Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-mwx4w Total loading time: 0 Render date: 2024-06-17T10:32:57.247Z Has data issue: false hasContentIssue false

28 - Vascular access: Venous and arterial ports

from Section X - Specialized interventional techniques in cancer care

Published online by Cambridge University Press:  05 September 2016

By
Thierry de Baère  and
Eric Desruennes
Edited by
Jean-Francois H. Geschwind  and
Michael C. Soulen
Thierry de Baère
Affiliation:
Institut de Cancérologie
Eric Desruennes
Affiliation:
Institut de Cancérologie
Jean-Francois H. Geschwind
Affiliation:
Yale University School of Medicine, Connecticut
Michael C. Soulen
Affiliation:
Department of Radiology, University of Pennsylvania Hospital, Philadelphia
Get access

Summary

Hepatic intra-arterial port

Indications

Because hepatic artery infusion chemotherapy (HAIC) is a local treatment, it is most often used in case of liver cancer without extrahepatic disease, or in patients with predominant hepatic disease. Such treatment has been used mostly as salvage therapies after failure of intravenous (IV) standard-of-care therapies for metastases, and because response rate remains interesting even when using the same drug that was or became inefficient with IV administration. Due to the high response rate of HAIC, there are some recent reports and ongoing study using such therapies in first line. The goal of such therapies in first line, as a so-called induction treatment, is to obtain as early as possible in the disease the highest response possible in order to downstage a non-surgical candidate to a surgical candidate. Indeed, it has been demonstrated that the increase in response rate of colorectal liver-only metastases (CRLM) to treatment is linearly correlated with an increase in resection rate, and consequently with an increased chance of cure. Such induction chemotherapy targeting specifically the liver is obviously even more interesting in patients with liver-limited disease which demonstrated a steeper slope of the linear correlation between response and downstaging from non-operable to surgical candidates. HAIC used in an adjuvant setting after liver resection has been demonstrated to increase survival.

For primary tumors, and namely hepatocellular carcinoma, the use of HAIC is less common due to the high efficacy of transarterial chemoembolization (TACE). Indications are probably in patients not responding to TACE or not candidates for TACE due to portal vein thrombosis or advanced liver insufficiency.

HAIC is technically more challenging than systemic chemotherapy, because it requires the implantation of an indwelling catheter in the hepatic artery that is connected to a subcutaneous port for the administration of repeated courses of HAIC. The main drawbacks that hampered the use of HAIC were that, until recently, the implantation of such a device required a laparotomy, and additionally, frequent catheter dysfunction led to discontinued treatment. For example, in a randomized controlled study comparing HAIC with 5-fluorouracil (5-FU) to systemic 5-FU in 290 cases, 50 (37%) patients allocated to HAIC did not start their treatment, and another 39 (29%) had to stop before receiving six cycles of treatment because of catheter failure. Only 33% of patients received at least six courses of HAIC vs. 78% for the IV route.

