This study investigates the incidence of extrahepatic perfusion and incomplete hepatic perfusion at intraoperative methylene blue testing and on postoperative nuclear imaging in patients undergoing hepatic arterial infusion pump (HAIP) chemotherapy. The first 150 consecutive patients who underwent pump implantation in the Netherlands were included. All patients underwent surgical pump implantation with the catheter in the gastroduodenal artery. All patients underwent intraoperative methylene blue testing and postoperative nuclear imaging (Tc-Macroaggregated albumin SPECT/CT) to determine perfusion via the pump. Patients were included between January-2018 and December-2021 across eight centers. During methylene blue testing, 29.3% had extrahepatic perfusion, all successfully managed intraoperatively. On nuclear imaging, no clinically relevant extrahepatic perfusion was detected (0%, 95%CI: 0.0–2.5%). During methylene blue testing, 2.0% had unresolved incomplete hepatic perfusion. On postoperative nuclear imaging, 8.1% had incomplete hepatic perfusion, leading to embolization in only 1.3%. Methylene blue testing during pump placement for intra-arterial chemotherapy identified extrahepatic perfusion in 29.3% of patients, but could be resolved intraoperatively in all patients. Postoperative nuclear imaging found no clinically relevant extrahepatic perfusion and led to embolization in only 1.3% of patients. The role of routine nuclear imaging after HAIP implantation should be studied in a larger cohort.

中文翻译：

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肝动脉输液泵植入后肝外灌注和不完全肝灌注：发生率和临床意义

本研究调查了接受肝动脉输注泵（HAIP）化疗的患者术中亚甲蓝检测和术后核成像时肝外灌注和不完全肝灌注的发生率。荷兰首批 150 名连续接受泵植入的患者被纳入其中。所有患者均接受手术泵植入术，并将导管插入胃十二指肠动脉。所有患者均接受术中亚甲蓝测试和术后核成像（Tc-巨聚集白蛋白 SPECT/CT）以确定通过泵的灌注。纳入 2018 年 1 月至 2021 年 12 月期间八个中心的患者。在亚甲蓝测试中，29.3% 的患者进行了肝外灌注，所有患者均在术中成功处理。核成像未检测到临床相关的肝外灌注（0%，95%CI：0.0–2.5%）。在亚甲蓝测试中，2.0% 的患者存在未解决的不完全肝灌注。术后核显像显示，8.1% 的患者肝脏灌注不完全，仅 1.3% 的患者发生栓塞。动脉内化疗泵放置期间的亚甲蓝测试发现 29.3% 的患者出现肝外灌注，但所有患者均可在术中解决。术后核成像未发现临床相关的肝外灌注，仅 1.3% 的患者发生栓塞。 HAIP 植入后常规核成像的作用应在更大的队列中进行研究。