Port-catheter System Research Articles

Hepatic arterial catheterization combining interventional radiological and laparotomic approaches

This report describes a modified method of implanting a catheter-port system for hepatic arterial infusion chemotherapy (HAIC) that combines interventional radiological (IVR) and laparotomic approaches. In patients, scheduled for HAIC and laparotomic surgery, we now employ a modified method of implanting the catheter-port system. In our method, an IVR approach is used to implant the catheter-port, and arterial occlusions are primarily carried out using a laparotomic approach. Following celiac and superior mesenteric arteriographies, a tapered microcatheter with a side hole is inserted by a catheter exchange method. The catheter tip is advanced far into the gastroepiploic artery via the gastroduodenal artery (GDA). The side hole is located at the orifice of the proper hepatic artery, and its location is confirmed by injection of contrast media. The microcatheter is connected to the port, and the port is buried in the subcutaneous pocket. During the laparotomy stage, the GDA lumen and the catheter lumen are clipped, and the right gastric artery (RGA) and all small branches supplying the stomach, duodenum, and pancreas are ligated. Among the 13 patients successfully implanted with a port-catheter system using our combined approach, no patients had hepatic artery occlusion or occlusion of the catheter system. Initial results from a study of a new method of implanting a microcatheter-port system in the hepatic artery using combined IVR and laparotomic approaches suggest that this method may enable operators to avoid complicated selective coiling and may lower the incidence of hepatic artery occlusion in patients receiving long-term HAIC.

Adjuvant hepatic arterial infusion after curative resection of colorectal liver metastases using removable intra‐arterial catheters with shape‐memory alloy

Although there are some reports that adjuvant hepatic arterial infusion (HAI) chemotherapy reduces the hepatic recurrence following curative resection of colorectal liver metastases, problems of indwelling catheters after chemotherapy cessation remains unsolved. The usefulness of adjuvant HAI was investigated using a removable port-catheter system. Spiral catheterstrade mark were attempted to be placed in 17 patients who underwent curative hepatectomy. The catheter contains a special shape-memory alloy at its tip, which allows stable fixation to the vascular wall without coiling so the catheter can be removed if necessary. 5-fluorouracil (5-FU) in total dose of 12 g was intra-arterially administered. W spiral catheterstrade mark were successfully placed in the hepatic artery by percutaneous approach in 82% of the patients. All patients underwent scheduled chemotherapy without serious adverse events. Reservoir-catheter system was removed easily and uneventfully after discontinuation of the chemotherapy. 3D-CT angiography revealed that the hepatic artery was well preserved with short-term chemotherapy. Postoperative hepatic recurrence was observed only in 18% of the patients with the median follow-up time of 19.9 months. Prophylactic 5-FU HAI using W spiral cathetertrade mark and subsequent catheter extirpation is a promising strategy following curative resection of colorectal liver metastases.

Role of a Minimally Invasive Approach in the Management of Laparoscopic Adjustable Gastric Banding Postoperative Complications

Complications after laparoscopic adjustable gastric banding as treatment for morbid obesity may require a major reintervention. A minimally invasive approach represents an attractive management alternative for such complications. Prospective case series. Major academic medical and surgical center. From January 1996 to July 2003, 47 patients who had undergone laparoscopic adjustable gastric banding were operated on again. Considering the causes for reoperation, the patients were divided into 4 groups: group A had major complications (n = 26); group B, minor complications (n= 11); group C, psychological problems (n=6); and group D, insufficient weight loss (n=4). Forty-three procedures, 38 using general anesthesia (groups A, C, and D) and 5 using local anesthesia (group B), were performed. Feasibility, safety, and effectiveness of a minimally invasive approach in the treatment of laparoscopic adjustable gastric banding complications. In group A, 9 of 10 patients with irreversible gastric pouch dilatation and 15 of 16 with intragastric band migrations were treated laparoscopically. In group B, 5 ports were substituted and 2 reconnections of the catheter-port system were performed. In group C, 6 laparoscopic band removals were carried out. In group D, 4 laparoscopic revision procedures for insufficient weight loss were performed. The operative mortality was nil. The most frequent cause of reoperation was intragastric migration (37.2%). A minimally invasive approach was adopted in 94.7% of cases. Laparoscopy is safe and effective, even as a second operative procedure.

