Reconstruction of replaced right hepatic artery, to implant a single-catheter port for intra-arterial hepatic chemotherapy.

Intra-arterial hepatic chemotherapy using an implantable subcutaneous port with a catheter inserted into the gastroduodenal artery is an acceptable treatment for patients with isolated, nonresectable liver metastases from colorectal cancer. Because of the common variations of hepatic arterial anatomy occurring in about one-half of the patients, this technique will result in complete perfusion of both hepatic lobes only in those with "classical" arterial anatomy (Michels type I). Many techniques have been described in these situations, usually using a dual-catheter port with the attendant risk of hepatic misperfusion and arterial thrombosis. We herein describe an alternative technique applicable to patients with a right hepatic artery arising from the superior mesenteric artery. In this technique the right hepatic artery is anastomosed end-to-end with the gastroduodenal artery, followed by implantation of a single-catheter port that is inserted into the splenic artery.