Palliation of malignant obstructive jaundice by intra-aortic infusion chemotherapy

Between Jan. 1983 and Jan. 1991, thirty patients with biliary obstruction caused by hepatocellular carcinoma (n= 15); and metastases to the liver or lymph nodes adjacent to the porta hepatis from various primaries (n=15), not suitable to other conventional therapy, were treated with subselective intra- aortic chemotherapy. The catheter was inserted retrogradely through the lateral circumflex artery into the aorta. The catheter tip was placed proximal to the branching of the celiac artery. Of all 30 patients treated 17 patients (57 %) exhibited a decrease in bilirubin levels (total/direct) from a mean of 16.3/9.5 mg/dl to 4.5/2.3 mg/dl, and a decrease in alkaline phosphatase from a mean of 483 IU to 214 IU. The survival time for responders varied from 1.5 to 17.8 months with a median of 4.8 months. Four out of five patients with percutaneous transhepatic biliary drainage, which failed to relieve jaundice, were successful in declining bilirubin and alkaline phosphatase levels by this therapy. The side effects were mild and tolerable. This therapeutic modality is a simple and effective alternative method for palliation of malignant obstructive jaundice.