VASCULAR COMPLICATIONS OF TOTAL ABDOMINAL PERFUSION AND AORTIC STOP-FLOW INFUSION

During a 2 year period (1992-1993), 149 patients with advanced abdomin al cancer underwent total abdominal ischemic perfusion (TAP) and stop- flow infusion (SFI) 159 times in an attempt to achieve palliation. The se procedures and aortic stop-flow infusion require insertion of ballo on catheters into the abdominal aorta and inferior vena cava by a tran sfemoral approach. Flow is arrested for 15 minutes, during which time chemotherapeutic agents are infused into the aorta, distal to the ball oon occlusion. Femoral access is by a surgical incision. The passage o f the catheters is guided by fluoroscopy. Some tumor response was obse rved in 35% of the patients. Ten patients had major vascular complicat ions; two iliac artery aneurysms were lacerated and required emergency repair. There were two femoral artery false aneurysms that required s urgical correction, one early and one late. Aortic dissection was dete cted in four patients, but these did not require surgical intervention . Two patients had thrombosis distal to the occluded vessel, both requ ired surgical intervention. To reduce the incidence of these vascular complications we recommend: (1) a clinical and vascular laboratory eva luation before the procedure, and (2) angiography of normal flow in pa tients with underlying vascular disease. (C) 1996 Wiley-Liss, Inc.