Hepatic Arterial Pumps

Why aren't hepatic arterial pumps more widely used?

Well first of all, the pumps are technically they are difficult to put in. Not terribly difficult, but you need to have a surgeon who knows what they are doing and is trained on how to put one in, because if you don't have the flow going to the correct place, for instance, if you are profusing outside the liver, the patient can get very toxic because you are using a very high dose right into the liver, which the liver can tolerate. But that same dose going outside is too high, so the patient could get very sick, so that's one problem. The other problem is that if it's going a little bit into the stomach, the patient could get ulcers.

So all these things have to be monitored, and then the medical oncologist has to very carefully follow liver function tests. So we use, I use books where I plug in the liver functions from every two weeks, but if you don't do that, then you don't see the slight elevations in liver function tests that you have to monitor. So it's a lot more monitoring and a lot of physicians with very heavy practices and not enough help you know and they don't want to be involved in something like that.