Hepatic arterial catheterization combining interventional radiological and laparotomic approaches.

Background and Objectives This report describes a modified method of implanting a catheter-port system for hepatic arterial infusion chemotherapy (HAIC) that combines interventional radiological (IVR) and laparotomic approaches. Methods and Results In patients, scheduled for HAIC and laparotomic surgery, we now employ a modified method of implanting the catheter-port system. In our method, an IVR approach is used to implant the catheter-port, and arterial occlusions are primarily carried out using a laparotomic approach. Following celiac and superior mesenteric arteriographies, a tapered microcatheter with a side hole is inserted by a catheter exchange method. The catheter tip is advanced far into the gastroepiploic artery via the gastroduodenal artery (GDA). The side hole is located at the orifice of the proper hepatic artery, and its location is confirmed by injection of contrast media. The microcatheter is connected to the port, and the port is buried in the subcutaneous pocket. During the laparotomy stage, the GDA lumen and the catheter lumen are clipped, and the right gastric artery (RGA) and all small branches supplying the stomach, duodenum, and pancreas are ligated. Among the 13 patients successfully implanted with a port-catheter system using our combined approach, no patients had hepatic artery occlusion or occlusion of the catheter system. Conclusions Initial results from a study of a new method of implanting a microcatheter-port system in the hepatic artery using combined IVR and laparotomic approaches suggest that this method may enable operators to avoid complicated selective coiling and may lower the incidence of hepatic artery occlusion in patients receiving long-term HAIC. J. Surg. Oncol. 2004;88:256–260. © 2004 Wiley-Liss, Inc.