SUPERIOR PORTOSYSTEMIC COLLATERAL CIRCULATION ESTIMATED BY AZYGOUS BLOOD-FLOW IN PATIENTS WITH CIRRHOSIS - LACK OF CORRELATION WITH ESOPHAGEAL-VARICES AND GASTROINTESTINAL-BLEEDING - EFFECT OF PROPRANOLOL

In patients with cirrhosis, superior portosystemic collateral circulation was evaluated by the continuous thermodilution method in the azygos vein. Azygos blood flow was 5 times higher in a group of patients with cirrhosis (alcoholic in 27, cryptogenic in 8, post-hepatitic in 2 and primary biliary cirrhosis in 1), than in a group of patients without portal hypertension (steatosis in 2, granulomatous hepatitis in 2, persistent chronic hepatitis in 2 and Hodgkin''s disease in 1). Azygos blood flow was not different in cirrhotic patients with no visible, in those with small-sized and in those with large sized esophageal varices. Azygos blood flow was not different in cirrhotic patients with and without a previous episode of gastrointestinal bleeding. Fifteen min after i.v. administration of 15 mg of propranolol, azygos blood flow significantly decreased whereas azygos blood flow did not change after placebo. The decrease in azygos blood flow was significantly more marked than the reduction in cardiac output. Superior portosystemic collateral blood flow is elevated in patients with cirrhosis and that the reduction in this collateral circulation might explain the efficiency of propranolol in the prevention of recurrent gastrointestinal bleeding.