Hepatic Arterial Infusion for Malignancy

Hepatic Arterial Infusion (HAI) chemotherapy most commonly entails the surgical implantation of a subcutaneous pump with a catheter that is inserted into the hepatic arterial system, allowing for the delivery of high-dose chemotherapy directly to the liver, typically given concurrently with systemic chemotherapy. The primary agent delivered via HAI is floxuridine (FUDR), which has the ideal properties of a short half-life (<10 minutes) and near-complete hepatic clearance, such that drug concentrations in the liver reach up to 400 times that which could be achieved with intravenous delivery, but without systemic exposure/toxicity. This text is the gold standard comprehensive resource encompassing much more than the essentials of hepatic arterial infusion therapy. Written by experts in the field, sections include a historical perspective of transarterial therapies and how implantable devices were developed, as well as the therapeutic optimization that has taken place over many decades. Subsequent chapters address key components of the preoperative evaluation and patient selection criteria, and surgeons will benefit from the thorough review of the conduct and nuances of pump implantation, inclusive of how to overcome commonly encountered intraoperative obstacles. The reader, regardless of their role on the HAI team, will have access to a toolkit to aid in diagnosis and management of commonly encountered complications, allowing insight into perioperative management of these complex patients. Furthermore, medical oncologists will benefit from exhaustive details pertaining to pump and systemic chemotherapy dosing and delivery, with specific attention to modifications that will facilitate improvements in HAI safety and therapeutic efficacy. This all-inclusive text also includes a thorough review of the existing body of literature, which will provide all readers with evidence-based context and justification for using HAI for specific patient populations. The book concludes with sections focused on essential steps for new HAI program implementation and sustainability, as well as the future of HAI, including device and drug development, and alternative transarterial chemotherapy delivery strategies. This HAI reference includes extensive illustrations and figures for visual clarity. Accompanying this book is a video atlas demonstrating technical maneuvers for open and robotic HAI pump implantation, management of aberrant anatomy and intraoperative troubleshooting, as well as instructional videos for how to prime, access, bolus, and refill the pump, all of which are key components of maintaining a functional device. It is the only reference that provides a comprehensive review of all aspects of HAI for all specialists and providers of a multidisciplinary HAI team.