HEPATIC ARTERIAL RESISTANCE IN CIRRHOSIS WITH AND WITHOUT PORTAL-VEINTHROMBOSIS - RELATIONSHIPS WITH PORTAL HEMODYNAMICS

Background/Aims: Little information is available on hepatic arterial h emodynamics in cirrhosis because of the invasiveness of methods. Hepat ic arterial resistance indexes were evaluated noninvasively by Doppler ultrasonography and were correlated with portal hemodynamics evaluate d both noninvasively and invasively. Methods: Hepatic arterial resista nce indexes, portal blood flow velocity and volume, and portal vein co ngestion index were evaluated in 31 controls and 171 cirrhotic patient s with (n = 13) or without (n = 158) portal vein thrombosis. Resistanc e to portal blood flow was also calculated in 15 patients from hepatic venous pressure gradient, measured by hepatic vein catheterization, a nd portal blood flew. Results: Resistance indexes were significantly h igher in cirrhotics without portal thrombosis than in controls (pulsat ility index, 1.30 +/- 0.29 vs. 0.89 +/- 0.09; P < 0.001; resistive ind ex, 0.71 +/- 0.07 vs. 0.59 +/- 0.04; p < 0.001). In patients with port al thrombosis, the pulsatility index (1.86 +/- 0.39) and resistive ind ex (0.81 +/- 0.06) were significantly higher than in controls (P < 0.0 01) and in patients without thrombosis (P < 0.001). Resistance indexes directly correlated with portal resistance (P < 0.01), the congestion index (P < 0.01)l and the degree of esophageal varices (p < 0.01). Co nclusions. Hepatic arterial resistance indexes increase in cirrhosis, particularly with portal vein thrombosis. The pathophysiology of the i ncrease in hepatic arterial resistance seems to be parallel to that of portal resistance.