SINGLE CATHETER TECHNIQUE OF HEPATIC VENOUS ISOLATION AND EXTRACORPOREAL CHARCOAL HEMOPERFUSION FOR MALIGNANT LIVER-TUMORS

BACKGROUND: A Single catheter technique of hepatic venous isolation an d charcoal hemoperfusion (HVI-CHP) using a 4-lumen/2-balloon (4L-2B) c atheter was developed to perform high-dose intra-arterial chemotherapy of the liver, Herein we report the technique, safety, and pharmacokin etics of this system in comparison with the original double-balloon te chnique, PATIENTS AND METHODS: Sixteen patients with malignant liver t umors were treated by hepatic arterial infusion (HAI) with adriamycin at a dose of 100 mg/m(2) under HVI-CHP. Seven patients underwent HVI-C HP by the double-balloon technique (group A), in which filtered hepati c effluent and the rest of the inferior vena caval blood were separate ly drawn and returned to the left axillary vein. The other nine patien ts were treated by the single catheter technique (group B). In group B , hepatic effluent was isolated by balloon inflations and directed to fitters through fenestrations of one major lumen of a 4L-2B catheter. The filtered blood was returned straight to the right atrium through t he other major lumen of the catheter, RESULTS: All patients in group A had a smooth stepwise induction of HVI-CHP, whereas one of nine patie nts in group B developed severe hypotension requiring interruption of HVI. The hepatic venous flow rate in group B during HVI-CHP was signif icantly higher than that in group A (P < 0.05). Systemic adriamycin ex posure, as assessed by the area under the time concentration curve in systemic serum, was significantly higher in group A compared to that i n group B (P < 0.01). CONCLUSION: The single catheter technique is hem odynamically tolerable and feasible in the majority of patients with m alignant liver tumors, In view of systemic drug exposure, the single c atheter technique is superior to the original double balloon technique . (C) 1997 by Excerpta Medica, Inc.