Intra-arterial Port Implantation for Intraarterial Chemoinfusion

PURPOSE: To evaluate, using various port systems, the technique and complications of intra-arterial portimplantation in visceral (mainly hepatic) arteries for intra-arterial chemoinfusion. MATERIALS AND METHODS: Weretrospectively evaluated 30 cases of intra-arterial port implantation in 29 patients. Angiography was performedin all cases, and insertion of an implantable polyurethane port catheter was followed by angiographic exchangewhich, utilizing a .035" hydrophilic guide wire, targeted the artery. If a change in the direction of flow wasrequired, arterial flow control was performed, using an enbolie coil. In order to insert the subcutaneous portchamber, an incision approximately 4cm long was made at the puncture site and subcutaneous tissue was dissected.The port chamber was inserted into the subcutaneous pocket and fixed with a black-silk tagging suture. When thefemoral artery was punctured, the port chamber was inserted into the supra-or infrainguinal area; when the leftsubclavian artery was used, the port chamber was inserted into the lateral one third of the left clavicle. Theport systems used in the procedure were as follows : 5.8F Port-A-Cath (SIMS, Deltec, U.S.A.)(n=20) ; 5.2F A-Port(Therex, U.S.A.)(N=5); 5F PU-Anthron(Deny, Japan)(n=4) ; 5.2F R-Port(Therex, U.S.A.)(n=1). The subcutaneouschambers were inserted into the infrainguinal (n=22), suprainguinal (n=6) or subclavian area(n=2). RESULTS: Theprocedure was technically successful in all 30 cases. Port catheter tips were located in the hepatic arteryproper(n=11), the right hepatic(n=9), gastroduodenal (n=6), common hepatic (n=2), inferior mesenteric (n=1) andinternal iliac artery(n=1). In 12 cases, flow was controlled using embolic coils. Follow-up study was performed in23 cases, with a mean follow up period of 55.8 (11-161) days. Complications were noted in four cases ; two wereprocedure related and two were catheter related. CONCLUSION: Intra-arterial port implantation is a safe procedureand can be performed easily by skilled radiologists; long-term observation is, however, still needed.

Superselective Intraarterial Chemotherapy into Bilateral Uterine Arteries in Uterine Cervical Carcinomas

PURPOSE: To assess the efficacy of superselective intra-arterial chemotherapy (SSIAC) via the bilateral uterine arteries in cases of cervical carcinoma. MATERIALS AND METHODS: Eighteen patients with stage IIa (n=10), IIb (n=7), or IIIa (n=1) cervical carcinoma underwent one (n=2) or two (n=16) courses of preoperative SSIAC with Vincristine, Cisplatin, and Mitomycin C. We estimated the extent of reduction of tumor volume and improvement of stage, comparing pre-SSIAC MRI to postoperative results. Tumor vascularity, as seen on uterine arteriography, and procedural complications, were also evaluated. RESULTS: A marked reduction in tumor volume was observed in all patients, an average reduction volume of 94.7%. Improvement of stage was noted in 16 patients, and in six of these, no residual viable tumor or microinvasive residual tumor was seen. On angiography, tumor hypervascularity was demonstrated in seven patients, but its degree was not substantially related to therapeutic response. In no case did significant systemic complications of result from chemotherapy; in one patient, however, we experienced a serious complication of necrotizing cystitis due to malpositioning of a catheter in the superior vesical artery. CONCLUSION: SSIAC via the bilateral uterine arteries is an effective complementary modality for the treatment of various stages of cervical carcinoma.

Chemoembolization of Hepatocellular Carcinoma: Long-term Survival and Prognostic Factors

PURPOSE: To analyse the long-term survival rate after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma and to determine prognostic factors. MATERIALS AND METHODS: In 1067 hepatocellularcarcinoma patients who had undergone TACE, of long-term survival rate and prognostic factors were retrospecfively analysed. Chemoembolization was accomplished by hepatic arterial infusion of a mixture of Lipiodol and Adriamycin(51%) or by Gelfoam embolization after infusion of the Lipiodol mixture(49%). The survival rate was calculated by the Kaplan-Meier method and multivariate analysis using the weibull model was applied to determine which prognostic factors were statistically significant. RESULTS: Among the 1067 patients, survival rates were asfollows : one-year, 60.6% ; two-year 42.3% ; three-year, 29.1% ; four-year, 23.7% ; and five-year, 14.7 %. The oneyear survival rate and median survival period of 432 patients with tumors 5cm in diameter or smaller were 77.7%and 33 months respectively, significantly higher than those of patients with larger tumors for whom the corresponding figures were 44.8% and 11 months. Other significant prognostic factors(p<0.0001) shown bymultivariate analysis included type of tumor, portal vein invasion and child-pugh classification. CONCLUSION: Theone-year survival rate agter chemoembolization in 1067 patients with hepatocellular carcinoma was 60.6%. The significant prognostic factors were size and type of the tumor, portal vein invasion, and Child-Pugh classification.