SIR 2024
Interventional Oncology
Harrison S. Blume, B.A. (he/him/his)
M.D. Candidate
Albert Einstein College of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Samagra Jain, B. S. Chemical Engineering
Medical Student
Baylor College of Medicine
Disclosure information not submitted.
Lauren E. Schleimer, MD
Research Fellow
Memorial Sloan Kettering Cancer Center
Disclosure information not submitted.
Anne Covey, MD
Attending
Memorial Sloan-Kettering Cancer Center
Disclosure information not submitted.
Ken Zhao, MD
Assistant Attending
Memorial Sloan Kettering Cancer Center
Disclosure information not submitted.
James Park, MD, PhD
Associate Attending
Memorial Sloan Kettering Cancer Center
Disclosure information not submitted.
William Jarnagin, MD
Chief Attending
Division of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
Disclosure information not submitted.
Alice Wei, MD, MS
Attending
Memorial Sloan Kettering Cancer Center
Disclosure information not submitted.
Kevin C. Soares, MD
Assistant Attending
Memorial Sloan Kettering Cancer Center
Disclosure information not submitted.
Peter Kingham, MD
Associate Attending
Division of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
Disclosure information not submitted.
Jeffrey Drebin, MD, PhD
Acting Hospital President
Memorial Sloan Kettering Cancer Center
Disclosure information not submitted.
Michael D'Angelica, MD
Attending
Division of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
Disclosure information not submitted.
Hooman Yarmohammadi, MD
Associate Attending
Memorial Sloan-Kettering Cancer Center
Disclosure information not submitted.
Brett Marinelli, MD
Assistant Attending
Memorial Sloan Kettering Cancer Center
Financial relationships: Full list of relationships is listed on the CME information page.
The purpose of this study is to identify characteristics and outcomes of patients undergoing interventions for pseudoaneurysm or active extravasation (vascular emergency) related to hepatic artery infusion pumps (HAIPs).
Materials and Methods:
A retrospective chart review was conducted of patients with HAIP undergoing endovascular intervention for vascular emergency between 1/1/2021 and 1/1/2023 at a single, tertiary cancer center. Demographics and baseline characteristics, medical imaging and IR intervention details, and adverse events were collected.
Results:
A total of 14 patients with HAIPs (1 ICC, 13 colorectal metastasis) with 15 vascular emergencies (13 pseudoaneurysm, 2 active extravasation) undergoing 18 IR procedures were reviewed (3 diagnostic, 15 interventional). Vascular emergencies manifested within one month (n=1), one year (n=5), or more than one year (n=9) after HAIP placement, and discovered incidentally on routine imaging (n=11) or following workup for clinical symptoms (n=4). One patient was found with pseudoaneurysm at a separate location two months after the initial intervention. Embolizations localized to the GDA stump (n=9) and distally in the left or right main hepatic arteries (n=6) were performed with coils (n=8), glue and coils (n=3), stent-assisted coil technique (n=1), or covered stent graft across the HAIP catheter insertion stump (n=3). There were no interventional-related complications. One patient did not demonstrate pseudoaneurysm on diagnostic angiography and continued with HAIP use. Stent grafts placed across HAIP insertion catheters were patent in two patients up to 12 months later (both 6mm VBX), and 1 occluded at 1 month (5mm VBX).
Conclusion:
IR intervention for vascular emergencies in patients with HAIP for treatment of liver cancer is safe and effective but does render the HAIP unusable. Placement of a stent graft can maintain patency of the hepatic artery to allow for future arterially directed treatments.