Vesical perfusion volume and internal iliac pressure during double balloon-occluded arterial infusion chemotherapy for bladder cancer.

Background: This study investigated the correlation between decreased internal iliac arterial blood pressure (IIABP) and blood perfusion volume within the vesical artery region during double-balloon-occluded arterial infusion chemotherapy (D-BOAI) for invasive bladder cancer, utilizing two-dimensional perfusion angiography (2D-PA).

Materials and methods: Sixteen patients were enrolled in this study. A double-balloon catheter was positioned into the contralateral internal iliac artery via the femoral artery approach. The catheter's side hole, located between the distal and proximal balloons, facilitated angiographic visualization of the contrast medium (CM) flow into the urinary bladder. Hemodynamic analysis of the CM in the pelvic arteries during D-BOAI was conducted using 2D-PA. Regions of interest (ROIs) were delineated at the side hole (A) as the outflow point for CM and in the vesical artery region (B). The ratio of the area under the curve (AUC) of CM at each ROI (C = B/A) was computed. The decrease in IIABP (D) following balloon occlusion was recorded at the catheter side hole. The relationship between C and D was analyzed using Pearson's product-moment correlation coefficient.

Results: A total of 32 sides from 16 patients were analyzed. The mean C value was 0.39, and the mean D value was 55.2 mmHg, while the mean IIABP post-occlusion measured 66.2 mmHg. A significant positive correlation between C and D was identified, with a correlation coefficient of 0.704 (p < 0.001).

Conclusion: The findings demonstrate a significant positive correlation between blood perfusion volume in the vesical artery region and the reduction in IIABP following balloon occlusion.

Relevance statement: Our results suggest that decreased IIABP after balloon occlusion could result in high concentrations of anticancer drugs in the vesical artery region, and favorable local tumor control in bladder cancer.

Key points: D-BOAI chemotherapy can treat invasive bladder cancer without radical cystectomy. IIABP and flow persist to some extent even following double balloon occlusion. 2D-PA allowed quantitative evaluation of vesical arterial perfusion volume in D-BOAI.