Intra-arterial infusion of fluorouracil as adjuvant chemotherapy by using removable catheters with shape-memory alloy following curative hepatectomy of metastatic colorectal carcinoma

3721 Background: Although there are some reports that adjuvant hepatic arterial infusion (HAI) chemotherapy reduces the hepatic recurrence following curative resection of colorectal liver metastases, a problem of indwelling catheters after cessation of the chemotherapy remains unsolved. The authors investigated the usefulness of adjuvant HAI by using a removable port-catheter system which was recently developed. Methods: A W spiral catheter was tried to place in 17 patients who underwent curative hepatectomy. The catheter was postoperatively inserted into the hepatic artery via the right femoral artery by percutaneous method. A W spiral catheter has a special shape-memory alloy in its apical portion, which allows stable fixation of the catheter in the vascular wall without coiling and removal of the catheter if necessary. 1500 mg of 5-fluorouracil (5-FU) was intra-arterially administered for 5 hours once a week for 8 weeks by using disposable infusion pumps, and the total dose was 12g. Results: A W spiral catheter was successfully placed into the aimed portion of the hepatic artery in 82% of the patients, and dislocation of the catheter was not observed throughout the period. All patients received the scheduled courses of chemotherapy without serious adverse events. The port-catheter system was removed easily and uneventfully after termination of the chemotherapy. Three-dimensional CT angiography revealed that the patency of the hepatic artery was well preserved in most cases. Postoperative hepatic recurrence was observed only in 3 patients. With the median follow-up time of 18.1 months, the 1- and 2-year hepatic disease free survival were 80% and 67%, respectively and the accumulative survival was 93% and 93%, respectively. Conclusions: Prophylactic HAI of 5-FU by using a W spiral catheter and subsequent extirpation of the catheter is a promising strategy following curative resection of colorectal liver metastases. No significant financial relationships to disclose.

Complications after percutaneous transaxillary implantation of a catheter for intraarterial chemotherapy of liver tumors: clinical relevance and management in 204 patients.

The purposes of the study were to evaluate the complications of patients who underwent percutaneous transaxillary implantation of a permanent catheter-port system for intraarterial hepatic chemotherapy and determine their clinical relevance and specific management. SUBJECTS AND METHODS. Catheter-port systems were placed in 204 patients with liver tumors (86.7% from colorectal metastases). Under sonographic and fluoroscopic guidance, a 5.8-French catheter was placed in the hepatic artery and connected to a subcutaneous reservoir after embolization of the gastroduodenal and right gastric arteries. Floxuridine plus dexamethasone and systemic low-dose heparin were administered. During the follow-up period, complications were classified as clinically not significant (type 1), clinically significant not requiring interruption of intrahepatic chemotherapy (type 2), clinically significant needing temporary suppression of intrahepatic chemotherapy (type 3), and clinically significant causing permanent suppression of intrahepatic chemotherapy (type 4). No complications occurred during the implantation procedures. The mean number of intrahepatic chemotherapy cycles was 8.1. The mean follow-up period was 270 days. Primary and secondary patency rates of the system were 71.6% and 91.2%, respectively. Temporary suppression of intrahepatic chemotherapy was necessary in 19.6% of the patients and definitive suppression, in 8.8%. Hepatic artery thrombosis, not recanalized by local thrombolysis, was the main cause of permanent intrahepatic chemotherapy interruption (4.4%). Catheter occlusions and cerebral complications were not observed. In 91.2% of the patients, intrahepatic chemotherapy could be completed. Percutaneous implantation of a removable and reimplantable catheter-port system for intrahepatic chemotherapy can be a safe procedure to treat unresectable liver metastases from colorectal cancer. Technical and pharmacologic complications with variable clinical relevance occurred, and various specific management strategies were necessary to reduce their incidence.

