HOW TO AVOID COMPLICATIONS OF INTRAHEPATIC ARTERIAL INFUSIONS OF CHEMOTHERAPEUTIC AGENTS

Abstract

Failure to properly place the intrahepatic arterial catheter or presence of an aberrant artery can result, not only in failure of the therapy, but also may cause serious complications. We have studied 49 consecutive patients with hepatic arterial chemotherapy for metastatic colon carcinoma. All 49 had hepatic arteriograms to aid in placement of the intra-arterial catheters. The pre-infusion findings were: an unusual position of the left hepatic artery (9) the right hepatic artery (5) and the gastroduodenal artery (2). Six patients had left hapatic and gastric artery communications, one an accessory hepatic artery and one celiac axis trifucation. Despite the fact that the catheter position was changed on the basis of these findings, most patients had clinical complications requiring therapeutic interventions. Tc-99m microsphere scintigraphy was performed in all 49 patients; 24 had findings that could have predicted ocmplications, 13 patients had extrahepatic perfusion including stomach, bowel, spleen or pancreas, 11 had liver perfusion abnormalities other than related to metastatic liver disease. Patients with hepatic artery abnormalities seen by hepatic arteriography are at high risk for unsuspected perfusion abnormalities and should be studied with radionuclide studies to avoid serious clinical complications. In the presence of hepatic artery abnormalities, blind reading of radionuclide scintigraphy was 92% accurate in predicting complications of hepatic artery infusion pump.