicators and Reagents; D007269:Injections, Intra-Arterial / Q000295:instrumentation; D015552:Injections, Intralesional / Q000295:instrumentation; D007412:Intestinal Fistula / Q000209:etiology; D008113:Liver Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D013927:Thrombosis / Q000209:etiology; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
D000964:Antimetabolites, Antineoplastic; D007202:Indicators and Reagents; D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes; D008751:Methylene Blue; D005472:Fluorouracil