Interventional Radiologic Treatment for Hepatic Arterial Occlusion after Repeated Hepatic Arterial Infusion Chemotherapy via Implanted Port–Catheter System

The present study evaluated the feasibility of interventional radiologic treatments for hepatic arterial occlusion after hepatic arterial infusion chemotherapy (HAIC) via an implanted port-catheter system. Treatment for hepatic arterial occlusion was attempted in seven patients with unresectable liver cancer. In six, the obstructed hepatic artery was recanalized. In three patients, the recanalized hepatic artery again became obstructed. However, by performing additional interventional radiologic procedures, secondary patency of the hepatic artery was successfully obtained in two patients. In conclusion, when hepatic arterial occlusion occurs, HAIC can be resumed in the attempt to recanalize the hepatic artery.

Scintigraphic monitoring of catheter-port systems in type I diabetics with continuous insulin therapy.

We developed a non-invasive scintigraphic procedure to control the function of percutaneous catheter-port systems for continuous insulin therapy. The aim of the study was to evaluate the scintigraphic results and to compare the absorption kinetics of intraperitoneal and umbilical catheter-ports. Seven patients with intraperitoneal and nine patients with umbilical catheter-port systems implanted into the partially redilated umbilical vein were investigated. All these patients had normal functioning catheter-ports. Additionally, three patients with intraperitoneal and three patients with umbilical catheter-port dysfunction confirmed either by radiography or laparoscopy were studied. After the injection of (99 m)TcO (4)(-) into the port a region-of-interest was drawn around the activity at the tip of the catheter and the half-life of tracer absorption (T(1/2)) calculated. The normal intraperitoneal catheter-port group showed a T(1/2) value of 6.7 +/- 3.2 min and the normal umbilical catheter-port group a T(1/2) of 6.6 +/- 2.0 min. There was no significant difference in T(1/2) between intraperitoneal and umbilicial systems. The dysfunctional catheter-port group (T(1/2) 19.3 +/- 6.7 min) differed ( p = 0.0005) from the normal catheter-port group (T(1/2) 6.7 +/- 3.2 min). On the basis of the normal group an upper threshold value of T(1/2) was calculated to be 11.8 min. Imaging with (99 m)TcO (4)(-) is an accurate, non-invasive, and quick method to assess the function of insulin catheter-ports. A T(1/2) value > 11.8 min is indicative of a catheter dysfunction. Umbilical and intraperitoneal catheter-ports show similar absorption rates of (99 m)TcO (4)(-).

Value of transcatheter arterial embolization with coils and n-butyl cyanoacrylate for long-term hepatic arterial infusion chemotherapy.

To assess the value of transcatheter arterial embolization (TAE) of splanchnic arterial branches to allow continuous application of repeat hepatic arterial infusion chemotherapy (HAIC). In 128 patients with unresectable advanced liver cancer, percutaneous implantation of a port catheter system and TAE of splanchnic arteries with coils and/or n-butyl cyanoacrylate (NBCA) were performed. Parameters included (a) methods selected for catheter placement; (b) embolic materials used (coils and/or NBCA, number of coils, administration rate of NBCA-iodized oil) for TAE of splanchnic arteries, details of embolized arteries, and frequency of recanalization; (c) ability to prevent gastrointestinal symptoms by avoiding inflow of anticancer drugs into extrahepatic adjacent organs and to maintain distribution of contrast agents in liver, as well as management of difficulties encountered; (d) complications related to catheter system implantation or to long-term HAIC and management of such complications; and (e) final success in performing scheduled HAIC while maintaining distribution over liver via a single route without gastrointestinal symptoms caused by inflow of anticancer drugs. Fisher exact test was used to compare recanalization rate between coil-embolized and NBCA- or NBCA-coil-embolized arteries, and frequency of heterogeneously poor distribution was compared between patients with single and those with multiple hepatic arteries. Embolization was successful during first catheterization in 326 arteries and during follow-up in 10. In 119 (93.0%) of 128 patients, repeat HAIC was effective until death or the time of this writing (observation period, 2-47 months). HAIC was continued in two patients, although anticancer drugs did not distribute to all liver tumors. Arteries once embolized with coils alone spontaneously recanalized at a significantly higher rate than those with NBCA (eight of 192 vs one of 144, P =.048). Rate of heterogeneously poor distribution was significantly higher in those with two or more hepatic arteries than in those with one (seven of 17 vs nine of 111, P =.001). TAE for various splanchnic organs is useful for efficient performance of long-term HAIC.

