Evaluation of percutaneous unilateral trans-femoral implantation of side-hole port-catheter system with coil only fixed-catheter-tip for hepatic arterial infusion chemotherapy

Jungang Hu, Xu Zhu, Xiaodong Wang, Guang Cao, Xiao Wang, Renjie Yang, Jungang Hu, Xu Zhu, Xiaodong Wang, Guang Cao, Xiao Wang, Renjie Yang

Abstract

Background: The technique for arterial infusion chemotherapy (HAIC) is not standardized which limits its widely application. The aim of this study was to evaluate the long-term functionality and complications of port-catheter system using percutaneous unilateral trans-femoral implantation with coil only fixed-catheter-tip method.

Methods: From January 2013 to January 2017, 205 consecutive patients (138 men; aged 28-88 years; mean, 59.1 ± 11.2 years) with unresectable malignant liver tumors underwent percutaneous implantation of side-hole infusion port-catheter into hepatic artery using coil only fixed-catheter-tip method via the unilateral femoral artery. Technical success, procedure time, duration of port functionality, and complications of port dysfunction were investigated.

Results: Implantation technical success was 98.5% and the procedure time was 59.1 ± 10.2 min. Predictable functionality of the port-catheter system at 6-, 12-, and 24 months were 97.5, 89.9, 70.5%, respectively. Complications of port irreversible dysfunction were hepatic artery obstruction (4.0%), catheter occlusion (3.5%), and catheter dislocation (0.5%). Median 5 HAIC cycles (range: 1-14 cycles) were received via port.

Conclusion: Percutaneous unilateral trans-femoral implantation of a side-hole port-catheter with coils only fixed-catheter-tip method is a simple and feasible interventional technique for HAIC which offers long-term functionality.

Keywords: Femoral artery; Fixed catheter tip; Hepatic arterial infusion chemotherapy; Hepatic metastasis; Hepatic tumor; Interventional oncology.

Conflict of interest statement

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this retrospective study formal consent is not required.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig.1
Fig.1
a. Schematic of percutaneous implantation of side-hole port-catheter system with coil-fixed-catheter-tip. CA = coeliac axis; CHA = common hepatic artery; GDA = gastroduodenal artery; PHA = proper hepatic artery; RGA = right gastric artery; SpA = splenic artery. b. Distal part of the indwelling catheter with side hole (white arrowhead) 5 cm to catheter tip
Fig. 2
Fig. 2
Location of skin access site and implanted port. a. Needle tip indicates skin incision access site ~ 1 cm above inguinal skin fold; b. Forcep head tip (same site as needle tip) indicates skin incision site with fluoroscopic image. c, d. Implanted port situated 2 cm medial to the antero-superior iliac crest, the lowest loop of the indwelling catheter (yellow dotted line) located above the inguinal site (c), and at the upper half portion of femur head (white arrowhead) on fluoroscopic image
Fig. 3
Fig. 3
Embolization of extrahepatic arteries and Hepatic artery redistribution embolization. a. Selective right gastric arteriogram from left hepatic artery shows right gastric artery (white arrows), embolized with microcoils; b. Left hepatic arteriogram showed accessory left gastric artery (black arrows) arising from left hepatic artery; c. Accessory left gastric artery (black arrows) was selectively catheterized and embolized with coils; d. Proper hepatic arteriogram shows whole hepatic artery without extrahepatic supplies. Black arrowheads refer to coils embolized in the accessory left gastric artery and right gastric artery. e. Celiac arteriogram indicates replaced left hepatic artery (black arrows) arising from left gastric artery. Black dotted arrows indicate right gastric artery. f. Replaced left hepatic artery (black arrows) selectively catheterized and embolized with microcoils. Right gastric artery was embolized with microcoils (black dotted arrow). g. Proper hepatic arteriogram from side hole (black arrowhead) of indwelling catheter shows whole hepatic arterial flow including right hepatic artery and the redistributed left hepatic artery (black arrows). h. CBCT-proper hepatic arteriogram shows contrast enhancement of the entire liver
Fig.4
Fig.4
a. Fluoroscopic image shows microcatheter (black arrows) inserted coaxially through side hole (white arrowhead) of indwelling catheter to gastroduodenal artery outside distal part of indwelling catheter (white arrows); b. Fluoroscopic image shows that tip of indwelling catheter (black arrowhead) is fixed to gastroduodenal artery with microcoils (white arrowheads); c. Fluoroscopic image shows that microcatheter (black arrows) coaxially passed through inside lumen of indwelling catheter tip (black arrowhead); d. Microcoil (black arrows) embolized to occlude the inside lumen of the distal tip of the indwelling catheter (white arrowheads)
Fig. 5
Fig. 5
Pushing indwelling catheter careful 1-2 cm within femoral artery to obtain sufficient curve (b black arrowheads) of the catheter from a straight line (a white arrowheads) in the aort
Fig. 6
Fig. 6
Kaplan-Meier analysis of cumulative functionality duration of port-catheter using a fixed-catheter-tip. Dotted lines represent 95% Confidence interval