Type
Chapter
Information
Interventional Oncology
Principles and Practice of Image-Guided Cancer Therapy
 , pp. 283 - 293
Publisher: Cambridge University Press
Print publication year: 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Boige, V, Malka, D, Elias, D, et al. Hepatic arterial infusion of oxaliplatin and intravenous LV5FU2 in unresectable liver metastases from colorectal cancer after systemic chemotherapy failure. Ann Surg Oncol 2008; 15: 219–226.Google Scholar
2. Kemeny, NE, Melendez, FD, Capanu, M, et al. Conversion to resectability using hepatic artery infusion plus systemic chemotherapy for the treatment of unresectable liver metastases from colorectal carcinoma. J Clin Oncol 2009; 27: 3465–3471.Google Scholar
3. Folprecht, G, Grothey, A, Alberts, S, Raab, HR, Kohne, CH. Neoadjuvant treatment of unresectable colorectal liver metastases: correlation between tumour response and resection rates. Ann Oncol 2005; 16: 1311–1319.Google Scholar
4. Kemeny, N, Huang, Y, Cohen, AM, et al. Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med 1999; 341: 2039–2048.Google Scholar
5. Seki, H, Kimura, M, Yoshimura, N, et al. 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.Google Scholar
6. Hwang, JY, Jang, BK, Kwon, KM, et al. [Efficacy of hepatic arterial infusion therapy for advanced hepatocellular carcinoma using 5-fluorouracil, epirubicin and mitomycin-C.] Korean J Gastroenterol 2005; 45: 118–124.Google Scholar
7. Kerr, DJ, McArdle, CS, Ledermann, J, et al. Intrahepatic arterial versus intravenous fluorouracil and folinic acid for colorectal cancer liver metastases: a multicentre randomised trial. Lancet 2003; 361: 368–373.Google Scholar
8. Meta-Analysis Group in Cancer. Reappraisal of hepatic arterial infusion in the treatment of nonresectable liver metastases from colorectal cancer. J Natl Cancer Inst 1996; 252–258.
9. Kemeny, NE, Niedzwiecki, D, Hollis, DR, et al. Hepatic arterial infusion versus systemic therapy for hepatic metastases from colorectal cancer: a randomized trial of efficacy, quality of life, and molecular markers (CALGB 9481). J Clin Oncol 2006; 24: 1395–1403.Google Scholar
10. Boige, V, Lacombe, S, Baere, T de. Hepatic arterial infusion of oxaliplatin combined with 5FU and folinic acid in non resectable liver metastasis of colorectal cancer: a promising option for failures to systemic chemotherapy. JCO 2003; 22 Proceeding of ASCO 2003: 291.Google Scholar
11. Kemeny, N, Jarnagin, W, Paty, P, et al. Phase I trial of systemic oxaliplatin combination chemotherapy with hepatic arterial infusion in patients with unresectable liver metastases from colorectal cancer. J Clin Oncol 2005; 23: 4888–4896.Google Scholar
12. Franklin, ME Jr, Gonzalez, JJ Jr. Laparoscopic placement of hepatic artery catheter for regional chemotherapy infusion: technique, benefits, and complications. Surg Laparosc Endosc Percutan Tech 2002; 12: 398–407.Google Scholar
13. Habbe, TG, McCowan, TC, Goertzen, TC, et al. Complications and technical limitations of hepatic arterial infusion catheter placement for chemotherapy. J Vasc Interv Radiol 1998; 9: 233–239.Google Scholar
14. 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.Google Scholar
15. Tanaka, T, Arai, Y, Inaba, Y, et al. Radiologic placement of side-hole catheter with tip fixation for hepatic arterial infusion chemotherapy. J Vasc Interv Radiol 2003; 14: 63–68.Google Scholar
16. Zanon, C, Grosso, M, Clara, R, et al. Combined regional and systemic chemotherapy by a mini-invasive approach for the treatment of colorectal liver metastases. Am J Clin Oncol 2001; 24: 354–359.Google Scholar
17. Castaing, D, Azoulay, D, Fecteau, A, Bismuth, H. Implantable hepatic arterial infusion device: placement without laparotomy, via an intercostal artery. J Am Coll Surg 1998; 187: 565–568.Google Scholar
18. 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.Google Scholar
19. Aldrighetti, L, Arru, M, Angeli, E, et al. Percutaneous vs. surgical placement of hepatic artery indwelling catheters for regional chemotherapy. Hepatogastroenterology 2002; 49: 513–517.Google Scholar
20. Farouil, G, Deschamps, F, Barah, A, et al. Interventional revisions of malfunctions affecting surgically implanted port-catheters for hepatic artery infusion. Surg Oncol 2013; 22: 48–54.Google Scholar
21. Ensminger, WD, Rosowsky, A, Raso, V, et al. A clinical–pharmacological evaluation of hepatic arterial infusions of 5-fluoro-2'-deoxyuridine and 5-fluorouracil. Cancer Res 1978; 38: 3784–3792.Google Scholar
22. Dzodic, R, Gomez-Abuin, G, Rougier, P, et al. Pharmacokinetic advantage of intra-arterial hepatic oxaliplatin administration: comparative results with cisplatin using a rabbit VX2 tumor model. Anticancer Drugs 2004; 15: 647–650.Google Scholar
23. Allen-Mersh, TG, Earlam, S, Fordy, C, Abrams, K, Houghton, J. Quality of life and survival with continuous hepatic-artery floxuridine infusion for colorectal liver metastases. Lancet 1994; 344: 1255–1260.Google Scholar
24. Rougier, P, Laplanche, A, Huguier, M, et al. Hepatic arterial infusion of floxuridine in patients with liver metastases from colorectal carcinoma: long-term results of a prospective randomized trial. J Clin Oncol 1992; 10: 1112–1118.Google Scholar
25. Lorenz, M, Muller, HH. Randomized, multicenter trial of fluorouracil plus leucovorin administered either via hepatic arterial or intravenous infusion versus fluorodeoxyuridine administered via hepatic arterial infusion in patients with nonresectable liver metastases from colorectal carcinoma. J Clin Oncol 2000; 18: 243–254.Google Scholar