Transjugular implantation of venous port catheter systems

Prospective analysis of success and complication rates of chest port implantation via the internal jugular vein. In 50 consecutive patients (25 men, 25 women; mean age 61 +/- 14 years) the internal jugular vein was punctured under ultrasound guidance. Through this access, a port system was inserted and the catheter tip was placed at the cavoatrial junction. The port reservoir was implanted into a subcutaneous infraclavicular pocket and fixed to the fascia of the pectoralis muscle. Indications for port implantation were chemotherapy (n = 46), total parenteral nutrition (n = 2) or intravenous medication (n = 2). A chest port catheter system was successfully implanted in all 50 patients. The mean duration of placement was 90 +/- 65 catheter days. No complications occurred during implantation. In the post-interventional period a single catheter dysfunction occurred (0.22 per 1,000 catheter days). Two local infections occurred in the early post-interventional period (0.43 per 1,000 catheter days). One port system had to be explanted prematurely due to pain. The ultrasound guided puncture of the internal jugular vein enables a safe access for insertion of a central venous port catheter system and is associated with a very low complication rate. Port placement via this access vein should therefore be the primary treatment.

New method of catheter-port system implantation in hepatic arterial infusion chemotherapy

Background This report describes a novel method of implantation of the catheter-port system in hepatic arterial infusion chemotherapy, which is the inferior epigastric arterial approach. Methods Using this method, the length of incision is about 3 cm in lower abdomen. The inferior epigastric artery is exposed above the inguinal ligament. The half of the artery is cut, and a vascular sheath is inserted into the external iliac artery along a guide wire. A catheter is inserted into the hepatic artery through the vascular sheath. Coil occlusion of nontarget artery is performed by the technique of interventional radiology. Then the vascular sheath is removed and the catheter is fixed to the inferior epigastric artery. A port is connected to the catheter and placed above the incision in the lower abdomen. Conclusions Using this method, the hip joint can be moved freely and port-related complications are few, which contributes to a good quality of life of patients during the therapy. The inferior epigastric arterial approach may give a benefit to those who are treated with hepatic arterial infusion chemotherapy.

Withdrawal of Implanted Port–Catheter for Hepatic Arterial Infusion Chemotherapy with Fixed Catheter Tip Technique

The purpose of the present study is to evaluate the feasibility of a method developed to withdraw a port-catheter system that had been implanted with use of the fixed catheter tip technique. Withdrawal of an implanted catheter was required in four patients with advanced liver cancer in whom port-catheter systems had been implanted for performance of repeated hepatic arterial infusion. In all patients, port-catheter systems were successfully removed without complications. In conclusion, an implanted port-catheter system can be removed even when implanted with the fixed catheter tip technique.

Preliminary experience with locoregional intraarterial chemotherapy of uterine cervical or endometrial cancer using the peripheral implantable port system (PIPS): a feasibility study.

