Abstract No. 121 Vascular Emergencies in Patients with Hepatic Arterial Infusion Pumps: A Single-Center Retrospective Study

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). 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 interventional radiology (IR) intervention details, and adverse events were collected. 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 6-mm VBX), and 1 occluded at 1 month (5-mm VBX). 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.