Methods of replacing blocked hepatic artery catheters

Background Regional chemotherapy using hepatic artery catheters is one method of treating patients with colorectal liver metastases. A problem arises when the catheter occludes in patients who are responding to treatment. This report describes experience of replacing occluded hepatic artery catheters. Methods Some 108 patients with colorectal liver metastases had hepatic arterial catheters surgically implanted for regional chemotherapy. The catheter occluded in 17 patients at a time when they were responding to treatment, Twelve catheters were replaced, of which seven were inserted retrogradely into the splenic artery, four were anastomosed end to side to the common hepatic artery via a saphenous vein graft and one was replaced in the patent gastroduodenal artery. Results The mean duration of catheter survival when a saphenous vein graft was used was 9.6 months compared with 2.5 months following retrograde insertion into the splenic artery, Conclusion Replacement of hepatic artery catheters is possible and may be of benefit in patients whose catheters fail while they are responding to treatment. The use of a saphenous vein graft appears to be a more anatomical and therefore preferable method of replacement than retrograde splenic artery cannulation.