Hepatic Artery Infusion Via Percutaneously Implanted Arterial Port-A-Cath In Elderly Patients

Background: Up to now no definitive data on hepatic artery infusion for colorectal liver metastases in elderly patients are available. Percutaneous implantation of an arterial Port a Cath was considered for the treatment of 39 elderly patients suffered for colorectal liver metastases non eligible for surgery. Methodology: The distal left subclavian artery was punctured under the clavicle and an angiographic study of the hepatic district was performed. Gastroduodenal artery or anomalous hepatic arteries were embolised with Gianturco coils. Then a polyurethane catheter was inserted distally into the hepatic artery and connected to the reservoir through a 3-4 cm subcutaneous tunnel. All patients underwent regional chemotherapy with FUDR 0.3 mg/kg/die + desamethasone 2 mg/die + Leucovorin 15 mg/m2 in continuous infusion. Results: We noticed 5 dislocations of the catheter and 2 hepatic artery thrombosis. Only one patient definitively suspended the treatment for complications related to the technique. Drugs toxicity occurred in 30.8% of patients. We found neither cholecystitis nor sclerosing cholangitis. 47% of objective clinical responses was noticed. Conclusions: Preliminary results suggest that hepatic artery infusion could be indicated in the treatment for elderly patients with inoperable colorectal liver metastases.