The purpose of this study was to assess the suitability of a percutaneously implantable catheter port system (PIPS) for repeated intraarterial locoregional chemotherapy (ILC) for cervical and endometrial carcinoma. In 30 patients with advanced, recurrent, or high-risk cervical (n = 23) or endometrial (n = 7) carcinoma, PIPS for ILC was implanted via a femoral access, the catheter localized in the infrarenal abdominal aorta. Chemotherapy was performed adjuvantly after surgery (n = 14) or neo-adjuvantly to enable surgery, or for palliation (n = 16). Port implantation, catheter placement, and repeated port puncture was uneventful in all patients. Complications included catheter dislocation (n = 1), catheter thrombosis (n = 2), subcutaneous infection (n = 1), port-bed skin atrophy (n = 1), requiring port explantation in 3 patients. At 2 years follow-up, complete remission was observed in 7/14 patients with adjuvant chemotherapy, partial remission in 3/14. Successful down-staging could be achieved in 4/8 patients with neo-adjuvant chemotherapy. The PIPS is suitable for repeated ILC which may be a valuable method for pre- and post-surgical therapy of advanced or high-risk cervical and endometrial cancer, for adjuvant chemotherapy as well as neo-adjuvantly for down-staging, or for palliation.

Using n-butyl cyanoacrylate and the fixed-catheter-tip technique in percutaneous implantation of a port-catheter system in patients undergoing repeated hepatic arterial chemotherapy.

The purpose of our study was to evaluate the usefulness of adding n-butyl cyanoacrylate to microcoils to fix the catheter tip in percutaneous implantation of a port-catheter system for hepatic arterial-infusion chemotherapy. Ninety-three patients (64 men and 29 women; age range, 38-83 years; mean age, 62.2 years) with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system with the catheter tip fixed at the gastroduodenal artery with microcoils and a mixture of n-butyl cyanoacrylate and iodized oil. The rates of successful implantation and complications closely associated with this technique and management of the complications were reviewed. Percutaneous port-catheter placement was successfully performed in all patients. However, in eight patients, complications occurred: hepatic arterial obstruction (n = 5, 5.4%); catheter dislocation (n = 2, 2.2%); recanalization of the gastroduodenal artery (n = 1, 1.1%); or movement of n-butyl cyanoacrylate (n = 1, 1.1%). In five of the eight patients with complications, hepatic arterial-infusion chemotherapy was continued either after observation of the patient to ensure that stability had been established or after treatment using comparatively easy interventional techniques. In three (3.2%) of the 93 patients, planned hepatic arterial-infusion chemotherapy could not be performed because of complications associated with the technique. Fixation of the catheter tip in the gastroduodenal artery using a combination of microcoils and a mixture of n-butyl cyanoacrylate and iodized oil is a useful and safe technique in percutaneous port-catheter placement for repeated hepatic arterial infusion chemotherapy.

Brain infarction after percutaneous implantation of port-catheter system via the left subclavian artery.

The aim of this study was to evaluate the incidence of brain infarction after percutaneous implantation of a port-catheter system via the left subclavian artery for hepatic arterial infusion chemotherapy. In 90 patients with inoperable liver cancer, a port-catheter system was implanted via the left subclavian artery. In 5 patients (5.6%) brain infarction occurred after port-catheter implantation. In one patient (1.1%) thrombi formed around the catheter, as confirmed by autopsy. The risk of brain infarction should be taken into consideration when a trans-left subclavian arterial access route is used for the percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy.

Intraperitoneal distribution of ultrasound contrast medium imaged with B-mode ultrasound and colour-stimulated acoustic emission imaging.

