Effect of propranolol on portosystemic collateral circulation in patients with cirrhosis

Abstract

Propranolol has been demonstrated to be effective in lowering portal pressure in cirrhotic patients. This effect is mediated by a reduction of splanchnic arterial inflow and a consequent decrease of portal vein and portocollateral blood flow. Although experimental studies suggest a direct effect of the drug on portocollateral circulation, little information exists about relative flow changes occurring in the portal vein and in collateral veins feeding esophageal varices. This study addressed the problem in 12 cirrhotic patients selected on the basis of feasibility of Doppler flowmetry in both the portal and left gastric veins. Caliber, flow velocity and flow volume in both vessels were measured by Doppler ultrasound before and at 60, 120 and 180 min after an oral dose of 40 mg propranolol, together with heart rate and mean arterial pressure. A significant decrease in heart rate (− 17.6% ± 1.1%, p < 0.001) and mean arterial pressure (− 10.6% ± 0.9%, p < 0.005) confirmed effective β-blockade. Baseline flow velocity was significantly lower in the portal vein than in the left gastric vein (12.4 ± 0.6 vs. 15.4 ± 1.5 cm/sec, p < 0.05). Maximal hemodynamic effect was reached at 120 min after administration of propranolol. The vessel caliber did not change significantly. Flow velocity fell from 12.4 ± 0.6 to 10.4 ± 0.7 cm/sec in the portal vein (p < 0.05) and from 15.4 ± 1.5 to 11.1 ± 0.9 cm/sec in the left gastric vein (p < 0.01). The percentage decrease in velocity and flow volume was significantly higher in the left gastric vein than in the portal vein (velocity = − 26.8% vs. − 15%, p < 0.05; flow = − 30.2 ± 4.4 vs. − 20.9 ± 3.3 cm/sec; p < 0.05). These data support the hypothesis of a direct effect of the drug on portocollateral resistance. (Hepatology 1991;14:824-829).