3 The procedure
3.1 The aim of chemosaturation via percutaneous hepatic artery perfusion and hepatic vein isolation is to treat liver cancer by delivering a high dose of chemotherapy directly into the hepatic artery. As the blood leaves the liver it is diverted out of the body through a catheter and filtered to reduce the level of chemotherapy drug before being returned to the circulation. This allows high doses of chemotherapy to be used, which would otherwise not be tolerated because of severe systemic side effects.
3.2 The procedure is usually done with the patient under general anaesthesia. Full anticoagulation is needed throughout. An infusion catheter is inserted into the femoral artery and guided into the hepatic artery. The femoral vein is then cannulated and a special multi-lumen, double-balloon catheter is inserted into the inferior vena cava, and across the hepatic veins. The balloons are inflated and positioned in such a way that all the blood leaving the liver (via the hepatic veins) enters this catheter, rather than the systemic circulation. High doses of a chemotherapy drug are then infused directly into the liver via the hepatic artery infusion catheter over a period of approximately 30 minutes. During this time, blood leaving the liver passes through an extracorporeal filtration system that removes most of the chemotherapy drug before the blood is returned to the circulation via a catheter in the internal jugular vein.
3.3 The haemodynamic status of the patient changes significantly during this procedure, and this will need management by the anaesthetic team and support from the perfusion scientist.