Hepatic arterial chemotherapy: role of angiography.

Abstract

Hepatic arterial infusion chemotherapy increases the hepatic concentration of chemotherapeutic agents without increasing systemic toxicity. Both percutaneous (most commonly left transbrachial) and surgical approaches are currently used for infusion catheter placement. Surgical catheter and pump placement has proved to be a reliable means of delivering drugs to the liver and has been commonly used for hepatic arterial chemotherapy for metastatic colorectal carcinoma. Meticulous angiographic evaluation of the hepatic vascular anatomy, its variations, and hemodynamics is necessary for correct catheter placement to achieve total liver perfusion without significant extrahepatic perfusion. Satisfactory hepatic perfusion should be documented before drug infusion. Hepatic arterial radionuclide flow imaging with technetium-99m-labeled macroaggregated serum albumin remains the most reliable means of assessing hepatic perfusion following catheter placement. Transcatheter techniques have been used to facilitate catheter placement, to prevent gastrointestinal drug toxicity, and to correct unsatisfactory perfusion following surgical catheter placement.

Transcatheter Embolization for the Treatment of Misperfusion After Hepatic Artery Chemoinfusion Pump Implantation

“…2 The use of intravenously administered fluoropyrimidine agents is associated with systemic side effects that can be diminished by directed hepatic administration. 2,7 However, this route is associated with other side effects, including hepatobiliary and extrahepatic toxicity, catheter-related complications, and pump misperfusion. 3,4,8,9 The direct toxic effect of these agents may be diminished by the addition of dexamethasone to the chemotherapeutic regimen.…”

Intra-arterial infusion of N-isopropyl-p[123I]iodoamphetamine for assessing effective blood supply to pulmonary and hepatic neoplasms

“…These count and concentration ratios were interconnected by an experimental study by SPECT using the liver, tumor and body phantoms. 28 On the other hand, Raoul et al noted that the T/L ratio in 23 cases of HCC was 4.3 ± 2.6 by planar scintigrams 24 hours after the arterial infusion of iodine-131-labeled lipiodol ultra-fluid. 29 In patients with hepatic metastases, the mean T/L ratio was 1.4 ± 0.7 at 2 minutes after the administration of 123 I-IMP.…”

“…Partial or complete hepatic arterial thrombosis and catheter thrombosis have been reported as the major causes of unsatisfactory perfusion after surgical placement for hepatric chemotherapy. [21][22][23] From this point of view, there is the possibility that stenosis of the catheter tip due to athrombus or arterial thrombosis adjacent to the catheter might have been overestimated in the s9mTc-MAA study. In the other 2 cases, the left lobe of the liver was not visualized in 99 mTc-MAA scintigraphy but it was seen in 123 I-IMP scintigraphy.…”

“…The occurrence of laminar flow in the hepatic artery, which may result in poor mixing of the infusate and the blood, might explain these findings. [22][23][24][25] The distribution of 91-Tc-MAA might be influenced by arterial flow and inadequate mixing in the blood because of its larger molecular weight than that of 1231-IMP.…”