Infusion technique

Patients presenting with severe burden of disease with either in transit lesions or large, unresectable tumors, limited to a single limb, are generally not considered for surgical resection, as we aim to provide limb-sparing optionsfor treatment. High-dose regional therapy was first described in melanoma in the 1950s using isolated limb perfusion (ILP), a complex, costly, and invasive procedure. Isolated limb infusion (ILI) was developed in the early 1990s to offer a minimally invasive approach with outcomes comparable to ILP. ILI is a technique of low-flow isolated limb chemotherapy infusion via percutaneously placed arterial and venous catheters. In this chapter, we review both the technical and clinical aspects of ILI, from patient selection to long-term follow-up. From a technical standpoint, we will discuss chemotherapy selection, catheter insertion technique, and nuances of the procedure. We will also discuss patient care, includingpreoperative assessment, intraoperative care, postoperative care and follow-up, as well as the indications for repeat ILI procedures.