title: Arterial embolization for salvage of hepatic artery infusion pumps.
abstract: OBJECTIVE
  Hepatic artery infusion pumps (HAIPs) ideally provide for homogenous perfusion of the liver with chemotherapeutic agents. Perfusion of extrahepatic organs or asymmetric liver perfusion (ie, "misperfusion") is diagnosed by nuclear scintigraphy and precludes the use of HAIPs. The purpose of this study is to report experience in salvaging HAIPs with arterial embolization.
  
  
  METHODS
  A single-center HAIP database was retrospectively reviewed for cases from 1999 to 2005 to identify patients who underwent angiography to treat misperfusion documented by nuclear scintigraphy. Patient demographics, nuclear scintigraphic findings before and after embolization, angiographic findings, embolization variables, and outcomes were recorded. Technical success (defined by cessation of flow to the vessel responsible for misperfusion) and clinical success (ie, successful use of the pump) were calculated.
  
  
  RESULTS
  During the study period, 475 HAIPs were implanted. Of those, 43 (9%) had abnormal nuclear scintigraphic findings of misperfusion, but only 32 (7%) had angiographic abnormalities. In eight of 32 cases, hepatic arterial thrombosis and extravasation at the catheter tip were found, which precluded salvage by embolization. In 24 of 32 cases, a vessel presumed responsible for the misperfusion was identified and targeted for embolization. Technical success and clinical success were achieved in 21 of 24 patients (87.5%) and 19 of 24 patients (79%), respectively, who underwent 27 embolization procedures. The three technical failures (12.5%) were the result of inability to catheterize the identified vessel.
  
  
  CONCLUSIONS
  Percutaneous arterial embolization of a vessel to correct misperfusion shown by nuclear scintigraphy is safe and effective. This approach can be expected to result in HAIP salvage in the majority of patients.
authors: Division of Interventional Radiology and Image-Guided Therapies, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA. constant@pol.net
authors: Constantinos T
authors: CT
authors: Sofocleous
authors: Johanna
authors: J
authors: Schubert
authors: Nancy
authors: N
authors: Kemeny
authors: Anne M
authors: AM
authors: Covey
authors: Lynn A
authors: LA
authors: Brody
authors: George I
authors: GI
authors: Getrajdman
authors: Raymond
authors: R
authors: Thornton
authors: Corinne
authors: C
authors: Winston
authors: Karen T
authors: KT
authors: Brown