The management of variant arterial anatomy during hepatic arterial infusion pump placement.

Abstract

The success of hepatic arterial infusion pump (HAIP) placement in patients with variant arterial anatomy has not been well described. Patients who underwent HAIP placement over a 5-year time period were evaluated. Arterial- and catheter-related pump complication rates and pump survival were compared between patients with normal and variant arterial anatomy. Pumps were placed in 265 patients. Variant anatomy was present in 98 (37%) patients. The presence of variant versus normal anatomy did not increase pump complication rates (8% vs. 4%; P =.18) or decrease pump survival (P =.12). In all patients with an isolated variant right or left hepatic artery (n = 56), ligation of the variant vessel and cannulation of the gastroduodenal artery (GDA) resulted in complete hepatic perfusion and no pump complications. Cannulation of vessels other than the GDA (n = 22) was associated with increased pump complication rates (27% vs. 4%; P =.0001) and decreased pump survival (P =.002). In this study, HAIP placement in patients with variant anatomy was not associated with increased pump complication rates or decreased pump survival. An optimal strategy for managing variant anatomy is to ligate isolated variant vessels and cannulate the GDA.