References

    1. Konstantinidis IT, Groot Koerkamp B, Do RK, et al. Unresectable intrahepatic cholangiocarcinoma: systemic plus hepatic arterial infusion chemotherapy is associated with longer survival in comparison with systemic chemotherapy alone. Cancer. 2016;122:758–765. doi: 10.1002/cncr.29824.
    1. Dhir M, Jones HL, Shuai Y, et al. Hepatic arterial infusion in combination with modern systemic chemotherapy is associated with improved survival compared with modern systemic chemotherapy alone in patients with isolated unresectable colorectal liver metastases: a case-control study. Ann Surg Oncol. 2017;24:150–158. doi: 10.1245/s10434-016-5418-6.
    1. Chan DL, Alzahrani NA, Morris DL, Chua TC. Systematic review and meta-analysis of hepatic arterial infusion chemotherapy as bridging therapy for colorectal liver metastases. Surg Oncol. 2015;24:162–171. doi: 10.1016/j.suronc.2015.06.014.
    1. Wang X, Hu J, Cao G, et al. Phase II study of hepatic arterial infusion chemotherapy with Oxaliplatin and 5-fluorouracil for advanced Perihilar cholangiocarcinoma. Radiology. 2017;283:580–589. doi: 10.1148/radiol.2016160572.
    1. Konstantinidis IT, Do RK, Gultekin DH, et al. Regional chemotherapy for unresectable intrahepatic cholangiocarcinoma: a potential role for dynamic magnetic resonance imaging as an imaging biomarker and a survival update from two prospective clinical trials. Ann Surg Oncol. 2014;21:2675–2683. doi: 10.1245/s10434-014-3649-y.
    1. Valle J, Wasan H, Palmer DH, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362:1273–1281. doi: 10.1056/NEJMoa0908721.
    1. Boehm LM, Jayakrishnan TT, Miura JT, et al. Comparative effectiveness of hepatic artery based therapies for unresectable intrahepatic cholangiocarcinoma. J Surg Oncol. 2015;111:213–220. doi: 10.1002/jso.23781.
    1. Mahnken AH, Pereira PL, de Baere T. Interventional oncologic approaches to liver metastases. Radiology. 2013;266:407–430. doi: 10.1148/radiol.12112544.
    1. De Baere T, Mariani P. Surgical or percutaneous hepatic artery cannulation for chemotherapy. J Visc Surg. 2014;151(Suppl 1):S17–S20. doi: 10.1016/j.jviscsurg.2013.12.004.
    1. Koganemaru M, Abe T, Iwamoto R, et al. Hepatic arterial infusion chemotherapy with a coaxial reservoir system using a non-braided spiral tip microcatheter. Jpn J Radiol. 2012;30:10–17. doi: 10.1007/s11604-011-0001-3.
    1. Yamagami T, Iida S, Kato T, et al. Using n-butyl cyanoacrylate and the fixed-catheter-tip technique in percutaneous implantation of a port-catheter system in patients undergoing repeated hepatic arterial chemotherapy. AJR Am J Roentgenol. 2002;179:1611–1617. doi: 10.2214/ajr.179.6.1791611.
    1. Sinn M, Nicolaou A, Ricke J, et al. Interventionally implanted port catheter systems for hepatic arterial infusion of chemotherapy in patients with primary liver cancer: a phase II-study (NCT00356161) BMC Gastroenterol. 2013;13:125. doi: 10.1186/1471-230X-13-125.
    1. Herrmann KA, Waggershauser T, Sittek H, Reiser MF. Liver intraarterial chemotherapy: use of the femoral artery for percutaneous implantation of catheter-port systems. Radiology. 2000;215:294–299. doi: 10.1148/radiology.215.1.r00ap14294.
    1. Seki H, Shiina M. Placement of a long tapered side-hole catheter in the hepatic artery: technical advantages, catheter stability, and arterial patency. AJR Am J Roentgenol. 2006;187:1312–1320. doi: 10.2214/AJR.05.0741.
    1. Deschamps F, Rao P, Teriitehau C, et al. Percutaneous femoral implantation of an arterial port catheter for intraarterial chemotherapy: feasibility and predictive factors of long-term functionality. J Vasc Interv Radiol. 2010;21:1681–1688. doi: 10.1016/j.jvir.2010.08.003.
