[Long-term regional chemotherapy for colorectal liver metastasis: significance of hepatic arterial anatomy in the surgical placement of the implantable infusion device].

The range and frequency of aberrant hepatic arterial anatomies and their significance for placement of implantable hepatic arterial infusion devices have been studied. The angiographs of 1439 patients treated at the Institute's Clinic (1985-2002) were used. The following 6 types of aberrant hepatic arterial anatomy were identified (J. Hiatt et al). Normal anatomy (type 1) was the most frequent (67.6%). The abnormal variants included: the aberrant left hepatic artery (LHA) running from the left gastric artery (LGA) (type 2)--9.9%; the aberrant right hepatic artery (RHA)--from the superior mesenteric artery (SMA) (type 3)--9.2%; the aberrant LHA from LGA with the aberrant RHA from SMA (type 4)--3.8%); the common hepatic artery running from SMA (type 5)--1.5%: other variants (type 6)--8.0%. Aberrant hepatic arterial anatomy occurred in every third patient. It was responsible for failed perfusion, frequent thrombosis of both hepatic arteries and infusion devices, suspension of regional chemotherapy and affecting its effectiveness. Proper identification of aberrant hepatic artery anatomy is vital for placement of implantable infusion systems.