title: Complications after percutaneous transaxillary implantation of a catheter for intraarterial chemotherapy of liver tumors: clinical relevance and management in 204 patients.
abstract: OBJECTIVE
  The purposes of the study were to evaluate the complications of patients who underwent percutaneous transaxillary implantation of a permanent catheter-port system for intraarterial hepatic chemotherapy and determine their clinical relevance and specific management. SUBJECTS AND METHODS. Catheter-port systems were placed in 204 patients with liver tumors (86.7% from colorectal metastases). Under sonographic and fluoroscopic guidance, a 5.8-French catheter was placed in the hepatic artery and connected to a subcutaneous reservoir after embolization of the gastroduodenal and right gastric arteries. Floxuridine plus dexamethasone and systemic low-dose heparin were administered. During the follow-up period, complications were classified as clinically not significant (type 1), clinically significant not requiring interruption of intrahepatic chemotherapy (type 2), clinically significant needing temporary suppression of intrahepatic chemotherapy (type 3), and clinically significant causing permanent suppression of intrahepatic chemotherapy (type 4).
  
  
  RESULTS
  No complications occurred during the implantation procedures. The mean number of intrahepatic chemotherapy cycles was 8.1. The mean follow-up period was 270 days. Primary and secondary patency rates of the system were 71.6% and 91.2%, respectively. Temporary suppression of intrahepatic chemotherapy was necessary in 19.6% of the patients and definitive suppression, in 8.8%. Hepatic artery thrombosis, not recanalized by local thrombolysis, was the main cause of permanent intrahepatic chemotherapy interruption (4.4%). Catheter occlusions and cerebral complications were not observed. In 91.2% of the patients, intrahepatic chemotherapy could be completed.
  
  
  CONCLUSIONS
  Percutaneous implantation of a removable and reimplantable catheter-port system for intrahepatic chemotherapy can be a safe procedure to treat unresectable liver metastases from colorectal cancer. Technical and pharmacologic complications with variable clinical relevance occurred, and various specific management strategies were necessary to reduce their incidence.
authors.affiliation: Department of Radiology, Scientific Institute S. Raffaele, Vita-Salute University, Olgettina 60, Milan 20132, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Venturini
authors.forename: Enzo
authors.initials: E
authors.lastname: Angeli
authors.forename: Marco
authors.initials: M
authors.lastname: Salvioni
authors.forename: Francesco
authors.initials: F
authors.lastname: De Cobelli
authors.forename: Monica
authors.initials: M
authors.lastname: Ronzoni
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
authors.forename: Marco
authors.initials: M
authors.lastname: Stella
authors.forename: Michele
authors.initials: M
authors.lastname: Carlucci
authors.forename: Carlo
authors.initials: C
authors.lastname: Staudacher
authors.forename: Valerio
authors.initials: V
authors.lastname: Di Carlo
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ferla
authors.forename: Eugenio
authors.initials: E
authors.lastname: Villa
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Maschio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies