Hepatic artery access ports: Recognizing and avoiding the problems

Background: Regional approaches to the management of hepatic tumours are ap propriate in some clinical situations and include hepatic arterial chemothe rapy (HAC) and selective internal radiation therapy (SIRT). Both require ac cess to the hepatic artery, which is conveniently achieved with a subcutane ously placed port. Placement and use of these ports may be associated with a variety of technical problems which can impact adversely on the outcome o f the treatment. The present paper outlines the problems related to port us age for regional hepatic therapies, with emphasis on the technical aspects of insertion and interpretation and management of subsequent problems. Methods: Hepatic artery port placement was attempted in 129 patients for us e with either SIRT and/or I-IAC. Ports were used or flushed at monthly inte rvals. Results: Successful port insertion was achieved in 127 patients, of whom 87 received HAC alone, seven received SIRT alone, 28 patients received both a nd in five patients the port was never used. Methylene blue injection was u sed to identify anomalous arterial anatomy, which was found in 26 of 95 pat ients (27%), and significant extrahepatic 'access', which was seen in 25 pa tients (26%) after initial placement. Forty-six instances of technical prob lems preventing continued use of the port occurred in 43 patients after a m edian of 4 (0-36) cycles of chemotherapy, including hepatic artery thrombos is (n = 26), catheter blockage (n = 4), duodenal fistula (n = 3), gastroint estinal (GI) bleeding (n = 3), side-effects (n = 3), access problems (n = 3 ), extravasation (n = 3) and infection (n = 1). Conclusion: Methods used to identify, manage and in some instances prevent the occurrence of these problems are discussed.