Arterial infusion therapy

Lin TM et al Continuous Intra-arterial Infusion therapy In hydrofluoric acid burns. J Occup Environ Med2000 42(9) 892-897. [PMID 10998764] (Case series of 10 patients with HP hand exposure treated successfully with Intra-arterial calcium Infusions.)... 

Natsume, H. Imamizu, M. Sugibayashi, K, Shibata, T. Miyagawa, A. Morimolo. Y. Oily Drug Carriers in Cancer Chemotherapy. II. Preparation of Viscous Ethyl Oleate for Intra-arterial Infusion Therapy and its Dispo.sition in Rats and Hamsters. Chemical Pharm. Bulletin, 40(6) 1554-1552, 1992. 

In 1958, Creech et al. used extracorporeal circulation to perfuse anticancer drugs locally in organs which could be separated from the systemic circulation. They attempted active intervention to eradicate all tumor cells and to decrease systemic adverse reactions more completely than can be achieved by arterial infusion therapy. This technique has been established primarily for primary or recurrent tumors located in the pelvic area. Up to now the technique of isolated perfusion has been established for different areas of the body such as the limbs, the liver, the thoracic region, the abdomen or the pelvis. 

Fig. 1. Floxuridine radiosensitization—long-term freedom from liver progression for patients with nondiffuse primary hepatobiliary cancer treated with combined radiation therapy and hepatic artery infusion of floxuridine.

Because approximately two-thirds of patients who undergo resection of hepatic metastases will have disease recurrence, adjuvant systemic and hepatic arterial infusion chemotherapy have been studied in an attempt to improve long-term outcomes. A randomized trial that compared 6 months of hepatic floxuridine and dexamethasone plus TV fluorouracil with leucovorin to TV fluorouracil with leucov-orin alone following resection of hepatic metastases in 156 patients showed improved 2-year DPS (86% vs. 72%) and hepatic recurrence-free survival at 2 years (90% vs. 60%) with the combined therapy. Many practitioners offer adjuvant chemotherapy to select patients following potentially curative hepatic resection, but further studies, especially those involving more active agents, are needed to determine an optimal treatment regimen. ... 

Infusional 5-FU/LV + oxaliplatin OR bolus orinfusional 5-FU/LV + irinotecan OR bevacizumab + 5-FU-based regimen or hepatic artery infusion systemic therapy (if hepatic disease only). If unable to tolerate oxaliplatin or irinotecan-combinatlon regimen, then capecitabine OR bolus 5-FU/LV. 

Floxuridine (FUdR) FUdR (fluorodeoxyuridine FUDR) is used primarily by continuous infusion into the hepatic artery for treatment of metastatic carcinoma of the colon or following resection of hepatic metastases, the response rate to such infusion is 40 to 50%, or double that observed with intravenous administration. Intrahepatic arterial infusion for 14 to 21 days may be used with minimal systemic toxicity. However, there is a significant risk of biliary sclerosis if this route is used for multiple cycles of therapy. Treatment should be discontinued at the earliest manifestation of toxicity (usually stomatitis or diarrhea) because the maximal effects of bone marrow suppression and gut toxicity will not be evident until days 7 to 14. 

Presently, numerous palliative hepatic-directed therapies are available for the treatment of non-resectable liver tumors, including conformal radiation therapy, microsphere brachytherapy, hepatic arterial infusion chemotherapy, transarte-rial chemoembolization, radiofrequency ablation and combinations of these treatments. 

Ashizawa K, Matsunaga N, Aso N et al (1991) Bile lake complication of transcatheter hepatic arterial infusion and embolization therapy. Nipon lagaku Hoshasen Gakkai Zasshi 51 121-126... 

Koyama H, Nishizawa Y, Wada T, Kabuto T, Shiba E, Iwanaga T, Terasawa T, Wada A (1985) Intra-arterial infusion chemotherapy as an induction therapy in multidisciplinary treatment for locally advanced breast cancer. A long-term follow-up study. Cancer 56 725-729 Krag DN, Weaver DL, Alex JC, Fairbank JT (1993) Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 2 335-340... 

