Hepatic arterial infusion pump (HAI) is a method of delivering chemotherapy directly to the liver through the hepatic artery. This artery is the liver's primary blood supply.
By delivering the chemotherapy directly to the tumor site, it allows for higher concentrations of the drug to reach the cancer cells while minimizing unpleasant side effects (compared to traditional systemic chemotherapy). HAI is primarily used to treat cancers that are primarily located in the liver. This includes:
HAI is not suitable for all patients with cancer in the liver. Factors such as the extent and location of the tumor, the patient's overall health, and liver function are considered. Your AHN surgical oncologist will be able to talk through your options with you and determine the best plan.
AHN is one of the few hospital systems in Pennsylvania to provide HAI procedures. The pump isn’t an option for everyone, but we are experienced in determining what is the best treatment option for your specific needs. With our surgical oncologists, you can expect:
Your initial evaluation for HAI will typically begin with a referral from your AHN oncologist or a specialist familiar with your specific care plan. Evaluation to ensure you are a good candidate for an HAI will typically include:
It’s important to understand the risks that are associated with HAI therapy. There is chance of liver injury and biliary sclerosis. These are rare, but a risk for some patients. Regular blood work is essential to track the body’s response to HAI.
Prior to your HAI procedure, you will undergo a pre-operative process that includes:
On the scheduled day, you’ll arrive at the hospital or procedure center and is taken to a pre-operative area to change into a gown, and an IV line is inserted. Vital signs are monitored continuously. You will meet with your AHN care team, which is often made up of a surgeon, interventional radiologist, anesthesiologist, and nurses. Together, you and your team will review the procedure and address any final questions.
A small pump is surgically implanted, typically in the abdomen, and connected to a catheter placed in the hepatic artery. The pump then delivers the chemotherapy drug over a period of time. It is primarily used to treat cancers that have spread to the liver or are primarily located in the liver. The HAI procedure usually includes:
Following the HAI procedure, you will likely be in the hospital a few days to rest and recover. Your surgical and care team will monitor you for any signs of complications including infection, bleeding, or pump malfunction. You will also be given pain medication to help manage any discomfort from the incision. Your care team will discuss what follow-up appointments are needed to check on the pump’s function, assess the response to treatment, and manage side effects.
The pump needs to be refilled every two weeks, and it alternates between chemotherapy and heparin. This is typically done in an outpatient setting at an AHN facility. A needle is inserted through the skin into a reservoir in the pump, and the old medication is withdrawn and replaced with new medication. For those patients who live farther away from an AHN facility, we have specialized care teams we work with who can often come to you to administer your medication at the schedule required.
There are different reasons why your HAI might be removed. Common reasons include:
To remove the HAI, the procedure is usually performed under general anesthesia, and the surgeon will most often use the original incision site to carefully remove the pump pocket. The length of the hospital stay after pump removal can vary. It's often shorter than the initial implantation, but it depends on the complexity of the removal and the patient's overall condition. Expect at least an overnight stay, possibly longer. You will be monitored to ensure your healing is going well, pain is being managed, and for other potential complications.
If you are a candidate for a hepatic artery infusion (HAI) pump, you likely have questions. Your AHN care team is here to help guide you through this process and provide answers that are specific to your unique case. To help you get started and gather information that can help in your discussions, we’ve included answers to some frequently asked questions patients have about HAI pumps.
A hepatic artery infusion (HAI) pump is a device used to deliver chemotherapy directly to the liver. It consists of a small pump, about the size of a hockey puck, that is surgically implanted under the skin of the abdomen. A catheter (a thin, flexible tube) connects the pump to the hepatic artery, which is the main blood vessel supplying the liver. The pump delivers chemotherapy drugs directly into the hepatic artery, allowing for a higher concentration of the drug to reach liver tumors while minimizing side effects to the rest of the body. In select patients, this is a minimally invasive surgery.
The HAI procedure involves surgically implanting the pump and catheter. First, imaging is used to map the liver's blood vessels. Under general anesthesia, an incision is made in the abdomen. The hepatic artery is identified, and the catheter is carefully inserted into it, with the tip positioned near the tumor(s). The pump is implanted in a pocket created under the skin, and the catheter is connected to the pump. The incision is then closed. After surgery, the pump is programmed to deliver the chemotherapy drug according to a specific schedule. The pump needs to be refilled with medication regularly, typically every 2 weeks, in an outpatient setting.
The duration that an HAI pump remains in place varies depending on the individual patient's situation and treatment plan. It can stay in place for months or even years. The pump may be removed if the treatment is completed, if the cancer is not responding, if complications arise, or if the patient chooses to discontinue the therapy.
The "success rate" of HAI is a complex question and depends on how success is defined. HAI is typically not a curative treatment, but it can be effective in shrinking liver tumors, slowing their growth, and improving quality of life. The response rate varies depending on the type and extent of the cancer, the specific chemotherapy drugs used, and other individual factors. Some studies have shown that HAI can significantly improve survival rates in patients with certain types of cancer in the liver compared to systemic chemotherapy alone. It's important to discuss realistic expectations and potential outcomes with your oncologist.
HAI is typically considered for patients with cancer in the liver, particularly those with:
Patients who are candidates for HAI generally have liver tumors that are not amenable to surgical resection (removal) or other local therapies, and who have good overall health to tolerate the procedure and chemotherapy. The decision to use HAI is made on a case-by-case basis by a multidisciplinary team of specialists.
If there is an emergency, and you cannot make it in for your refill appointment, there is two-day reserve supply. However, you should contact your care team as soon as possible about coming in for your refill. If you are planning a trip or will be away when you are scheduled to refill, we can use an agent called glycerol that will last eight weeks and give the patient the medication they need. This can also be used post-treatment if you need to keep your pump when there is a risk of reoccurrence.
Please call 833-246-7662 to make an appointment directly with surgical oncology and schedule a hepatic arterial infusion.
Bring any test results or imaging done outside of our office with you to your first appointment. If you or a health care provider has medical films, slides, or other information that would be helpful, use the Medical Records page to learn more about transferring documents.
