December 1968

Control of Portal Hypertension by Selective Mesenteric Arterial Drug Infusion

Author Affiliations

From the departments of surgery and radiology of the Division of Graduate Medicine, School of Medicine, Graduate Hospital of the University of Pennsylvania, Philadelphia.

Arch Surg. 1968;97(6):1005-1013. doi:10.1001/archsurg.1968.01340060183022

THE CONTROL of portal hypertension and associated bleeding esophageal and gastric varices continues to be a major problem in emergency situations. Experience with the pharmacologic control of portal hypertension has been an outgrowth of the authors' interest in the preoperative arteriographic demonstration of intraluminal gastrointestinal bleeding1-4 and the diagnosis of advanced cirrhosis with portal hypertension and varices by selective mesenteric arteriography. Selective infusions of a variety of pharmacologic agents were made into the superior mesenteric artery in a series of dogs with experimentally constructed portal hypertension.5 These previously reported experimental infusions utilized doses of epinephrine, norepinephrine, angiotensin amide, vasopressin, and vasopressin derivatives at a much lower level than can be employed systemically to produce pharmacologic effects. Epinephrine, norepinephrine, and angiotensin amide caused a significant decrease in the flow in the superior mesenteric artery and thus decreased portal inflow, but the production of a concomitant portal venous outflow block

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