Adjuvant hepatic arterial infusion following liver resection has been employed without success to improve long-term survival. In a randomized controlled series of 226 patients, Lorenz et al. (1998) reported no improvements in response with postoperative arterial infusion of 5-FU (1000 mg/m per day -1-5 days) and folinic acid (200 mg/m per day -1-5 days). Systemic chemotherapy given after resection of hepatic metastases was compared to combined systemic and hepatic arterial chemotherapy in another randomized trial of 156 patients reported by Kemeny et al. (1999). The 2-year survival rates improved from 72% to 86% between the systemic therapy group and the combined systemic/hepatic... 

Chemoembolization In a series of 17 patients, Yayoi et al. (1995) compared intraarterial hepatic chemoembolization (n=9) of Adriamycin and lipiodolwith hepatic artery infusion (n=8) with Adriamycin. All intraarterial therapies were followed by endocrine therapy consisting of medroxyprogesterone acetate. There was no significant difference in rates of... 

Fig. 9.9a, h. Breast carcinoma with hepatic metastases. Hepatic artery infusion, a Abdominal computed tomography (CT). Multiple hilohar hepatic metastases prior to intraarterial infusion. The patient had failed previous intravenous therapy, b Abdominal CT, 7 months later, demonstrated an excellent response after treatment with courses of hepatic artery infusion with Taxol (Bristol Myers Squibb, Princeton, NJ)... 

Pajkos G et al. (1998) Combined therapy of metastatic liver neoplasms intrahepatic chemoembolization and systemic chemotherapy. Orv Hetil 139 1013-1017 Parkin DM et al. (1999) Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 80 827-841 Patt YZ et al. (1994) Hepatic arterial infusion of floxuridine, leucovorin, doxorubicin, and cisplatin for hepatocellular carcinoma effects of hepatitis B and C viral infection on drug toxicity and patient survival. J Clin Oncol 12 1204-1211... 

PGE therapy in peripheral vascular disease. Carlson and Eriksson [292] reported in 1973 that femoral arterial infusions of very low doses of PGEi in patients with severe ischaemic peripheral vascular disease was effective in alleviating rest pain and gangrene. More recently Carlson and Olsson have shown that low intravenous doses are also effective [293] and also femoral arterial infusions in patients with verified arterial obstructions produce a dose-related increase in blood flow through the calf of the infused leg [294]. These results suggest that PGEi infusion will soon be available for the non-surgical treatment of such diseases. 

However there are no based data about the choice of one or another arterial channel of the ophthalmic region for the implantation of the infusion catheter because the existing anatomic variety of face vessel architectonics makes difficult this stage of infusion therapy. 

The third version evidenced about reduced character of circulation through these branches. Compression tests may show a prevailed influence of circulation from the pool system of the outer carotid artery. Periferic extracranial segments of outer carotid artery is advisable to use as arterial collector for intraarterial infusion therapy in this case. 

As shown, our experimental angiographic investigations use the traditional streaming method of drug infusion into the face artery only partially provides its infusion into a.ophthalmica. It is explained by the fact that an infusion fluid pressure reated in catheters exit multiply exceeds systolic pressure level in the ophthalmic artery. That is why a considerable part of the infused drug (more than 99% is spread outside of eye blood supply pool). Thus, this method may be considered as "relative" regional intraarterial infusion therapy (Fig. 1-a). 

Table 2. Acuity vision and electrophysiological data in patients with toxic neuritis before and after intraarterial infusion therapy via supraorbital arteries (direct regional intraarterial infusion therapy).

L.V. Kucherenko, Efficacy of infusion therapy via superficial temporal artery in eye diseases. Synopsis of the scientific work for the degree of the degree of medical doctor [Odessa, Ukraine],(1991). 

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