    1. Yamagami T, Kato T, Iida S, Tanaka O, Nishimura T. Value of transcatheter arterial embolization with coils and n-butyl cyanoacrylate for long-term hepatic arterial infusion chemotherapy. Radiology. 2004;230:792–802. doi: 10.1148/radiol.2303021564.
    1. Matsumoto T, Yamagami T, Yoshimatsu R, et al. Hepatic arterial infusion chemotherapy by the fixed-catheter-tip method: retrospective comparison of percutaneous left subclavian and femoral port-catheter system implantation. AJR Am J Roentgenol. 2014;202:211–215. doi: 10.2214/AJR.12.10502.
    1. Seki H, Kimura M, Yoshimura N, Yamamoto S, Ozaki T, Sakai K. Hepatic arterial infusion chemotherapy using percutaneous catheter placement with an implantable port: assessment of factors affecting patency of the hepatic artery. Clin Radiol. 1999;54:221–227. doi: 10.1016/S0009-9260(99)91155-8.
    1. Yamagami T, Nakamura T, Yamazaki T, Iida S, Kato T, Nishimura T. Catheter-tip fixation of a percutaneously implanted port-catheter system to prevent dislocation. Eur Radiol. 2002;12:443–449. doi: 10.1007/s003300100943.
    1. Imamine R, Shibata T, Shinozuka K, Togashi K. Complications in hepatic arterial infusion chemotherapy: retrospective comparison of catheter tip placement in the right/left hepatic artery vs. the gastroduodenal artery. Surg Today. 2017;47:851–858. doi: 10.1007/s00595-016-1465-7.
    1. Park SI, Lee SJ, Lee M, et al. Prospective randomized trial comparing pushable coil and detachable coil during percutaneous implantation of port-catheter system for hepatic artery infusion chemotherapy. Abdom Imaging. 2015;40:595–600. doi: 10.1007/s00261-014-0239-1.
    1. Arai Y, Takeuchi Y, Inaba Y, et al. Percutaneous catheter placement for hepatic arterial infusion chemotherapy. Tech Vasc Interv Radiol. 2007;10:30–37. doi: 10.1053/j.tvir.2007.08.007.
    1. Shindoh N, Ozaki Y, Kyogoku S, Yamana D, Sumi Y, Katayama H. Stabilization of a percutaneously implanted port catheter system for hepatic artery chemotherapy infusion. Cardiovasc Intervent Radiol. 1999;22:344–347. doi: 10.1007/s002709900404.
    1. Irie T. Intraarterial chemotherapy of liver metastases: implantation of a microcatheter-port system with use of modified fixed catheter tip technique. J Vasc Interv Radiol. 2001;12:1215–1218. doi: 10.1016/S1051-0443(07)61682-0.
    1. Choi SY, Kim AH, Kim KA, Won JY, Lee do Y, Lee KH. A simplified technique of percutaneous hepatic artery port-catheter insertion for the treatment of advanced hepatocellular carcinoma with portal vein invasion. Korean J Radiol. 2010;11:648–655. doi: 10.3348/kjr.2010.11.6.648.
    1. Yamagami T, Terayama K, Yoshimatsu R, Matsumoto T, Miura H, Nishimura T. Use of N-butyl cyanoacrylate in implantation of a port-catheter system for hepatic arterial infusion chemotherapy with the fixed-catheter-tip method: is it necessary? AJR Am J Roentgenol. 2008;191:1523–1529. doi: 10.2214/AJR.07.3717.
    1. Yamagami T, Kato T, Iida S, Hirota T, Nishimura T. Management of end hole in placement of port-catheter system for continuous hepatic arterial infusion chemotherapy using the fixed catheter tip method. AJR Am J Roentgenol. 2005;184:1332–1339. doi: 10.2214/ajr.184.4.01841332.
    1. Yamagami T, Yoshimatsu R, Matsumoto T, Nishimura T. Evaluation of non-target arterial patency after implantation of hepatic arterial catheter using a modified implantation technique with the fixed catheter tip method. Clin Radiol. 2009;64:164–170. doi: 10.1016/j.crad.2008.06.016.
    1. Seki H, Ozaki T, Shiina M. Side-hole catheter placement for hepatic arterial infusion chemotherapy in patients with liver metastases from colorectal cancer: long-term treatment and survival benefit. AJR Am J Roentgenol. 2008;190:111–120. doi: 10.2214/AJR.07.2038.

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