Hemodynamic changes during a new procedure for regional chemotherapy involving occlusion of the thoracic aorta and inferior vena cava

Study Objective: To describe the hemodynamic consequences of a regional che motherapy procedure involving occlusion of the thoracic aorta and inferior vena cava (NC) by intraluminal balloons. Design: Prospective study. Setting: Operating rooms of an academic hospital. Patients: 10 patients with inoperable intraabdominal malignancy. Interventions: After the induction of general anesthesia and the insertion of a pulmonary artery catheter the patients underwent the regional chemothe rapy procedure Measurements and Main Results: Occlusion of the thoracic aorta induced an I ncrease in blood perssure (BP) and systemic vascular resistance (SVR) (41 % +/- 8 % and 80 % +/- 15% from baseline, respectively), and a 30% +/- 7% de crease in cardiac output (CO). After aortic balloon deflation at the end of the procedure, we observed a decrease in BP to baseline values, decrease i n SVR (to 62 % +/- 12% below baseline), and increase In CO (to 80% +/- 15% above baseline). Those changes resemble those described during vascular sur gery. isolated occlusion of the NC before aortic occlusion caused hemodynam ic deterioration in only three of 10 patients, suggesting incomplete obstru ction or collateral blood flow in others. Occluding the IVC while the aorta was occluded, caused minimal hemodynamic changes. Conclusions: Independent inflation of the NC balloon should not be performe d routinely because of possible unpredicted hemodynamic instability. Inferi or vena cava occlusion should always be performed after complete aortic occ lusion, because it is then that it produces negligible hemodynamic conseque nces. It is possible that a better assessment of NC occlusion after balloon inflation needs to be done by contrast injection to prevent a possible lea k of chemotherapeutic drugs. (C) 1998 by Elsevier Science Inc.