Percutaneous implantation of hepatic artery infusion reservoir by sonographically guided left subclavian artery puncture.

H, Oi; Kishimoto, Hiroyuki; Matsushita, Mitsunobu; Hori, Minoru; Nakamura, Hiroyasu

doi:10.2214/ajr.166.4.8610557

Cited by 33 publications

(13 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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].…”

Section: Discussionmentioning

confidence: 99%

“…Hepatic arterial occlusion occurs in between 0% [10,21] and 24% [18,19,22] of cases, and catheter occlusion occurs in between 0% [15,21] and 21% [18,19,20] of cases. The hepatic artery is more likely to occlude when the catheter tip is inside the proximal hepatic artery and anticancer agents are infused from the end hole of the catheter because the catheter tip mechanically stimulates the inner lumen of the hepatic artery and most anticancer agents are toxic to the endotherium of the artery [18].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

2004

View full text Add to dashboard Cite

The aim of this study was to verify the feasibility of using a J-tipped guidewire as a target for puncture of the subclavian artery in the placement of a reservoir port and catheter system (RPCS). Twenty-five patients with various hepatic malignancies underwent percutaneous implantation of an RPCS through the left subclavian artery for regional chemotherapy. To successfully puncture the left subclavian artery, a J-tipped guidewire was used as a target with fluoroscopic guidance. Technical success and complication rates, and numbers of puncture failures, were retrospectively analyzed. Implantation of the RPCS was successful in all patients. Eight (32%) patients had minor complications and no patient had major complications. The number of puncture failures per patient was 0 to 1 (mean=0.32). The J-tipped guidewire is a safe and appropriate target for puncture of the subclavian artery in the placement of an RPCS.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

2004

View full text Add to dashboard Cite

show abstract

“…Among various methods to implant port-catheter systems using interventional techniques [1,2,3,4,5,6,7,8,9,10,11], the procedure of Arai et al [5] (which we employ) is advantageous for long-term infusion chemotherapy. With this procedure, the frequency of hepatic arterial occlusion and catheter dislocation is low [8,9], occurring in only 5.3% [9] and 4.4% [8] of patients, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Implanted port-catheter systems for hepatic arterial infusion chemotherapy using interventional techniques have employed various access routes such as transfemoral [1,2], brachial [3,4], hypogastric [5], and subclavian [5,6,7,8] arteries. In this study we percutaneously implanted port-catheter systems via the left subclavian artery with a direct puncture technique aided by a targeting guide wire placed beforehand in the left subclavian artery.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2003

View full text Add to dashboard Cite

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.

show abstract

“…Surgical stress, the need for an adequate vascular anatomy, the risk of life-threatening complications and the irreversibility of the procedure are well known disadvantages of the surgical implant. A percutaneous transaxillary implant technique has recently been introduced into clinical practice (25)(26)(27)(28)(29)(30) and represents the solution for overcoming both patient distress and irreversibility of the traditional laparotomic procedure. Furthermore, the percutaneous procedure with embolizations of aberrant vessels allows implantation of the catheter even in the presence of several anatomical variations in the so-called standard hepatic vascular anatomy.…”

mentioning

confidence: 99%

Past, Present and Future of Long-Term Hepatic Arterial Accesses with Implantable Ports

et al. 2001

View full text Add to dashboard Cite

Intra-Arterial Hepatic Chemotherapy (IAHC) with floxuridine (FUdR) is an effective treatment for unresectable hepatic metastases from colorectal cancer, providing higher response rates than systemic treatments (1,2). The administration of IAHC requires a long-term vascular access to the hepatic arterial stream. Following a few anecdotal reports, in 1970 Watkins (3) published an extensive and detailed description of the surgical technique for implanting an indwelling catheter into the hepatic artery via the gastroduodenal artery for the administration of regional chemotherapy in patients affected by liver metastases from colorectal cancer. The original technique described the implantation of an external catheter with the tip placed into the lumen of the hepatic artery. However, a high incidence of device-related complications was reported, including catheter occlusion and vascular thrombosis. During the 80s, subcutaneous totally implantable reservoirs or infusion pumps were connected to a silicone catheter provided with a suture bead (4); the technique was modified by placing the tip of the catheter at the confluence between the gastroduodenal artery and the hepatic artery without causing any resistance to the regular arterial flow towards the liver. These changes in both the device and the surgical technique decreased the incidence of catheter occlusion, vascular thrombosis and infections, thus allowing an improvement in the results of locoregional hepatic treatments. Since then, partially or totally implantable devices with an indwelling catheter placed into the hepatic arterial stream have been extensively used for different purposes, including palliative treatment of unresectable lesions (5), adjuvant therapy after liver resection (6,7), and neoadjuvant therapy for tumor downstaging prior to surgery (8). However, the ever increasing experience in the field of surgically placed, long-term arterial accesses has been leading surgeons and oncologists to face up to the complications and limits of this approach. Complications secondary to surgically implanted arterial devices include mostly catheter occlusion and displacement (8.4% among infusion pumps and 21.6% among subcutaneous reservoirs) (9), hepatic artery thrombosis (1.4-8.1%) (9-12), device infection (1.1-4.4%) (9-12), decubitus of the catheter (11, 13), and other rare adverse events (i.e. hepatic artery-biliary fistula) (14). Furthermore, the traditional surgical technique requires a laparotomy and includes a meticolous dissection of the hepatic hilum with exposure of the hepatic arterial axis from the origin of the gastroduodenal artery up to the biforcation of the common hepatic artery and the so-called gastroduodenal de-vascularization. This approach of implanting the catheter into the hepatic artery has so far represented a significant limiting factor in an extensive application of IAHC in patients with metachronous metastatic liver disease. In such cases, indeed, an extensive surgical procedure whose only purpose is the implantation of a device may be...

show abstract

Percutaneous implantation of hepatic artery infusion reservoir by sonographically guided left subclavian artery puncture.

Cited by 33 publications

References 0 publications

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

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

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

Past, Present and Future of Long-Term Hepatic Arterial Accesses with Implantable Ports

Contact Info

Product

Resources

About