Clinical Study
Dual-Port versus Mono-Port Implantation for Intra-Arterial Chemoinfusion Therapy for Treatment of Hepatocellular Carcinoma in Patients with Anatomic Hepatic Artery Variation

https://doi.org/10.1016/j.jvir.2018.06.006Get rights and content

Abstract

Purpose

To compare the feasibility and safety of mono-port catheter system and dual-port catheter system for advanced hepatocellular carcinoma (HCC) in patients with anatomic hepatic artery variation and portal vein tumor thrombosis.

Materials and Methods

This retrospective study consisted of 22 patients with infiltrative or multiple HCC with unilateral or bilateral portal vein thrombosis who had hepatic artery variation. A mono-port or dual-port catheter system was determined according to the degree of blood supply to the entire tumor through the common hepatic and variant hepatic arteries. Intrahepatic perfusion pattern, hepatic toxicity, and tumor response were investigated on computed tomography, medical records, and follow-up imaging study.

Results

The most common hepatic arterial variation was replaced right hepatic artery arising from the superior mesenteric artery (n = 16), followed by replaced left hepatic artery (n = 5) and replaced right posterior segmental artery (n = 1). Twelve patients were treated with mono-port catheter system, and 10 patients were treated with dual-port catheter system. All 10 patients in the dual-port group showed homogeneous distribution of contrast material in the entire liver after port implantation, and 6 patients (50%, n = 6/12) in the mono-port group showed heterogeneous distribution (P = .018). The objective tumor response rates (P = .361) were 18.2% and 40%, and the disease control rates (P = .395) were 36.4% and 60% in the mono-port and dual-port groups, respectively.

Conclusions

The dual-port catheter system is a safe and effective technique that allows the even distribution of hepatic arterial infusion chemotherapy without hemodynamic modification of anatomic variation in the hepatic arteries.

Section snippets

Materials and Methods

The institutional review board of our institution approved the study design and waived the requirement for informed consent based on the study’s retrospective design. Between July 2011 and November 2016, a total of 232 HCC patients underwent percutaneous placement of hepatic arterial-port catheter systems at our interventional unit. The patients were refractory to previous treatment or not amenable to locoregional therapies, such as ethanol injection, radiofrequency ablation, or transcatheter

Results

Of a total of 22 patients, 12 patients underwent mono-port systems, and 10 patients underwent dual-port systems. The patients received a total of 60 cycles of HAIC, with a median of 2 cycles (range, 1–7 cycles). The most common cause of underlying liver disease was hepatitis B (72.7%). All patients were Barcelona Clinic Liver Cancer stage C and had PVTT involving lobar (n = 16) or bilobar (n = 6) portal veins. The most common hepatic arterial variation was replaced right hepatic artery arising

Discussion

Maintaining homogeneous distribution of anticancer drugs throughout the entire tumor-bearing region in the liver is important to accomplish HAIC efficiently (12). For the homogeneous distribution of anticancer drugs, only 1 implanted catheter is recommended in patients with conventional anatomy of the celiac and superior mesenteric arteries. In patients with accessory or replaced hepatic arteries, embolization of aberrant arteries is required for redistribution of the hepatic arterial perfusion

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None of the authors have identified a conflict of interest.

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