RECONSTRUCTION OF REPLACED RIGHT HEPATIC-ARTERY, TO IMPLANT A SINGLE-CATHETER PORT FOR INTRAARTERIAL HEPATIC CHEMOTHERAPY

Intra-arterial hepatic chemotherapy using an implantable subcutaneous port with a catheter inserted into the gastroduodenal artery is an acc eptable treatment for patients with isolated, nonresectable liver meta stases from colorectal cancer. Because of the common variations of hep atic arterial anatomy occurring in about one-half of the patients, thi s technique will result in complete perfusion of both hepatic lobes on ly in those with ''classical'' arterial anatomy (Michels type I). Many techniques have been described in these situations, usually using a d ual-catheter port with the attendant risk of hepatic misperfusion and arterial thrombosis. We herein describe an alternative technique appli cable to patients with a right hepatic artery arising from the superio r mesenteric artery. In this technique, the right hepatic artery is an astomosed end-to-end with the gastroduodenal artery, followed by impla ntation of a single-catheter: port that is inserted into the splenic a rtery.