Hepatic artery infusion pumps: cannulation techniques and other surgical considerations

Area of Science:

• Oncology
• Vascular Surgery
• Interventional Radiology

Background:

• Hepatic artery chemotherapy is a key treatment for liver metastases.
• Technological advancements have made long-term hepatic artery chemotherapy feasible.
• Surgical placement of infusion pumps and catheters can lead to significant morbidity.

Purpose of the Study:

• To outline critical technical considerations for safe and effective surgical placement of hepatic artery chemotherapy pumps and catheters.
• To minimize surgical complications associated with hepatic artery chemotherapy delivery.
• To ensure optimal drug delivery and reduce treatment-related morbidity.

Main Methods:

• Detailed surgical technique including gastroduodenal devascularization.
• Intraoperative fluorescein injection and postoperative scintigraphy for anatomical confirmation.
• Precise catheter tip placement at the gastroduodenal-hepatic artery junction with secure fixation.
• Routine cholecystectomy to prevent chemical cholecystitis.
• Management of intrahepatic arterial collateralization through selective vessel ligation.

Main Results:

• Meticulous attention to surgical details significantly reduces morbidity.
• Gastroduodenal devascularization and precise catheter placement minimize complications like hepatic artery thrombosis and catheter migration.
• Intraoperative and postoperative imaging confirm successful liver perfusion and catheter function.
• Routine cholecystectomy prevents chemical cholecystitis.

Conclusions:

• Careful surgical technique and anatomical consideration are paramount for safe and effective long-term hepatic artery chemotherapy.
• Minimizing surgical complications enhances patient outcomes and supports further therapeutic development.
• This approach facilitates the continued use of hepatic artery chemotherapy for liver metastases.