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AJR 2004; 182:1417-1426
© American Roentgen Ray Society

Complications After Percutaneous Transaxillary Implantation of a Catheter for Intraarterial Chemotherapy of Liver Tumors: Clinical Relevance and Management in 204 Patients

Massimo Venturini1, Enzo Angeli1, Marco Salvioni1, Francesco De Cobelli1, Monica Ronzoni2, Luca Aldrighetti3, Marco Stella4, Michele Carlucci5, Carlo Staudacher5, Valerio Di Carlo4, Gianfranco Ferla3, Eugenio Villa2 and Alessandro Del Maschio1

1 Department of Radiology, Scientific Institute S. Raffaele, Vita-Salute University, Olgettina 60, Milan 20132, Italy.
2 Department of Oncology, Scientific Institute S. Raffaele, Vita-Salute University, Milan 20132, Italy.
3 Department of General Surgery, First Division, Scientific Institute S. Raffaele, Vita-Salute University, Olgettina 60, Milan 20132, Italy.
4 Department of General Surgery, Second Division, Scientific Institute S. Raffaele, Vita-Salute University, Milan 20132, Italy.
5 Department of Emergency Surgery, Scientific Institute S. Raffaele, Vita-Salute University, Milan 20132, Italy.

OBJECTIVE. The purposes of the study were to evaluate the complications of patients who underwent percutaneous transaxillary implantation of a permanent catheter-port system for intraarterial hepatic chemotherapy and determine their clinical relevance and specific management.

SUBJECTS AND METHODS. Catheter-port systems were placed in 204 patients with liver tumors (86.7% from colorectal metastases). Under sonographic and fluoroscopic guidance, a 5.8-French catheter was placed in the hepatic artery and connected to a subcutaneous reservoir after embolization of the gastroduodenal and right gastric arteries. Floxuridine plus dexamethasone and systemic low-dose heparin were administered. During the follow-up period, complications were classified as clinically not significant (type 1), clinically significant not requiring interruption of intrahepatic chemotherapy (type 2), clinically significant needing temporary suppression of intrahepatic chemotherapy (type 3), and clinically significant causing permanent suppression of intrahepatic chemotherapy (type 4).

RESULTS. No complications occurred during the implantation procedures. The mean number of intrahepatic chemotherapy cycles was 8.1. The mean follow-up period was 270 days. Primary and secondary patency rates of the system were 71.6% and 91.2%, respectively. Temporary suppression of intrahepatic chemotherapy was necessary in 19.6% of the patients and definitive suppression, in 8.8%. Hepatic artery thrombosis, not recanalized by local thrombolysis, was the main cause of permanent intrahepatic chemotherapy interruption (4.4%). Catheter occlusions and cerebral complications were not observed. In 91.2% of the patients, intrahepatic chemotherapy could be completed.

CONCLUSION. Percutaneous implantation of a removable and reimplantable catheter-port system for intrahepatic chemotherapy can be a safe procedure to treat unresectable liver metastases from colorectal cancer. Technical and pharmacologic complications with variable clinical relevance occurred, and various specific management strategies were necessary to reduce their incidence.


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