Liver Intraarterial Chemotherapy: Use of the Femoral Artery for Percutaneous Implantation of Catheter-Port Systems

Abstract

To provide intraarterial chemotherapy of the liver in 30 outpatients with colorectal cancer metastases and other malignancies, 32 catheter-port systems were implanted percutaneously via the femoral artery. Mean patency was 229 days. Percutaneous placement was feasible and safe. Compared with surgical placement, the overall complication rate (12%) was comparable or less.

J-tipped guidewire as a target for puncture of the subclavian artery in the placement of a reservoir port and catheter system

“…A percutaneously implanted port and catheter system is used and has proved to be advantageous for external chemotherapy [9,10,11,12,13]. The sites of catheter placement include the brachial, axillary, subclavian, and femoral arteries [9,10,11,12,13,14,15].…”

“…The sites of catheter placement include the brachial, axillary, subclavian, and femoral arteries [9,10,11,12,13,14,15]. Percutaneous implantation of RPCS has several theoretical advantages: (a) patients do not undergo laparotomy; (b) procedure can be performed in outpatients; (c) occlusion of nontarget arteries can be performed to minimize gastroduodenal complications; (d) dislodged catheter can be replaced; (e) and costs and invasiveness are lower [10,16,17]. Radiologic placement does not allow performance of preventive cholecystectomy to avoid cholecystitis, but this does not seem to be a crucial problem [10,18].…”

“…Dislocation is one major problem and occurs in between 0 [5] and 36% [18,19] of cases. The frequency of dislocation appears to be particularly high when the axillary or brachial artery is used [10,19,20]. Catheter-related dislocation could also be due to the catheter material, which should not be too soft and flexible.…”

Interventional management of gastroduodenal lesions complicating intra-arterial hepatic chemotherapy

“…We used the technique described by Herrmann et al [4]. The common femoral artery is punctured using the Seldinger technique and the catheter advanced to the celiac trunk to assess the anatomy and possible variant hepatic arterial supply.…”

“…Chemotherapeutic agents administered arterially will be extracted mainly by the liver, thus reducing systemic toxicity [2,3]. Intra-arterial hepatic catheters can be placed surgically or percutaneously [4]. The most common site of surgically implanted catheter systems is the gastroduodenal artery (GDA) [5], whereas in the percutaneous approach a catheter is placed in the most suitable hepatic artery and may be associated with the embolization of the GDA and other aberrant hepatic arteries [4].…”