Treatment of hepatic metastases by transaxillary hepatic artery chemotherapy using an implanted drug pump.

The objective of this study was to evaluate the feasibility of integrating an implantable, refillable drug infusion pump with transaxillary angiographic hepatic arterial catheterization. The implantation is performed under local anesthesia in the radiology suite. A 2-3 cm incision in the left upper arm is made through skin and subcutaneous tissue. Through an axillary artery puncture, a 5.3F polyethylene catheter is fluoroscopically placed into the hepatic artery. To minimize gastroduodenitis, the gastroduodenal artery is occluded with a Gianturco coil and Gelfoam. The Model 400 Infusaid pump is implanted in the upper chest and attached subcutaneously to the angiography catheter using a friction connector. Patients are discharged 2-3 days later. Over a two-year period, 20 such implants have been performed. Floxyuridine (FUdR) has been used by continuous infusion; mitomycin-C (MMC) and 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) by intermittent intra-arterial infusion. The pump/catheter system has been left in place for as long as 18 months. Partial responses in the colorectal cases are as follows: FUdR four of nine patients, MMC two of three, FUdR + MMC one of one, and FUdR + MMC + BCNU three of three. No arm vascular complications, hepatic arterial occlusions, peripheral emboli, pump malfunctions, or catheter occlusions took place over a total experience of 3210 patient days. Three catheter migrations occurred requiring repositioning in two patients, and three cracked catheters required replacement. This innovative approach offers a comfortable, convenient method for long-term ambulatory hepatic arterial chemotherapy obviating both laparotomy and extra-corporeal pumps.