fig1

Figure 1. Overview of the PHP setup. Introducer sheaths are inserted in the left common femoral artery (5 French) and the right common femoral vein (18 French). As shown on the magnified image of the liver, a catheter is placed in the proper hepatic artery to infuse melphalan to the diseased liver parenchyma (for better visualization, catheter is not shown in a selective position). A double-balloon catheter is inserted in the inferior vena cava (IVC). To isolate the retrohepatic segment of the IVC, the cephalic balloon is inflated at the cavoatrial junction, and the caudal balloon is inflated below the confluence of the liver veins. The catheter in between the balloons is equipped with multiple fenestrations. Using the suction forces of a bypass machine, the melphalan-enriched venous blood from the liver is pumped into an extracorporeal filtration system, which separates the melphalan from the blood before passing on the melphalan-cleansed blood to a 10 F introducer sheath placed in the right internal jugular vein for systemic return.