ILP can be carried out via the following veins:
- Upper extremity:
- Axillary vein
- Brachial vein
- Lower extremity:
- External iliac vein
- Femoral vein
- Popliteal vein
Iliac access is used often for lower limb perfusions.
- A diagonal incision is made across the iliacal fossa.
- The fascia and muscles are cut.
- Dissection down to the external iliac veins.
- Vascular control is secured proximally and distally with vessel loop.
- The side branches are ligated.
- Anticoagulation with heparin is administered.
- Venous and arterial cannulas are inserted.
- A tourniquet is placed proximally on the thigh.
- Temperature probes are inserted in the extremity both in subcutaneous tissue and in the muscle distally and proximally.
- The cannulas are connected to the heart/lung machine.
- Perfusion is maintained at 400–500 ml/min for lower extremity and 150–300 ml/min for upper extremity.
- For large melanoma metastases TNF is added to the perfusion and circulated for 30 minutes.
- The perfusion is heated to 38.5–39.5°C.
- Melfalan is added.
- The duration of the perfusion with melfalan is 60 minutes. Total duration of the entire perfusion when TNF is added to melfalan is 90 minutes.
Monitoring of leakage
- Potential leakage is measured with radioactive-labeled albumin, which is injected into the perfusate.
- A gamma detector is placed over the heart.
- Radioactivity in perpheral plasma is monitored continually with specialized software.
- For leakage > 10 %, it must be decided whether the perfusion should be interrupted due to risk of systemic toxicity.
Completion of ILP
- The drug perfusion is stopped and the extremity is perfused with 3-5 L Macrodex.
- The pump is turned off and the tourniquet and cannula removed.
- The veins are sutured and the circulation is reestablished in the extremity.
- The incision is closed.