• Jeremy M Sharib, John M Creasy, Benjamin Wildman-Tobriner, Charles Kim, Hope Uronis, Shiaowen David Hsu, John H Strickler, Sepideh Gholami, Michael Cavnar, Ryan P Merkow, Peter Kingham, Nancy Kemeny, Sabino Zani, William R Jarnagin, Peter J Allen, Michael I D'Angelica, and Michael E Lidsky.
• Department of Surgery, Duke University Medical Center, Durham, NC.
• Ann. Surg. 2022 Dec 1; 276 (6): 943956943-956.

BackgroundHepatic artery infusion (HAI) is a liver-directed therapy that delivers high-dose chemotherapy to the liver through the hepatic arterial system for colorectal liver metastases and intrahepatic cholangiocarcinoma. Utilization of HAI is rapidly expanding worldwide.Objective And MethodsThis review describes the conduct of HAI pump implantation, with focus on common technical pitfalls and their associated solutions. Perioperative identification and management of common postoperative complications is also described.ResultsHAI therapy is most commonly performed with the surgical implantation of a subcutaneous pump, and placement of its catheter into the hepatic arterial system for inline flow of pump chemotherapy directly to the liver. Intraoperative challenges and abnormal hepatic perfusion can arise due to aberrant anatomy, vascular disease, technical or patient factors. However, solutions to prevent or overcome technical pitfalls are present for the majority of cases. Postoperative HAI-specific complications arise in 22% to 28% of patients in the form of pump pocket (8%-18%), catheter (10%-26%), vascular (5%-10%), or biliary (2%-8%) complications. The majority of patients can be rescued from these complications with early identification and aggressive intervention to continue to deliver safe and effective HAI therapy.ConclusionsThis HAI toolkit provides the HAI team a reference to manage commonly encountered HAI-specific perioperative obstacles and complications. Overcoming these challenges is critical to ensure safe and effective pump implantation and delivery of HAI therapy, and key to successful implementation of new programs and expansion of HAI to patients who may benefit from such a highly specialized treatment strategy.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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