Percutaneous Implantation of a Microcatheter-Port System for Hepatic Arterial Infusion Chemotherapy of Unresectable Liver Tumors: Technical Feasibility, Functionality, and Complications.

Marco Midulla,François Ghiringhelli,Olivier Chevallier,Ségolène Mvouama,Kévin Guillen,Sylvain Manfredi,Romaric Loffroy,Julie Pellegrinelli,Nicolas Falvo

doi:10.3390/diagnostics11030399

Marco Midulla, François Ghiringhelli + Show 7 more

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https://doi.org/10.3390/diagnostics11030399

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Abstract

To evaluate the feasibility and safety of percutaneously implanted arterial port catheter systems for hepatic arterial infusion of chemotherapy (HAI) in patients with unresectable liver malignancies. From October 2010 to August 2018, arterial port catheters for HAI were percutaneously implanted in 43 patients with unresectable liver malignancies. Three different catheter placement techniques were compared: a conventional end-hole catheter placed in the common hepatic artery (technique 1, n = 16), a side-hole catheter with the tip fixed in the gastroduodenal artery (technique 2, n = 18), and a long-tapered side-hole catheter with the tip inserted distally in a segmental hepatic artery (technique 3, n = 6). Catheter implantation was successful in 40 (93%) of the 43 patients. Complications related to catheter placement were observed in 10 (23%) patients; 5 (83%) of the 6 major complications were resolved, as well as all 4 minor complications. Catheter migration and occlusion occurred in 9 (22.5%) patients. Catheter migration was more frequent with technique 1 (n = 6) than with technique 2 (n = 1), although the difference was not significant (p = 0.066). Percutaneous arterial port catheter implantation for HAI is highly feasible and carries a low risk of complications.

Highlights

The liver derives its blood supply from two sources; namely, the arterial circulation and the portal circulation [1,2]
Three different catheter placement techniques were compared: a conventional end-hole catheter placed in the common hepatic artery, a side-hole catheter with the tip fixed in the gastroduodenal artery, and a long-tapered side-hole catheter with the tip inserted distally in a segmental hepatic artery
The main source of blood supply is the hepatic artery for liver metastases and primary liver cancers, whereas the portal circulation supplies the normal liver cells

Summary

Introduction

The liver derives its blood supply from two sources; namely, the arterial circulation and the portal circulation [1,2]. The main source of blood supply is the hepatic artery for liver metastases and primary liver cancers, whereas the portal circulation supplies the normal liver cells. The implantation of permanent intra-arterial port catheter systems was initially performed surgically. This method was invasive and exposed patients to the risks associated with laparotomy and general anesthesia. Since the 1980 s, minimally invasive percutaneous techniques have allowed easier and safer port catheter implantation, with no laparotomy or general anesthesia [4]. The aims of this study were to determine the feasibility and safety of percutaneous port-catheter system insertion for HAI in patients with unresectable liver malignancies

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