A Percutaneous, High‐Flow, Hyperthermic Isolated Limb Perfusion Technique for Extremity Malignancies: Point of Technique

Isolated limb perfusion (ILP) has long been a cornerstone treatment for unresectable extremity malignancies, offering high local control while sparing the limb. Traditional hyperthermic ILP (HILP), though effective, requires open vascular access and carries significant morbidity. In contrast, isolated limb infusion (ILI) employs a percutaneous approach, but it compromises perfusion quality and treatment duration. This paper describes a hybrid technique that integrates the minimally invasive percutaneous access of ILI with the high-flow, oxygenated, hyperthermic circuit characteristic of HILP. Using advanced endovascular access, extracorporeal oxygenation, and rigorous real-time leakage monitoring, this method replicates the physiological parameters of open HILP while eliminating the need for surgical incisions. The technique expands access to high-efficacy regional chemotherapy for patients previously deemed unfit for open procedures. It represents a significant advancement in limb-sparing therapy, balancing oncologic efficacy with patient safety and procedural simplicity. This paper provides a step-by-step technical guide to its implementation.