Treatment of hepatic metastases by transaxillary hepatic artery chemotherapy using an implanted drug pump

Abstract

The feasiliby of integrating an implantable, refillable drug infusion pump [for the administration of anticancer chemotherapeutics] with transaxillary angiographic hepatic arterial catheterization was studied. The implantation is performed under local anesthesia in the radiology suite. A 2-3 cm incision in the left upper arm is made through skin and s.c. tissue. Through an axillary artery puncture, a 5.3F polyethylene catheter is fluoroscopically placed into the hepatic artery. To minimize gastroduodenitis, the gastroduodenal artery is occluded with a Gianturco coil and Gelfoam. The Model 400 Infusaid pump is implanted in the upper chest and attached s.c. to the angiography catheter using a friction connector. Patients are discharged 2-3 days later. Over a 2 yr period, 20 such implants were performed. Floxuridine (FUdR) has been used by continuous infusion; mitomycin-C (MMC) and 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) by intermittent intra-arterial infusion. The pump/catheter system has been left in place for as long as 18 mo. Partial responses in colorectal [cancer] cases are as follows: FUdR, 4 of 9 patients; MMC, 2 of 3; FUdR + MMC; 1 of 1; FUdR + MMC + BCNU; 3 of 3. No arm vascular complications, hepatic arterial occlusions, peripheral emboli, pump malfunctions or catheter occlusions took place over a total experience of 3210 patient days. Three catheter migrations occurred requiring repositioning in 2 patients; 3 cracked catheters required replacement. This innovative approach offers a comfortable, convenient method for long-term ambulatory hepatic arterial chemotherapy obviating laparotomy and extra-corporeal pumps.