Intraperitoneal port catheter systems for local delivery of cytotoxic drugs require imaging prior to chemotherapy to confirm homogenous distribution of an injected fluid in the entire peritoneal cavity. This study was performed to assess whether contrast-enhanced ultrasound (US) is a suitable imaging modality for this task. Twelve patients with peritoneal carcinosis and an implanted intraperitoneal port catheter system were studied before chemotherapy. Ultrasound examinations were performed after bolus injections of the microbubble contrast medium Levovist. Distribution of the contrast medium in the peritoneal cavity was imaged using B-mode US and colour-stimulated acoustic emission imaging (SAE). Contrast-enhanced CT imaging was used as term of reference for evaluating the US results. Distribution of the microbubbles in the peritoneal cavity was easily detected by both US methods. In 10 of 12 patients a free distribution in all abdominal quadrants was seen with both US techniques. In 2 of 12 patients, CT and US showed contrast medium limited to the perihepatic area. Therapy was stopped and surgical repositioning of the catheter was performed. Ultrasound after intraperitoneal injection of a microbubble contrast agent provides reliable information about the distribution of intraperitoneally injected fluid in the peritoneal cavity. This method is therefore well suited for imaging port catheter systems prior to chemotherapy.

Technical developments: use of targeting guide wire in left subclavian puncture during percutaneous implantation of port-catheter systems using the catheter tip fixation method

Our objective was to evaluate the feasibility and safety of a new method in approaching the access route percutaneously for the implantable port-catheter system for repeated hepatic arterial infusion chemotherapy. Fifteen patients underwent port-catheter system placement via the left subclavian artery with the catheter tip fixed within the gastroduodenal artery with embolic materials and a catheter side hole opening to the common hepatic artery. Before port-catheter placement, the right gastric artery was embolized via the femoral catheter access. Then a 0.035-in. guide wire was inserted from the right femoral artery to the left subclavian artery. The guide wire was left in place during puncture by the needle as an access route for catheter placement. At the time of puncture, the tip of the puncture needle was aimed at the guide wire placed in the subclavian artery beforehand. In all 15 patients the procedure was successfully completed in a reasonable time (mean time 95.0 min, range 50-240 min). Complications occurred in two patients: a transient numbness of the arm in 1 patient and a mild hematoma detected in the subcutaneous pocket in another patient. This experience indicates the possibility of using a targeting guide wire in puncture of the subclavian artery as an access route for catheter placement.

Arterial port catheter system placement using a translumbar aortic route.

Implantable ports for arterial infusion hold promise in a growing number of clinical applications, including regional chemotherapy and gene therapy. Percutaneous placement of arterial infusion ports has been described clinically; however, existing sites of access pose unique anatomic challenges. The feasibility of translumbar aortic placement of a port-catheter system for long-term arterial infusion was assessed. Eight swine underwent placement of a percutaneously implantable arterial port-catheter system using a translumbar aortic approach for catheter placement. The tip of the catheter was positioned in the left or right hepatic artery and the port reservoir implanted in the paraspinal subcutaneous tissues. Patency and position of the port-catheter system were assessed at 7 to 10 days and 28 days. The insertion procedure was modified in two animals by introducing tissue adhesive around the catheter to prevent dislodgment. Immediate technical success was achieved in 6 of 8 animals (75%). Catheters were dislodged into the aorta in two animals on the day of the procedure, extravascular in four animals and intra-aortic in one animal by day 10. One animal died at 21 days of sepsis. The port-catheter systems remained functional at 28 days with catheters positioned within the left or right hepatic artery in three animals, including two animals in which the catheter had been fixated within the paraspinal soft tissues with tissue adhesive. A translumbar aortic route for percutaneous placement of arterial infusion port-catheter systems is feasible in swine and holds potential as an ancillary access site in a clinical setting if the obstacle of catheter fixation can be overcome.

