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Results of a Standardized Protocol Using Vasopressin and Transhepatic Embolization

Ronald M. Gembarowicz, MD; John J. Kelly, MD; Thomas F. O'Donnell, Jr, MD; Victor A. Millan, MD; Ralph A. Deterling, MD; Allan D. Callow, MD

Arch Surg. 1980;115(10):1160-1164.

Abstract
• We reviewed the courses of 40 patients with variceal bleeding treated with a standardized protocol, including intravenous (IV) vasopressin (Pitressin) and transhepatic embolization. Twelve of the 32 patients with acute episodes of massive variceal bleeding responded to the administration of IV vasopressin alone. Of the 20 patients who did not respond to vasopressin therapy, emergency transhepatic portography with embolization produced cessation of bleeding in ten (50%). The remaining ten patients who failed to respond to either IV vasopressin therapy or transhepatic embolization died, regardless of whether they were treated with aggressive medical therapy or emergency portosystemic shunt. Transhepatic embolization in both the emergent and elective situation demonstrated a thrombotic complication rate of 20%, which limited or precluded eventual therapy with elective portosystemic shunt. Because of this relatively high incidence of occult portal thromboses after transhepatic embolization, transhepatic portography should be obtained routinely prior to elective portosystemic shunts in those patients who have a history of transhepatic embolization.

(Arch Surg 115:1160-1164, 1980)

Author Affiliations
From the Departments of Surgery (Drs Gembarowicz, Kelly, O'Donnell, Deterling, and Callow) and Radiology (Dr Millan), Tufts University School of Medicine, New England Medical Center Hospital, Boston.

Footnotes
Accepted for publication April 15, 1980.

Read before the sixth annual meeting of the New England Society for Vascular Surgery, Waterville Valley, NH, Sept 28, 1979.

Reprint requests to Department of Surgery, New England Medical Center Hospital, 171 Harrison Ave, Boston, MA 02111 (Dr O'Donnell).

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