Clinical study
Percutaneous Femoral Implantation of an Arterial Port Catheter for Intraarterial Chemotherapy: Feasibility and Predictive Factors of Long-term Functionality

https://doi.org/10.1016/j.jvir.2010.08.003Get rights and content

Purpose

To evaluate the feasibility, functionality, and dysfunctions of an arterial port catheter implanted via the femoral artery.

Materials and Methods

From November 2001 to May 2008, 93 consecutive patients (mean age 57 years old) with unresectable hepatic colorectal metastases were referred for intraarterial chemotherapy. The arterial port catheters were percutaneously implanted via the femoral artery. The catheter tips were placed as “free-floating” in the common hepatic artery (technique 1), “fixed” in the gastroduodenal artery (technique 2), or inserted in a segmental hepatic artery (technique 3). Embolization of the right gastric artery was always attempted.

Results

The technical success rate of the femoral approach was 94% (n = 88 of 93). Intraarterial chemotherapy (average 7.3 courses) was administered to 84 patients. Migration and occlusion of the catheters occurred in 12% (n = 10 of 84) and 11% (n = 9 of 84) of patients, and extrahepatic perfusion occurred in 30% (n = 25 of 84) of patients. Catheter migration occurred significantly more frequently with technique 1 (50%; n = 3 of 6) than with technique 2 (11%; n = 7 of 64; P = .03) or technique 3 (0%; n = 0 of 14; P = .02). Occurrence of gastroduodenal ulcerations was significantly lower (P = .01) when embolization of the right gastric artery was performed (8%; n = 4 of 48) than when it was not (28%; n = 11 of 36). The success rate of embolization of the right gastric artery significantly improved (P = .006) from the first half of patients treated to the second half, resulting in a significant (P = .02) decrease in the occurrence of ulcerations from 28% (n = 12 of 42) in the first half of patients treated to 7% (n = 3 of 42) in the second half.

Conclusions

Percutaneous femoral placement of an arterial port catheter is highly feasible. Right gastric artery embolization and use of techniques 2 and 3 are good predictive factors for long-term functionality.

Section snippets

Materials and Methods

Data from a series of 93 consecutive patients who underwent percutaneous implantation of an arterial port catheter in our hospital from November 2001 to May 2008 were retrospectively analyzed.

Catheter Implantation

The overall technical success rate of catheter implantation was 98% (n = 91 of 93).

Discussion

Advances in minimally invasive techniques have allowed the percutaneous femoral implantation of a catheter for intraarterial chemotherapy under local anesthesia. The catheter implantation success rate has been reported to be 90%–100% in the literature (8, 9, 10, 11, 12, 13).

In our experience, failure of percutaneous implantation occurred in only two cases (2%), including one that could not be overcome by surgical placement. Our experience indicates that today when intraarterial chemotherapy is

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    None of the authors have identified a conflict of interest.

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