Combined Therapy involving Hepatic Arterial Chemoinfusion through a Percutaneously Implanted Port, and External Irradiation for Advanced Hepatocellular Carcinoma

Purpose: To evaluate the efficacy of combined therapy involving intra-arterial hepatic chemoinfusion through a percutaneously implanted port and external irradiation for the treatment of advanced hepatocellular carcinoma. Materials and Methods: Fifteen patients (12 males and 3 females; mean age=47.5 years) with advanced hepatocellular carcinoma localized in one lobe and with portal vein thrombosis (stage IVa) were included in this study. To permit chemoinfusion through the hepatic artery, a Chemoport？ was implanted percutaneously in the right inguinal area via the femoral artery. Initial external radiation therapy lasted five weeks (44 Gy in a daily fraction of 1.8 Gy), with concurrent intra-arterial hepatic infusion of 5-fluorouracil. This initial treatment was followed by five cycles of intra-arterial hepatic infusion of cisplatin and 5-fluorouracil for three consecutive days every month. Two and six months after treatment was begun, the patients underwent CT scanning and angiography, and their response was assessed in terms of change in tumor size and vascularity, the degree of portal vein thrombosis and arterio-portal shunt, and alpha-fetoprotein levels. Any complications arising from this combined therapy and the clinical status of each patient were also followed up during the treatment period. Results: The response rates at months 2 and 6 were 60% and 33.3%, respectively. One patient (6.7%) showed complete remission, and serum alpha-fetoprotein levels decreased significantly in all patients who responded. In five of the twelve patients, the thrombi in the main portal vein showed marked regression. The one-year survival rate was 30% and the median survival period was 10.6 (range, 3.7 to 28) months. The complications arising after treatment involved the catheter-port system (n=2) or were due to gastroduodenitis (n=9). Conclusion: In these patients with advanced hepatocellular carcinoma and portal vein thronbosis, combined therapy involving hepatic arterial chemoinfusion through a Chemoport？ and external irradiation achieved favorable results. Further controlled studies aimed at evaluating the prognostic factors involved are, however, required.

Catheter-tip fixation of a percutaneously implanted port-catheter system to prevent dislocation.

The aim of this study was to evaluate the incidence of catheter tip dislocation in patients with percutaneously implanted port-catheters for hepatic arterial chemotherapy with catheter tip fixation. Forty-seven patients (31 men and 16 women; mean age 66 years) with unresectable advanced liver cancers (primary liver cancer, n=19; metastatic liver cancer, n=28) underwent percutaneously implantable port-catheter system placement with the tip fixed at the gastroduodenal artery with coils and side hole opened at the common hepatic artery. In 39 patients, n-butyl cyanoacrylate (NBCA) mixed with Lipiodol was added for fixation. The position of the side hole after the indwelling port-catheter system was investigated, and the correction method in cases with catheter dislocation was determined. In 2 (25%) of the 8 patients without NBCA fixation, dislocation of the catheter was noted, in contrast to none (0%) of 37 patients with NBCA fixation. Two patients in whom NBCA was used could not undergo long-term intra-arterial chemotherapy because of hepatic arterial thrombotic occlusion which occurred after placement of the indwelling catheter, and were excluded from the evaluation. Fixation of the catheter tip with combined use of coils and NBCA--Lipiodol mixture to the gastroduodenal artery is important to prevent dislocation of the port-catheter system.

Interventional radiological procedures in impaired function of surgically implanted catheter-port systems

System-related complications in surgically implanted catheter-port systems (CPS) for intraarterial (i.a.) chemotherapy are well known. In most cases of complications, the treatment must be interrupted and the catheter-port system must be repaired surgically. We describe microinvasive interventional radiological procedures to correct some dysfunctions of CPS. Five patients with repetitive dysfunction of CPS were treated with interventional techniques. Two patients presented with perfusion impairment, one patient had a pseudoaneurysm of the hepatic artery, and two patients presented with catheter displacement. Radiological interventions included mechanical recanalization with a guidewire, vascular stenting, and correction of catheter dislocation with a goose-neck snare. In all cases, correct function of the CPS was restored. No intervention-related complications occurred and surgery was avoided. Chemotherapy could be continued for a period of 4--10 months. For some system-related complications, minimally invasive radiological interventions can be used to restore the function of CPS for i.a. chemotherapy.