Mixing problems of low flow hepatic artery infusion. Improvement with small caliber double lumen balloon catheters

The problem of inhomogeneous mixing encountered during hepatic artery (HA) chemotherapy infusion was assessed and a practical solution examined. A glass model of the human HA distribution was used to determine mixing homogeneity of low flow (1.4 mL/minute) dye infusion into pulsatile flow (280-300 mL/minute) of a fluid isoviscous to blood. Dye concentration in each of 16 HA branches was determined by photospectrometry. Dye infusion was carried out through 2-2.5F double lumen end hole or proximal side hole balloon catheters without balloon inflation, with balloon inflation maintaining full HA flow, and with the balloon inflated so that HA flow was reduced by 50%. The measurements taken without balloon inflation showed gross inhomogeneity of dye concentration in various branches. The inhomogeneity was not improved during balloon inflation as long as full HA flow was maintained. After balloon inflation reduced HA flow by 50%, dye mixing was improved significantly, with infusion through side hole catheters (alpha = .002) but not significantly (alpha = .2) with infusion through end hold catheters. This investigation suggests that the proposed technique might be useful for clinical application and deserves further evaluation in an in vivo system.