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Leakage through the bone-marrow during isolated limb perfusion in the lower extremity.

Journal article
Authors Dimitrios Katsarelias
John Båth
Per Carlson
Jan Mattsson
Roger Olofsson Bagge
Published in Journal of surgical case reports
Volume 2019
Issue 4
Pages rjz090
ISSN 2042-8812
Publication year 2019
Published at Institute of Clinical Sciences, Department of Surgery
Pages rjz090
Language en
Subject categories Surgery


Isolated limb perfusion (ILP) is used for melanoma in-transit metastases of the extremities. The use of Melphalan and TNF-alpha, necessitates monitoring of possible systemic leakage throughout the perfusion. It has been suspected that leakage through bone marrow is possible. We present the case of a patient with in-transit melanoma metastases in the lower extremity, who underwent minimally invasive ILP, according to our new protocol through percutaneous insertion of the catheters under fluoroscopy. Following cannulation of the vessels a high leakage rate was recorded. The procedure was converted to open with clamping of the artery and vein, however the leakage was not possible to control, and venography showed that this was due to bone marrow veins. To the best of our knowledge this is the first case of a verified leakage during ILP through bone marrow veins. We believe that some minor leakages registered under ILP could be attributed to this leakage route.

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