Simplified Technic of Continuous Intraarterial Infusion for Chemotherapy of the Head and Neck

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THE complications associated with continuous intraarterial infusion for chemotherapy of the head and neck have been of such magnitude as to approach the morbidity and mortality of the natural course of the disease for which the treatment is being given. This has precluded treatment for all patients except those whose condition is essentially hopeless. Many of these complications are referable to the unduly complicated technics associated with this method of therapy.

For example, in general, a major operative procedure using endotracheal anesthesia has been advocated to insert the cannula into the carotid artery. Endotracheal anesthesia alone is associated with risk. Complex technics have been used for suturing the cannula directly to the artery. Then, a mechanical pump or compressed gas usually is used to force the infusate into the artery. Operative intervention in the region of the carotid bifurcation increases the likelihood of cerebrovascular accidents and arterial hemorrhage. Direct suture of a cannula to the carotid artery carries the risk of possible avulsion of a portion of the artery if the cannula is inadvertently removed. The use of a continuous force to maintain the infusion is fraught with the ever-present danger of air embolus and drug overdosage. Air embolus is a possibility even when an airtrap is interposed between the machine and the patient. The expense of machines is another disadvantage. Any method of therapy that is so complex is certain to have a high morbidity and a significant mortality.

When continuous intraarterial infusion therapy for malignant lesions of the . . .



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