title: Placement of a long tapered side-hole catheter in the hepatic artery: technical advantages, catheter stability, and arterial patency.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the technical advantages, safety, and efficacy of placing a catheter distally in the hepatic artery using a long tapered side-hole catheter with an implantable port for hepatic arterial infusion chemotherapy.
  
  
  METHODS
  Fifty patients with unresectable malignant liver tumors underwent radiologic implantation of catheter-port systems using the long tapered catheter placement method. A 2.7-French distal shaft of the catheter was inserted distally in the hepatic artery with its side hole located proximally, and a 5-French proximal shaft was placed in the aorta; the catheter tip was not fixed. Technical success, complications including catheter stability and hepatic artery patency, and tumor response were assessed and compared with the following two historical controls: 35 patients with a 5-French catheter inserted simply in the hepatic artery (conventional method), and 131 patients with a 5-French catheter, the tip of which was fixed in the gastroduodenal artery (the fixed-catheter-tip method).
  
  
  RESULTS
  The technical success rate using the long tapered catheter placement method was 92% (46/50 patients), whereas the feasibility of the fixed-catheter-tip method was confined to 79% of historical controls (131/166 patients). Among patients in whom the gastroduodenal artery was present, a decreased frequency of gastroduodenal artery embolization was seen using the long tapered catheter placement method (39%; 17/44 patients) compared with the conventional method (p = 0.0112) and the fixed-catheter-tip method (p < 0.0001). Cumulative stability rates of the catheter (6 months, 94.9%; 1 year, 94.9%; 2 years, 86.2%) and cumulative patency rates of the hepatic artery (6 months, 89.9%; 1 year, 89.9%; 2 years, 83.5%) were significantly higher using the long tapered catheter placement method than using the conventional method (p = 0.0208 and p = 0.0066, respectively) but were similar to those using the fixed-catheter-tip method. The time of hepatic tumor progression was significantly longer using the long tapered catheter placement method than using the conventional method (p = 0.0299) but was comparable to the time using the fixed-catheter-tip method.
  
  
  CONCLUSIONS
  The long tapered catheter placement method should find wider application in hepatic arterial infusion chemotherapy because it is useful in preventing catheter dislodgment and hepatic artery occlusion.
authors.affiliation: Department of Radiology, Niigata Cancer Center Hospital, 2-15-3, Kawagishi-cho, Niigata 951-8566, Japan. hseki@niigata-cc.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Seki
authors.forename: Makoto
authors.initials: M
authors.lastname: Shiina
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002406:Catheterization, Peripheral / Q000379:methods*; D002408:Catheters, Indwelling; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional
chemical_list: D000970:Antineoplastic Agents