Technical Complications and Salvage of Hepatic Artery Infusion Pumps: An Institutional Experience of 2935 Consecutive Cases.

Omar A. Zaki L. Schleimer H. Kalvin Ankur P. Choubey A. Barekzai Joslyn Jung Misha Armstrong Remo Alessandris Merve Rousian R. Geevarghese Danielle R. Silliman M. Gonen B. Marinelli M. Lidsky V. Balachandran J. Drebin L. Saadat Alice C. Wei K. Soares T. Kingham W. Jarnagin M. D'Angelica

Oct 2026 · Annals of Surgery · 0 citations

Medicine

Abstract

Objective

Describe the technical complications of hepatic artery infusion pump (HAIP) placement and characterize salvage rates. SUMMARY

Background

DATA HAIP chemotherapy is an effective tool used in the treatment of hepatic malignancies and has become increasingly adopted at select centers. Much of the safety data is reported from small, newer programs or older, large series.

Methods

Retrospective analysis of all patients who underwent HAIP placement at our institution between 2000 and 2022 was conducted. Pump salvage was defined as the ability to receive HAIP chemotherapy after a pump-associated complication. Pump failure was defined as an HAIP-related complication permanently stopping ongoing HAIP chemotherapy.

Results

Over the study period, 2935 patients had an HAIP placed for colorectal liver metastases (n=2582, 88%), intrahepatic cholangiocarcinoma (n=294, 10%) or another malignancy (n=59, 2%). Of all patients, 759 (26%) had an HAIP-related complication, with 404/759 (53%) having their pump salvaged. The most common complications were abnormal perfusion (n=360 [12%], 285/360 [79%] salvaged), arterial pseudoaneurysm and/or hemorrhage (n=117 [4%], 7/117 [6%] salvaged), and pump-pocket infection (n=115 [4%], 60/115 [52%] salvaged). The complications with the highest salvage rates were pump-pocket seroma (n=15/16, 94%), pump-flipping (n=41/44, 93%), and pump-pocket hematoma (n=45/49, 92%). Unsalvaged complications were catheter dislodgement from vessel (n=0/47, 0%), catheter erosion into bowel (n=0/25, 0%), and arterial thrombosis (n=0/19, 0%). The cumulative incidence of pump failure at 1 year in patients receiving adjuvant therapy was 6.6%, and 4.5% among those receiving palliative therapy.

Conclusions

HAIP-related complications occur in about one quarter of patients, predominantly perfusion and pump-pocket complications. These are salvageable in the majority of cases with multidisciplinary interventions.

DOI PubMed Semantic Scholar

View source