Transcatheter management for multiple liver tumors after hepatic artery obstruction following reservoir placement.

BACKGROUND/AIMS: Hepatic arterial infusion chemotherapy via an implantable port system has been widely used to treat unresectable liver neoplasms. Complications of the hepatic artery occlusion following reservoir placement, however, makes it impossible to continue the infusion therapy. The purpose of our study was to assess the possibility of transcatheter treatment after the hepatic artery obstruction following reservoir placement.

METHODOLOGY: Between April 1999 and May 2002, 14 patients with liver tumors had the complication of hepatic artery obstruction following reservoir placement. We conducted a prospective trial to assess 1) the collateral pathways of feeding artery using angiography, 2) the possibility of transcatheter treatment or 3) re-reservoir placement for liver tumors.

RESULTS: 1) Angiography revealed that the main collateral pathway of the feeding artery was the inferior phrenic artery in 7 patients (50%), the dorsal pancreatic artery in 4 patients (29%) and the anastomotic branch of the celiac axis in 1 patient (7%). The main collateral pathway could not be detected in 2 patients (14%). 2) Transcatheter treatment was successfully performed in all patients (100%). 3) Rereservoir placement failed in all cases.

CONCLUSIONS: These results suggest that transcatheter treatment may be possible for patients with hepatic artery obstruction.