Dutta Anuj K, Shankar Vishal, Santos Ernesto G, Marinelli Brett, Alexander Erica S, Sotirchos Vlasios S, Zhao Ken
Albert Einstein College of Medicine, New York, NY, 10461, USA.
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
CVIR Endovasc. 2025 Jan 9;8(1):5. doi: 10.1186/s42155-024-00515-w.
Hepatic artery infusion pump (HAIP) chemotherapy is a locoregional treatment for intrahepatic malignancies. HAIPs are surgically implanted, and the catheter tip is typically inserted into a ligated gastroduodenal artery stump. Potential complications at the catheter insertion site include dehiscence, pseudoaneurysm or extravasation, and adjacent hepatic arterial stenosis and thrombosis. Bleeding complications can be treated with stent-graft placement or coil embolization across the injury site, typically with standard antegrade arterial approach into the hepatic arterial system by transfemoral or transradial access. However, in cases where an antegrade approach is not possible, alternative methods are necessary.
A patient presented with an enlarging hematoma due to bleeding at the gastroduodenal artery HAIP catheter insertion site. Emergent angiography revealed concomitant common hepatic artery occlusion and retrograde perfusion of the GDA via tortuous, diminutive hepatic collaterals which precluded standard antegrade approach. Collateral inflow from the dorsal pancreatic artery was utilized to opacify the right hepatic artery. The segment 5 hepatic artery was percutaneously accessed under fluoroscopic guidance, and microcoils were deployed both proximal and distal to origin of the gastroduodenal artery. The patient remained stable throughout the postoperative period and was discharged after an otherwise uneventful admission. Follow-up computed tomography demonstrated resolution of the hematoma and no bleeding or biliary complication from transhepatic access.
This report highlights the safety and efficacy of percutaneous transhepatic arterial access for endovascular management of HAIP associated bleeding at the gastroduodenal artery when standard antegrade interventions cannot be performed. Interventional radiologists caring for patients with HAIPs should be familiar with their potential complications and the range of techniques required for management.
肝动脉灌注泵（HAIP）化疗是一种针对肝内恶性肿瘤的局部区域治疗方法。HAIP通过手术植入，导管尖端通常插入结扎的胃十二指肠动脉残端。导管插入部位的潜在并发症包括裂开、假性动脉瘤或渗漏，以及相邻肝动脉狭窄和血栓形成。出血并发症可通过在损伤部位放置覆膜支架或进行弹簧圈栓塞来治疗，通常采用经股动脉或桡动脉入路的标准顺行动脉途径进入肝动脉系统。然而，在无法采用顺行途径的情况下，需要其他替代方法。
一名患者因胃十二指肠动脉HAIP导管插入部位出血出现血肿增大。急诊血管造影显示肝总动脉同时闭塞，胃十二指肠动脉通过迂曲、细小的肝侧支逆行灌注，这排除了标准的顺行途径。利用来自胰背动脉的侧支血流使右肝动脉显影。在透视引导下经皮进入肝5段动脉，在胃十二指肠动脉起始部的近端和远端均部署了微弹簧圈。患者术后全程保持稳定，在入院过程平稳后出院。随访计算机断层扫描显示血肿消退，经肝穿刺未出现出血或胆道并发症。
本报告强调了在无法进行标准顺行干预时，经皮经肝动脉入路对HAIP相关胃十二指肠动脉出血进行血管内治疗的安全性和有效性。负责治疗HAIP患者的介入放射科医生应熟悉其潜在并发症及所需的一系列治疗技术。
