Percutaneous assisted venous return isolated limb perfusion

Isolated limb perfusion (ILP) is a short term therapy used in conjunction with or without hyperthermia to deliver chemotherapeutic agents to localized areas, thus avoiding the severity of side effects caused by systemic administration. The most common treatment approach is hyperthermic isolated limb perfusion (HILP) with increased oxygenation of the chemotherapeutic perfusate for treatment of melanoma, soft tissue sarcoma, or synovial sarcoma. HILP traditionally involves open surgical dissection and direct cannulation. This approach involves significant morbidity including blood loss, infection, and nerve and blood vessel trauma. Isolated limb infusion (ILI) has been proposed as a less invasive procedure to reduce the morbidity and isolation complications of ILP. However, the warming and recirculation rates of ILI are inferior to traditional ILP. We describe a minimally invasive technique of angiographically placed percutaneous cannulae with vacuum assisted return for HILP. The extracorporeal circuit is comprised of a traditional hardshell oxygenator/reservoir and accommodates all acid base management strategies. This technique allows superior circulation of chemotherapeutic agents with minimal morbidities and can be performed on an outpatient or limited stay basis.