Complications of long term transbrachial hepatic arterial infusion chemotherapy

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Complications of long term transbrachial hepatic arterial infusion chemotherapy

ME Clouse, R Ahmed, RB Ryan, RA Oberfield, and JA McCaffrey

A total of 127 transbrachial hepatic artery catheters were placed in 75 patients for prolonged infusion of chemotherapeutic agents for primary and secondary tumors of the liver. Hepatic or celiac artery catheterization was possible in 97.4% of patients. The most frequent major complication was partial or complete arterial thrombosis (30 patients). bleeding at the arteriotomy site and pseudoaneurysm also occurred. Minor complications included displacement of catheter from the hepatic artery in 46, cracks or leaks in the catheter at the arteriotomy site in 21, and clotted catheter in 10 instances. Infection occurred in four patients and loss of radial pulse in seven. In view of a significant increase in survival, the complications did not contraindicate long term intraarterial infusion of chemotherapeutic agents. The no. 5 French blue thin wall 1.24-1.70 mm tubing proved to be easiest to use and least prone to complications. Proper management of these patients by a team approach (nurse, oncologist, and radiologist) helps to minimize the frequency and severity of complications.
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