Control of Portal Hypertension by Selective Mesenteric Arterial Drug Infusion

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 bleeding^1-4 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