26. Malka, D, Paris, E, Caramella, C, et al. Combined hepatic oxaliplatin, intravenous LV5FU2 and erbitux. Proc ASCO 2010; 2010: abstract 3558.Google Scholar
27. Goere, D, Benhaim, L, Bonnet, S, et al. Adjuvant chemotherapy after resection of colorectal liver metastases in patients at high risk of hepatic recurrence: a comparative study between hepatic arterial infusion of oxaliplatin and modern systemic chemotherapy. Ann Surg 2013; 257: 114–120.Google Scholar
28. Feng, WM, Tang, CW, Huang, SX, et al. Prophylactic adjuvant hepatic arterial infusion chemotherapy reduced hepatic metastases from stage III colorectal cancer after curative resection. Hepatogastroenterology 2012; 59: 1087–1090.Google Scholar
29. Sperling, J, Brandhorst, D, Schafer, T, et al. Liver-directed chemotherapy of cetuximab and bevacizumab in combination with oxaliplatin is more effective to inhibit tumor growth of CC531 colorectal rat liver metastases than systemic chemotherapy. Clin Exp Metastasis 2013; 30 (4): 447–455.Google Scholar
30. Wieners, G, Redlich, U, Dudeck, O, et al. [First experiences with intravenous port systems authorized for high pressure injection of contrast agent in multiphasic computed tomography.] Rofo 2009; 181: 664–668.Google Scholar
31. Lamperti, M, Bodenham, AR, Pittiruti, M, et al. International evidence-based recommendations on ultrasound-guided vascular access. Intensi Care Med 2012; 38: 1105–1117.Google Scholar
32. Aitken, DR, Minton, JP. The “pinch-off sign”: a warning of impending problems with permanent subclavian catheters. Am J Surg 1984; 148: 633–636.Google Scholar
33. Ouaknine-Orlando, B, Desruennes, E, Cosset, MF, Baere, T de, Roche, A. [The pinch-off syndrome: main cause of catheter embolism.] Ann Fr Anesth Reanim 1999; 18: 949–955.Google Scholar
34. Karakitsos, D, Labropoulos, N, Groot, E de, et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care 2006; 10: R162.Google Scholar
35. Wu, SY, Ling, Q Cao, LH, et al. Real-time two-dimensional ultrasound guidance for central venous cannulation: a meta-analysis. Anesthesiology 2013; 118: 361–375.Google Scholar
36. Biffi, R, Orsi, F, Pozzi, S, et al. Best choice of central venous insertion site for the prevention of catheter-related complications in adult patients who need cancer therapy: a randomized trial. Ann Oncol 2009; 20: 935–940.Google Scholar
37. Marcy, PY, Magne, N, Castadot, P, et al. Is radiologic placement of an arm port mandatory in oncology patients? Analysis of a large bi-institutional experience. Cancer 2007; 110: 2331–2338.Google Scholar
38. Bertoglio, S, DiSomma, C, Meszaros, P, et al. Long-term femoral vein central venous access in cancer patients. Eur J Surg Oncol 1996; 22: 162–165.Google Scholar
39. Wolosker, N, Yazbek, G, Munia, MA, et al. Totally implantable femoral vein catheters in cancer patients. Eur J Surg Oncol 2004; 30: 771–775.Google Scholar
40. Luciani, A, Clement, O, Halimi, P, et al. Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US. Radiology 2001; 220: 655–660.Google Scholar
41. Cadman, A, Lawrance, JA, Fitzsimmons, L, Spencer-Shaw, A, Swindell, R. To clot or not to clot? That is the question in central venous catheters. Clin Radiol 2004; 59: 349–355.Google Scholar
42. Geerts, WH, Bergqvist, D, Pineo, GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 2008; 133: 381S–453S.Google Scholar
43. Debourdeau, P, Chahmi, D Kassab, Gal, G Le, et al. 2008 SOR guidelines for the prevention and treatment of thrombosis associated with central venous catheters in patients with cancer: report from the working group. Ann Oncol 2009; 20: 1459–1471.Google Scholar
44. Cavanna, L, Civardi, G, Vallisa, D, et al. Ultrasound-guided central venous catheterization in cancer patients improves the success rate of cannulation and reduces mechanical complications: a prospective observational study of 1,978 consecutive catheterizations. World J Surg Oncol 2010; 8: 91 Google Scholar
45. Labourey, JL, Lacroix, P, Genet, D, et al. Thrombotic complications of implanted central venous access devices: prospective evaluation. Bull Cancer 2004; 91: 431–436.Google Scholar
46. Couban, S, Goodyear, M, Burnell, M, et al. Randomized placebo-controlled study of low-dose warfarin for the prevention of central venous catheter-associated thrombosis in patients with cancer. J Clin Oncol 2005; 23: 4063–4069.Google Scholar
47. Karthaus, M, Kretzschmar, A, Kroning, H, et al. Dalteparin for prevention of catheter-related complications in cancer patients with central venous catheters: final results of a double-blind, placebo-controlled phase III trial. Ann Oncol 2006; 17: 289–296.Google Scholar
48. Blot, F, Nitenberg, G, Chachaty, E, et al. Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures. Lancet 1999; 354: 1071–1077.Google Scholar
49. Mermel, LA, Farr, BM, Sherertz, RJ, et al. Guidelines for the management of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2001; 22: 222–242.Google Scholar
50. Messing, B, Peitra-Cohen, S, Debure, A, Beliah, M, Bernier, JJ. Antibiotic-lock technique: a new approach to optimal therapy for catheter-related sepsis in home-parenteral nutrition patients. JPEN J Parenter Enteral Nutr 1988; 12: 185–189.Google Scholar
51. Schiffer, CA, Mangu, PB, Wade, JC, et al. Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2013; 31: 1357–1370,Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×