Radial Artery Access for Hepatic Chemosaturation: The First Description of Technical Feasibility.

Joshua P Frost,Jon Bell,Pavan Najran,Damian Mullan

doi:10.7759/cureus.18852

Abstract

Chemosaturation with percutaneous hepatic perfusion (CS-PHP; Hepatic CHEMOSAT® Delivery System, Delcath Systems Inc, Wilmington, Delaware) is an interventional radiology procedure that delivers high doses of melphalan, a chemotherapeutic agent, directly to the liver in patients with unresectable primary and secondary liver tumours.Traditionally, CS-PHP is delivered by arterial access via the femoral artery. However, there can be many risks and adverse effects associated with femoral artery punctures, such as retroperitoneal haemorrhage and haematoma formation. The monitoring and bed rest required following the removal of a femoral arterial catheter may also cause significant distress to patients as they remain immobile, potentially prolonging their stay in hospital. The radial artery is an alternative access point, with fewer reported adverse events and increased patient tolerance when compared with femoral access.This case report details the first reported use of Hepatic CHEMOSAT® therapy being delivered via the radial artery. Two patients received hepatic chemosaturation with no reported complications. This report demonstrates that access via the radial artery is a feasible alternative for the delivery of chemotherapy, which may reduce morbidity and the risks usually associated with femoral access.

Highlights

Hepatic chemosaturationChemosaturation with percutaneous hepatic perfusion (CS-PHP; Hepatic CHEMOSAT® Delivery System; Delcath Systems Inc, Wilmington, Delaware) is an interventional radiology procedure that delivers high doses of melphalan directly to the liver in patients with unresectable primary and secondary liver tumours [1]
This case report details the first reported use of Hepatic CHEMOSAT® therapy being delivered via the radial artery
In CS-PHP, melphalan is delivered directly into the hepatic artery via a catheter inserted from the femoral artery into the proper hepatic artery

Summary

Introduction

Chemosaturation with percutaneous hepatic perfusion (CS-PHP; Hepatic CHEMOSAT® Delivery System; Delcath Systems Inc, Wilmington, Delaware) is an interventional radiology procedure that delivers high doses of melphalan directly to the liver in patients with unresectable primary and secondary liver tumours [1]. Ultrasound-guided puncture of the 2.3 mm left distal radial artery was performed, with a 5 French radial catheter (Performa UltimateTM; Merit Medical Systems, Inc., South Jordan, UT) to access the coeliac trunk, and a 2.4 French Microcatheter (PROGREAT® Microcatheters; Terumo Interventional Systems, Somerset, NJ) to access the treatment position in the common hepatic artery (Figure 2). After a period of remission, further scans revealed new, inoperable liver metastases, prompting recommendation for a further cycle of CS-PHP (Figure 7) On this occasion, the 2.1 mm right distal radial artery was used as the access site, as the left radial artery was 1.7 mm and deemed too small to catheterise. A compression band (PreludeSYNCTM Radial Compression Device; Merit Medical Systems, Inc.) was placed to provide 'hands-free' haemostasis Both the right jugular and femoral vein sheaths were removed without. Surgical clips are seen in situ (black arrows) due to previous surgical resection of liver metastases

Discussion

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Disclosures