Percutaneous implantation of intra-arterial port system for regional drug infusion: Results and complications in 110 cases

PURPOSE: To investigate the feasibility and complications of a percutaneously implantable port system for regional drug infusion. MATERIALS AND METHODS: For intra-arterial drug infusion, a 5.8 or 5-F pediatric venous port system was implanted in 110 patients with hepatocelluar carcinoma (n = 79), liver metastasis (n = 16), gallbladder cancer (n = 4), stomach cancer (n = 3), pancreatic cancer (n = 3), Burger's disease (n = 2), diabetes mellitus (n = 2), or lymphoma (n = 1). All intra-arterial port implantations were performed percutaneously in an angiographic ward through the common femoral artery (n = 98), left subclavian artery (n = 10), or left superficial femoral artery (n = 2). Complications were evaluated during the follow-up period, which ranged from 21 to 530 (mean, 163) RESULTS: The technical success rate for percutaneous implantation of the system was 97.3% (107 of 110 patients). The tips of the port catheter were located in the common hepatic artery (n = 34), proper hepatic artery (n = 49), right hepatic artery (n = 8), left hepatic artery (n = 1), descending aorta at T9 level (n = 10), left popliteal artery (n = 2), right external iliac artery (n = 1), left external iliac artery (n = 1), or left deep femoral artery (n = 1). Complications were encountered in 24 patients(22.4%), namely chamber site infection (n = 7), catheter dislodgement (n = 7), catheter occlusion (n = 3), migration of coil (n = 2), disconnection between chamber and catheter (n = 1), kinking of catheter (n = 1), arterial occlusion (n = 1), necrosis of overlying skin (n = 1), and leakage around port chamber (n = 1). Outcomes of complications included removal of port systems or cessation of therapy in 12 cases (11.2%), correction of catheter location using a guide wire in five (4.7%), thrombolysis with urokinase in three (2.8%), and straightening using a snare in one (0.9%). In three patients, the port system was used without reintervention. CONCLUSION: Percutaneous implantation of an intra-arterial port system showed a high technical success rate and a low rate of serious complications. The method may be useful for regional drug infusion in various

US-guided Left-sided Percutaneous Biliary Drainage: Analysis of the Technical Factors Related to Procedure

PURPOSE: To evaluate the factors affecting procedure related technical difficulties of US-guided left sidedPTBD and the complications involved in the use of this method. MATERIAL AND METHODS: We prospectively evaluatedUS-guided left PTBD in 26 patients with malignant biliary obstructions. The causes of underlying malignancy werebile duct carcinoma(n=10), adenocarcinoma of the pancreas(n=8), GB carcinoma(n=4), metastasis to the portahepatis(n=2), duodenal carcinoma(n=1), hepatocellular carcinoma(n=1). We divided the procedure into four steps forthe evaluation of technical difficulties, and we measured procedure time and fluoroscopic exposure time. And weevaluated the incidence of procedure related complications. RESULTS: US-guided left PTBD was successful in allattempted cases. The average procedure time and fluoroscopic exposure time involved were 14.2 min. and 5.5 min.,respectively. From the first step to the fourth step, the average time required was 4.4 min, 2.3 min., 1.9 min.,5.6 min., respectively. One major complication involved sepsis(3.8%), and ten minor complications including fivetransient hemobilia(19.2%), three tube malfunction(11.5%), and two fever(7.6%). CONCLUSION: US-guided left PTBDwas easy to perform and a relatively safe method. The total procedure time was short, and as the radiologistbecomes more experienced, this could be further reduced.