Poster Sessions

CANCER-16

Elliot Levy

E. Levy, A. Kam, J. Pingpank, M.B. Hughes, R. Chang, N. Abi Jaoudeh, H. Amalou, J. Locklin, H.R. Alexander, M. Dreher, B. Wood

Technical Considerations in Percutaneous Isolated Hepatic Perfusion: Experience with 130 Consecutive Patients at the NIH Clinical Center

High dose melphalan was administered to the liver in a 30 minute infusion with simultaneous extracorporeal filtration in phase I, II, and III clinical trials at one institution. The procedures and images for 112 consecutive patients treated with 282 percutaneous isolated hepatic perfusions at the NIH between 2004 and 2009 were reviewed and summarized according to pharmacological interventions, arterial interventions, and manipulation of the Delcath balloon occlusion catheter. Records were reviewed for incidence of vasospasm requiring arterial nitroglycerin, vessels embolized, variant anatomy, and technical complications. Nontarget vessels requiring embolization prior to melphalan infusion included gastroduodenal artery, left gastric artery, and right gastric artery. Left hepatic artery infusion beyond the right gastric artery was also not uncommon. Maneuvers performed to completely isolate hepatic venous return included increasing inflation volume of the cephalad balloon as well as maintaining traction on the balloon catheter during the melphalan infusion. Marked transient hypotension was observed in all patients upon initiation of charcoal-based filtration during venous bypass, requiring transient IV administration of norepinephrine. Percutaneous isolated hepatic perfusion therapy can be safely completed following careful exclusion of nontarget circulation, intervention for arterial spasm, and meticulous isolation of hepatic venous return.