Percutaneous implantation of a catheter with subcutaneous reservoir for intraarterial regional chemotherapy: Technique and preliminary results

Purpose: We present the technique and the preliminary results of percutaneo us implantation of intraarterial catheters connected to a subcutaneous infu sion reservoir for prolonged regional chemotherapy of hepatic and extrahepa tic tumors. Methods: Two hundred patients with primary or secondary hepatic neoplasms, pelvic, pancreatic, renal, lingual, and breast cancer underwent the procedu re. The access was the left axillary artery (188 patients) and the femoral artery (12 patients). The catheter tip was placed in the hepatic (170 patie nts), hypogastric (18), splenic (4), internal thoracic (2), gastroduodenal (3), renal (2) or the external carotid artery (1). The catheter was connect ed to a subcutaneous reservoir and filled with heparin; chemotherapeutic in fusion was subsequently started. Results: One hundred percent immediate technical success was obtained. Fort y-three of 200 (21.5%) patients had a complication: 29 patients had a cathe ter dislodgment, nine had arterial thrombosis, three had a pseudoaneurysm o f the left axillary artery and two had a port pocket hematoma. Most complic ations (37/43, 86%) were treated percutaneously without interruption of che motherapy. In only six cases (3% of the total population) was chemotherapy discontinued due to the complication itself. The mean duration of catheter patency was 7.2 months. Conclusion: Percutaneous placement of an intraarterial catheter is feasible and causes less discomfort to the patient than the surgical approach. The technique has an acceptable complication rate (21.5%), similar to that for surgical implantation (17.8%), with the advantage that in most cases the co mplications can be resolved percutaneously, This technique represents an al ternative to surgical implantation in the treatment of liver metastases fro m colorectal cancer and opens new therapeutic possibilities for the local p rolonged treatment of other kinds of tumor, though its clinical efficacy mu st be assessed in selected trials.