Treatment of colorectal liver metastases and intrahepatic cholangiocarcinoma with hepatic artery infusion (HAI) is a liver-directed therapy that uses the hepatic arterial system to deliver high-dose chemotherapy directly to the liver. The global adoption of HAI is gaining momentum. This overview explains how to go about implanting an HAI pump, with special attention paid to the typical technical snags and the ways in which they might be avoided.

Common complications after surgery and how to spot them during the operation are also covered. The most frequent method of treating HAI is to surgically implant a subcutaneous pump and insert the pump’s catheter into the hepatic artery system to deliver chemotherapy directly to the liver through inline flow. Improper anatomy, vascular disease, and technical or patient issues may contribute to surgery difficulties and abnormal hepatic perfusion. Many technological difficulties can be avoided or worked with, though. About 8% to 18% of patients experience pump pocket issues, 10%-20% experience catheter complications, 5%- 10% experience vascular complications, and 2%-8% experience biliary complications post-operatively.

To continue providing safe and effective HAI treatment, early detection and rapid response can save most patients who develop severe problems. The HAI team can resort to this toolbox to help them overcome typical HAI-related perioperative challenges and problems. Overcoming these obstacles is crucial for ensuring safe pump insertion and administration of HAI therapy, as well as for implementing new programs and expanding HAI to patients who may benefit from such a specific treatment strategy.

Source: journals.lww.com/annalsofsurgery/Abstract/2022/12000/Hepatic_Artery_Infusion_Pumps__A_Surgical_Toolkit.1.aspx