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Unsatisfactory hepatic perfusion after placement of an implanted pump and catheter system: angiographic correlation
J C Andrews1, D M Williams, K J Cho
1Department of Radiology, University of Michigan Medical School, Ann Arbor 48109-0030.
Insights
Angiography helps define causes of poor hepatic artery perfusion after pump placement. This imaging is crucial for guiding treatment when initial scans show unsatisfactory results.
Area of Science:
- Interventional Radiology
- Vascular Imaging
- Hepatic Artery Interventions
Background:
- Implanted pump and catheter systems are used for hepatic artery therapies.
- Hepatic artery perfusion scintigraphy is the initial method to assess perfusion.
- Unsatisfactory perfusion requires further investigation to identify the cause.
Purpose of the Study:
- To evaluate the role of angiography in defining causes of unsatisfactory hepatic artery perfusion.
- To determine the effectiveness of selective angiography and digital subtraction angiography (DSA) in this patient subset.
Main Methods:
- Thirty-five patients with unsatisfactory hepatic artery perfusion on scintigraphy were studied.
- Selective angiography (33 cases) and DSA (6 cases) were performed.
- Contrast injection via the pump side port was utilized in DSA procedures.
Main Results:
- The cause of unsatisfactory perfusion was identified in 34 of 35 patients.
- Hepatic artery thrombosis and extrahepatic collateral flow each accounted for 14 cases.
- Catheter malposition and inadequate hepatic artery length were identified in 4 and 2 cases, respectively.
Conclusions:
- Angiography is essential for diagnosing perfusion defects after implanted pump placement.
- It plays a critical role in managing patients with unsatisfactory hepatic artery perfusion identified by scintigraphy.
Abstract:
Thirty-five patients with scintigrams showing unsatisfactory hepatic artery perfusion after surgical placement of an implanted pump and catheter system were examined with selective angiography (33 cases) or digital subtraction angiography (DSA) during which the contrast material was injected through the side port of the pump (six cases). In 34 of 35 cases, the cause of the unsatisfactory (either extrahepatic or incomplete) hepatic perfusion was defined. DSA was definitive in only two cases, in which extrahepatic flow through collateral vessels was demonstrated. The cause of the perfusion defect was hepatic artery thrombosis in 14 cases, extrahepatic flow through collateral vessels in 14 cases, a misplaced catheter in four cases, and a short proper hepatic artery without adequate length for mixing in two cases. Although hepatic artery perfusion scintigraphy is the primary tool for evaluation of hepatic perfusion after catheter placement, angiography plays an important role in treating the subset of patients with unsatisfactory hepatic perfusion.