Transcatheter embolization for the treatment of misperfusion after hepaticartery chemoinfusion pump implantation

Background: The use of surgically implanted chemoinfusion pumps for the tre atment of hepatic metastases from colorectal carcinoma can be complicated b y intra- or extrahepatic misperfusion. This may result in suboptimal tumor exposure to the chemotherapeutic agent and injury to other gastrointestinal organs. Misperfusion can be managed by selective arterial transcatheter em bolization. Methods: Between 1989 and 1996, 16 patients with liver metastases from colo rectal carcinoma and with hepatic artery chemoinfusion pump misperfusion we re treated using transcatheter coil embolization. Six female and 10 male pa tients (age range, 34-84 years; median, 51.5 years) were identified by retr ospective review of the records of the Department of Interventional Radiolo gy, After pump placement, abnormal liver perfusion scan or methylene blue e ndoscopy study results prompted angiography with coil embolization. After e mbolization, the imaging studies were repeated and patients were monitored in the Oncology Clinic. Results: Eight patients exhibited intrahepatic misperfusion (group 1) and e ight extrahepatic misperfusion (group 2). Coil embolization was immediately successful in 100% of patients in group 1, with restoration of normal hepa tic perfusion, and in 75% in group 2. There were no immediate procedure-rel ated complications. Follow-up periods ranged from 1 to 23 months (median, 1 3.5 months). Embolization was unsuccessful for two patients (in group 2), w ho tolerated a modified chemotherapeutic regimen, with follow-up periods of 18.5 and 22 months. Conclusions: Transcatheter coil embolization is the therapy of choice for t he management of hepatic artery chemoinfusion pump misperfusion. It is rapi d, effective, and well tolerated by patients and obviates the need for addi tional surgical intervention.