Arterial embolization for salvage of hepatic artery infusion pumps Journal Article

  


Authors: Sofocleous, C. T.; Schubert, J.; Kemeny, N.; Covey, A. M.; Brody, L. A.; Getrajdman, G. I.; Thornton, R.; Winston, C.; Brown, K. T.
Article Title: Arterial embolization for salvage of hepatic artery infusion pumps
Abstract: PURPOSE: Hepatic artery infusion pumps (HAIPs) ideally provide for homogenous perfusion of the liver with chemotherapeutic agents. Perfusion of extrahepatic organs or asymmetric liver perfusion (ie, "misperfusion") is diagnosed by nuclear scintigraphy and precludes the use of HAIPs. The purpose of this study is to report experience in salvaging HAIPs with arterial embolization. MATERIALS AND METHODS: A single-center HAIP database was retrospectively reviewed for cases from 1999 to 2005 to identify patients who underwent angiography to treat misperfusion documented by nuclear scintigraphy. Patient demographics, nuclear scintigraphic findings before and after embolization, angiographic findings, embolization variables, and outcomes were recorded. Technical success (defined by cessation of flow to the vessel responsible for misperfusion) and clinical success (ie, successful use of the pump) were calculated. RESULTS: During the study period, 475 HAIPs were implanted. Of those, 43 (9%) had abnormal nuclear scintigraphic findings of misperfusion, but only 32 (7%) had angiographic abnormalities. In eight of 32 cases, hepatic arterial thrombosis and extravasation at the catheter tip were found, which precluded salvage by embolization. In 24 of 32 cases, a vessel presumed responsible for the misperfusion was identified and targeted for embolization. Technical success and clinical success were achieved in 21 of 24 patients (87.5%) and 19 of 24 patients (79%), respectively, who underwent 27 embolization procedures. The three technical failures (12.5%) were the result of inability to catheterize the identified vessel. CONCLUSIONS: Percutaneous arterial embolization of a vessel to correct misperfusion shown by nuclear scintigraphy is safe and effective. This approach can be expected to result in HAIP salvage in the majority of patients. © SIR, 2006.
Keywords: adult; clinical article; controlled study; treatment outcome; middle aged; retrospective studies; artificial embolism; antineoplastic agents; liver neoplasms; methodology; antineoplastic agent; colorectal cancer; metastasis; pathology; retrospective study; postoperative complication; colorectal neoplasms; postoperative complications; liver; colorectal tumor; liver tumor; device; scintiscanning; conventional angiography; intraarterial drug administration; infusions, intra-arterial; radiography; bile duct carcinoma; technique; embolization, therapeutic; angiography; hepatic artery; scintigraphy; implantation; infusion pumps, implantable; infusion pump; liver perfusion; extravasation
Journal Title: Journal of Vascular and Interventional Radiology
Volume: 17
Issue: 5
ISSN: 1051-0443
Publisher: Elsevier Science, Inc.  
Date Published: 2006-05-01
Start Page: 801
End Page: 806
Language: English
DOI: 10.1097/01.rvi.0000217937.81939.18
PUBMED: 16687745
PROVIDER: scopus
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-33745031572&partnerID=40&md5=61aee8feeeed470618f9eb07c8cc7418
Notes: --- - "Cited By (since 1996): 3" - "Export Date: 4 June 2012" - "CODEN: JVIRE" - "Source: Scopus"
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MSK Authors
  1. George I Getrajdman
    118 Getrajdman
  2. Anne Covey
    165 Covey
  3. Lynn Brody
    119 Brody
  4. Karen T Brown
    178 Brown
  5. Corinne B Winston
    26 Winston
  6. Constantinos T Sofocleous
    244 Sofocleous
  7. Raymond H Thornton
    84 Thornton
  8. Nancy Kemeny
    543 Kemeny
  9. Johanna Schubert
    12 Schubert
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