EFFECTS OF ENDOSCOPIC VARICEAL SCLEROTHERAPY ON AZYGOS VEIN BLOOD-FLOW AND SYSTEMIC HEMODYNAMICS

The present study was designed to determine the systemic haemodynamic effects of obliterating oesophageal varices by endoscopic sclerotherap y. We evaluated systemic and splanchnic haemodynamics before and after the first course of sclerotherapy in cirrhotic patients. The baseline cardiac index was significantly correlated with baseline azygos vein blood flow (r=0.64; P<0.01) and the azygos vein blood flow and cardiac index significantly decreased (-33% and -16%, respectively; P<0.01) f ollowing sclerotherapy. The systemic vascular resistance index was als o increased significantly (+20%; P<0.01) in these patients. Moreover, the per cent change in azygos vein blood flow was directly correlated with that of the cardiac index (r=0.51; P<0.03). We conclude from thes e findings that the obliteration of portosystemic collaterals by scler otherapy significantly reverses hyperdynamic circulation in such patie nts via a decrease in cardiac preload. The blood flow of the portosyst emic shunt per se is a leading contributor to the hyperdynamic circula tion observed in patients with well-developed portal systemic collater al vessels.