title: Intravenous vasopressin for the prevention of nontarget gastrointestinal embolization during liver-directed cancer treatment: experimental study in a porcine model.
abstract: OBJECTIVE
  The aim of this study was to evaluate the potential for intravenous vasopressin to reduce the risk of nontarget gastrointestinal embolization during transcatheter liver-directed cancer therapies in a porcine model.
  
  
  METHODS
  An angiographic catheter was used to select the celiac or common hepatic artery under fluoroscopic guidance in six anesthetized pigs. After angiography of the hepatic and splanchnic territories was performed, technetium-99m macroaggregated albumin ((99m)Tc-MAA) was injected through the catheter. Serial arteriograms were obtained before, every 5 minutes during, and after peripheral intravenous vasopressin infusion at 0.4 U/min for a minimum of 20 minutes. After 10 minutes of infusion, indium-111 ((111)In)-MAA was injected through the arterial catheter. Quantitative comparisons of liver and gastrointestinal activity using dual-isotope single-photon emission computed tomography (SPECT)/CT imaging were performed.
  
  
  RESULTS
  Catheter angiography demonstrated reduced blood flow to the splanchnic vasculature while maintaining blood flow through the hepatic arteries during vasopressin infusion. Angiographic findings correlated with the relative distribution of (99m)Tc-MAA (before the vasopressin infusion) and (111)In-MAA (after the vasopressin infusion) on SPECT/CT. The increased ratio of liver to gastrointestinal tract activity during the vasopressin infusion was statistically significant (6.2:11.4, respectively; P = .018).
  
  
  CONCLUSIONS
  Intravenous vasopressin reduces arterial blood flow to the splanchnic vasculature while preserving hepatic arterial blood flow in a healthy porcine model. Intraprocedural vasopressin administration has the potential to benefit liver-directed cancer therapies by enhancing tumor targeting as well as preventing the unintended delivery of bland embolic, chemoembolic, or radioembolic agents into the gastrointestinal vascular territories.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. durackj@mskcc.org
authors.forename: Jeremy C
authors.initials: JC
authors.lastname: Durack
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Hope
authors.forename: Youngho
authors.initials: Y
authors.lastname: Seo
authors.forename: Maythem
authors.initials: M
authors.lastname: Saeed
authors.forename: Jiang
authors.initials: J
authors.lastname: He
authors.forename: Mark W
authors.initials: MW
authors.lastname: Wilson
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kerlan
authors.forename: Ernest J
authors.initials: EJ
authors.lastname: Ring
mesh_terms: D000818:Animals; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000187:drug effects; D019610:Cytoprotection; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D041981:Gastrointestinal Tract / Q000098:blood supply*; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000187:drug effects; D007262:Infusions, Intravenous; D008099:Liver / Q000098:blood supply*; D008113:Liver Neoplasms / Q000098:blood supply* / Q000628:therapy*; D023421:Models, Animal; D064847:Multimodal Imaging; D009942:Organometallic Compounds; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012709:Serum Albumin; D000075462:Serum Albumin, Human; D013552:Swine; D013668:Technetium Tc 99m Aggregated Albumin; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*; D014667:Vasopressins / Q000008:administration & dosage*
chemical_list: D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D012709:Serum Albumin; D013668:Technetium Tc 99m Aggregated Albumin; D014662:Vasoconstrictor Agents; C035387:indium aggregated albumin; D014667:Vasopressins; D000075462:Serum Albumin, Human