Hepatic Arterial Catheter for Intra-Arterial Chemotherapy

Background and indications

Hepatic intra-arterial catheter (HIAC) placement enables prolonged and repeated hepatic intra-arterial chemotherapy (HIAC). HIAC delivers 15 to 400 times higher chemotherapy concentration in the liver compared to systemic administration, with reduced systemic toxicity. The main indication is treatment of unresectable colorectal liver metastases, in combination with systemic chemotherapy.

Pre-procedure assessment

Assessment includes liver MRI, contrast-enhanced CT (hepatic arterial mapping), hepatic blood panel, and tumor board discussion. Hepatic arterial anatomy is studied for catheterization planning (frequent anatomic variants).

Procedure

Under local anesthesia and sedation (or general), a catheter is introduced through the femoral artery or more commonly surgically (during associated laparotomy). The catheter is positioned in the gastroduodenal or proper hepatic artery, with collateral branch occlusion (gastroduodenal, right gastric artery) to prevent extrahepatic perfusion. The catheter is connected to a subcutaneous implantable port (pump). The procedure takes 2 to 3 hours.

Results and scientific evidence

HIAC with floxuridine (FUDR) combined with systemic chemotherapy showed 70-80% hepatic response rate and increased survival compared to systemic chemotherapy alone for unresectable colorectal metastases (Kemeny et al., Journal of Clinical Oncology, 2006; DOI: 10.1200/JCO.2005.05.3801). Conversion to resectability is achieved in 25-50% of initially unresectable cases.

Risks and complications

Catheter-related complications (thrombosis, displacement, infection: 10-20%), FUDR biliary toxicity (chemical cholangitis: 5-10%, prevented with dexamethasone), gastroduodenal ulcer from extrahepatic perfusion (< 5%). MAA scintigraphy verifies proper perfusion distribution.

Recovery

2-3 day hospitalization. Intra-arterial chemotherapy starts 2 weeks after placement. 2-week treatment cycles alternating with 2-week rest periods.

Practical information

The procedure is performed as an inpatient. It is performed by an interventional radiologist or surgeon, in coordination with the oncologist.