Patency Rate of Implantable Devices During Long-Term Intraaterial Chemotherapy

Abstract

Intraarterial implantable drug delivery systems have been considered as an alternative method for treating patients with unresectable liver malignancies. However, catheter problems with external implanted devices have resulted in limited application of chemotherapy. The introduction of subcutaneous devices offers an opportunity for long-term locoregional chemotherapy. Twelve external intraarterial catheters were implanted into 12 patients and 52 subcutaneously placed devices into 51 patients, all with various hepatic malignancies. Retrospective analyses comparing those two intraarterial systems were conducted taking into account the function and complication rate (hepatic artery thrombosis, infection, leaking, hemorrhage, and dislocation). The follow-up time for the external system was two to eight months (median five weeks), the thrombosis rate 33.3%, and the infection rate 25%. One instance of severe bleeding from the hepatic artery occurred during chemotherapy. One catheter dislocated. For the subcutaneously implanted intraarterial devices the follow-up time was five to forty-one months (median sixteen months), the thrombotic complication rate 17.3%, and the infection rate 7.6% (all patients with simultaneous bowel surgery). Catheter dislocation one year later required reimplantation; in 1 patient therapy had to be discontinued because of a catheter leak. The overall function rate was 71.3% with a median follow-up time of eight months. Anticoagulation therapy for subcutaneously implanted devices starting from the beginning of intraarterial chemotherapy is recommended to achieve long-term patency. No implantation should be preformed simultaneously with bowel surgery. The subcutaneously placed intraarterial devices had a higher function rate and were available for a longer period as compared with external implanted catheters.

Value of Micronester coils in port-catheter implantation for continuous hepatic arterial infusion chemotherapy with fixed catheter tip method

“…Yamagami et al [21] reported in their study of port-catheter implantation with catheter tip fixation in 128 subjects that the mean number of micro-coils used for catheter tip fixation was 4.6 and that in 93% of these procedures the addition of NBCA-Lipiodol was necessary to obtain sufficient fixation. The present study showed similar results in those cases that did not receive Micronester coils for catheter tip fixation; the mean number of used micro-coils was 4.2 (range, [1][2][3][4][5][6][7][8][9][10][11][12], and in 86% NBCA-Lipiodol was required for sufficient fixation.…”

“…In the past, such catheter placement was done by surgical laparotomy under general anesthesia [3][4][5][6], making this an invasive procedure. However, recent advancements in interventional radiological techniques allow the less invasive implantation of port-catheter systems, that is, percutaneous implantation under local anesthesia [7][8][9][10][11][12][13][14].…”

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

“…anesthesia [5,6,15]; however, the recent development of interventional techniques has made it possible to implant port-catheter systems percutaneously under local anesthesia [3,4,7,8,9,10,11,12,13,14,16,17]. Thus, attention has come to be paid to hepatic arterial infusion chemotherapy which can be performed repeatedly at the outpatient clinic via a percutaneously implanted portcatheter system for patients with advanced liver cancer as one effective treatment from the point of view of prolonging normal-quality survival [2].…”

Efficacy of the Left Gastric Artery as a Route for Catheterization of the Right Gastric Artery

“…In the past, such catheters were placed by surgical laparotomy with the patient under general anesthesia [3][4][5][6], making this procedure invasive. However, recent advancements in interventional techniques allow the implantation of port-catheter systems percutaneously with the patient under local anesthesia [7][8][9][10][11][12][13][14].…”