Technical Aspects of Arterial Access and Constant Infusion

Abstract

Liver metastases are a common cause of death in colon carcinoma. One therapeutic modality for the treatment of these metastases for the past two decades has been direct hepatic artery drug infusion. However, this method has not gained popularity because of the difficulties encountered using external catheters and pumps needed to deliver this type of therapy. (1, 2, 3) Besides, of the reported intra-arterial results, none have proven statistically significant improvement in survival over intravenous 5-FU. There has been only one prospective randomized study reported comparing intra-arterial chemotherapy with systemic chemotherapy. (4) This study demonstrated no significant difference between systemic and intra-arterial chemotherapy. However, the intra-arterial chemotherapy carried out for only a short period of time (three weeks), and all patients treated with intra-arterial chemotherapy subsequently received systemic chemotherapy. Recently, a number of investigators have reported response rates of 60 to 80 percent and improvement in median survival using the Infusaid* implantable infusion pump. (5,6,7) The system was first developed by Blackshear (8) at the University of Minnesota. From the preliminary reports using this system, it appears that the patients who will benefit most from this implantable system are those with colon metastases to liver only. (5,7) Other factors that play a role include the degree of liver involvement and histology. Selection of patients for this type of therapy should include the following work-up and criteria.