Complications After Percutaneous Transaxillary Implantation of a Catheter for Intraarterial Chemotherapy of Liver Tumors: Clinical Relevance and Management in 204 Patients
Massimo Venturini1,
Enzo Angeli1,
Marco Salvioni1,
Francesco De Cobelli1,
Monica Ronzoni2,
Luca Aldrighetti3,
Marco Stella4,
Michele Carlucci5,
Carlo Staudacher5,
Valerio Di Carlo4,
Gianfranco Ferla3,
Eugenio Villa2 and
Alessandro Del Maschio1
1 Department of Radiology, Scientific Institute S. Raffaele, Vita-Salute
University, Olgettina 60, Milan 20132, Italy.
2 Department of Oncology, Scientific Institute S. Raffaele, Vita-Salute
University, Milan 20132, Italy.
3 Department of General Surgery, First Division, Scientific Institute S.
Raffaele, Vita-Salute University, Olgettina 60, Milan 20132, Italy.
4 Department of General Surgery, Second Division, Scientific Institute S.
Raffaele, Vita-Salute University, Milan 20132, Italy.
5 Department of Emergency Surgery, Scientific Institute S. Raffaele, Vita-Salute
University, Milan 20132, Italy.
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Fig. 1A. —45-year-old man with liver metastases from colorectal cancer.
Control radiograph shows loop (arrow) of proximal part of catheter at
level of shoulder.
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Fig. 1B. —45-year-old man with liver metastases from colorectal cancer.
Angiogram shows catheter dislocation (catheter malposition) and opacification
of splenic artery (arrow).
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Fig. 2A. —57-year-old man with liver metastases from colorectal cancer.
Axial fast spoiled gradient-echo T1-weighted images (TR/TE, 175/4.2) obtained
before starting intrahepatic chemotherapy show three hypointense liver
metastases (arrows, A) in right lobe and two hypointense liver
metastases (arrows, B) in left lobe.
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Fig. 2B. —57-year-old man with liver metastases from colorectal cancer.
Axial fast spoiled gradient-echo T1-weighted images (TR/TE, 175/4.2) obtained
before starting intrahepatic chemotherapy show three hypointense liver
metastases (arrows, A) in right lobe and two hypointense liver
metastases (arrows, B) in left lobe.
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Fig. 2C. —57-year-old man with liver metastases from colorectal cancer.
MR images obtained at same levels as A and B after four cycles
of intrahepatic chemotherapy show significant volume reduction of three
lesions (arrows, C) in right lobe, whereas two metastases
(arrows, D) on left lobe have significantly increased in
volume.
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Fig. 2D. —57-year-old man with liver metastases from colorectal cancer.
MR images obtained at same levels as A and B after four cycles
of intrahepatic chemotherapy show significant volume reduction of three
lesions (arrows, C) in right lobe, whereas two metastases
(arrows, D) on left lobe have significantly increased in
volume.
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Fig. 2E. —57-year-old man with liver metastases from colorectal cancer.
Angiogram shows catheter malposition: catheter tip (arrow) is located
in right hepatic artery without opacification of left hepatic artery.
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Fig. 2F. —57-year-old man with liver metastases from colorectal cancer.
Angiograms show that, as result of using Simmons catheter via transfemoral
approach, catheter of port at level of celiac trunk entrance is hooked
(arrow, F) and then retracted (white arrow, G)
with consequent repositioning of tip into proper hepatic artery (black
arrow, G). Bilateral perfusion of intrahepatic chemotherapy is, in
this way, achieved without surgical opening of pocket in left subclavian
area.
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Fig. 2G. —57-year-old man with liver metastases from colorectal cancer.
Angiograms show that, as result of using Simmons catheter via transfemoral
approach, catheter of port at level of celiac trunk entrance is hooked
(arrow, F) and then retracted (white arrow, G)
with consequent repositioning of tip into proper hepatic artery (black
arrow, G). Bilateral perfusion of intrahepatic chemotherapy is, in
this way, achieved without surgical opening of pocket in left subclavian
area.
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Fig. 3A. —69-year-old woman with liver metastases from colorectal
cancer. Angiogram shows hepatic artery thrombosis with retrograde
opacification of superior mesenteric artery (right hepatic artery arising from
superior mesenteric artery).
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Fig. 3B. —69-year-old woman with liver metastases from colorectal
cancer. Angiogram obtained after local thrombolysis based on recombinant
tissue plasminogen activator administration shows recanalization of right
hepatic artery. Intrahepatic chemotherapy, which was temporarily stopped, can
be continued.
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Fig. 4A. —48-year-old woman with liver metastases from colorectal
cancer. This patient was being treated with intraarterial administration of
5-fluorouracil because of unavailability of floxuridine and was affected by
melena. Axial contrast-enhanced CT scan shows hypodense area (arrow)
around catheter at level of right hepatic artery due to segmental dilatation
of biliary duct.
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Fig. 4B. —48-year-old woman with liver metastases from colorectal
cancer. This patient was being treated with intraarterial administration of
5-fluorouracil because of unavailability of floxuridine and was affected by
melena. Angiogram shows arteriobiliary fistula with opacification of biliary
ducts and duodenum. In this case, intrahepatic chemotherapy cessation was
necessary: There was spontaneous resolution of fistula, after ending
intrahepatic chemotherapy infusion.
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Copyright © 2004 by the American Roentgen Ray Society.
