DUPLEX COLOR DOPPLER SONOGRAPHY - MEASUREMENT OF CHANGES IN HEPATIC ARTERIAL HEMODYNAMICS FOLLOWING INTRAARTERIAL ANGIOTENSIN-II INFUSION

Angiotensin II (AT-II) has been used to target regionally-administered cytotoxic microspheres in patients with intrahepatic tumours. The opt imisation of vasoconstrictor targeting requires a knowledge of the blo od flow changes induced by agents such as AT-II. We therefore assessed duplex/colour Doppler sonography (DCDS) as a means of evaluating tge effects of AT-II infusion on hepatic arterial blood flow (HABF) and ar terial resistance in patients with intrahepatic tumours. HABF was meas ured continuously in nine patients using DCDS before, during and after an infusion of AT-II (15 micrograms in 3 ml of saline over 90 s) via a hepatic artery catheter. In seven patients with less than 30% hepati c replacement by tumour, the baseline level of HABF was 331 +/- 85 ml min-1 (mean +/- s.d.), and this was reduced by 75-80% within 30 s of t he start of AT-II infusion. HABF recovered rapidly from the end of the infusion, and increased by up to 20% above the baseline for approxima tely 2 min. In two patients with greater than 50% hepatic replacement, HABF showed no reduction but rose continuously from the start of AT-I I infusion, increasing by a factor of 2-2.5 after 3-4 min. Arterial re sistance showed reciprocal changes in all cases. We conclude that DCDS is effective in assessing the temporal changes in hepatic arterial bl ood flow caused by AT-II. In order to optimise tumour targeting, the i njection of microspheres loaded with cytotoxic drugs should be complet ed before the end of the AT-II infusion. The targeting advantage of AT -II in patients with a high percentage hepatic replacement by tumour s hould be re-assessed.