Arterial complications from long-term hepatic artery chemoinfusion catheters: evaluation with CT

The purpose of this study was to define CT changes in the common hepatic artery and the porta hepatis caused by complications of long-term placement of a catheter in the hepatic artery for infusion of chemotherapeutic agents via a surgically implanted pump or port.

We retrospectively reviewed abdominal CT scans of 115 patients before and after placement of a catheter into a hepatic artery for chemoinfusion, with special attention to the common hepatic artery and the porta hepatis. The changes seen on CT scans were correlated with clinical findings and other imaging findings (arteriography and radionuclide scanning) in patients who had symptoms related to catheters and pumps, including pain during treatment, persistent pain without apparent cause, or occlusion of the catheter.

CT scans of 20 patients (17%) showed changes along the common hepatic artery. Five had rounded, low-density fluid collections around the tip of the catheter, believed to be caused by extravasation of chemotherapeutic agents or heparin. Five had well-defined soft-tissue densities along the hepatic artery, where the tip of the catheter was located; these were thought to be caused by dissection of the artery with periarterial fibrosis. Ten had poorly defined areas of low density along the vessel, which may have been caused by periarterial edema, arteritis, or extravasation of the chemotherapeutic agents. Two patients had pain on injection through the device, but no changes were seen on CT scans. Fourteen of 16 patients who had symptoms related to infusion catheters had CT changes in the porta hepatis.

Fluid collections and soft-tissue densities around the tip of the catheter and along the hepatic artery seen on CT scans of patients who had surgical placement of catheters for chemoinfusion should be recognized as possible complications from the treatment and lead to further study to confirm the diagnosis.