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Updated: Jan 22, 2026

Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver
Published on: July 31, 2016
Angiotensin II for the Treatment of Vasodilatory Shock during Percutaneous Hepatic Perfusion Cases: A Case Report
Caroline Andrew1, Robert Suriani, Jamie L Sparling
1From the Mass General Brigham, Department of Anesthesiology, Massachusetts General Hospital, Boston, Massachusetts.
Abstract:
Percutaneous hepatic perfusion (PHP) is an effective treatment for isolated liver metastases from uveal melanoma. Intraoperative anesthetic management is challenging due to extreme hemodynamic fluctuations associated with the venovenous bypass circuit, hemofiltration system, and hepatic artery chemotherapy delivery. Patients often require maximal doses of multiple vasopressors to maintain adequate perfusion. The mechanism of intraoperative hypotension is hypothesized to be due to catecholamine filtration, though literature supporting this mechanism is limited. The following report describes the successful use of angiotensin II for hypotension management during a PHP procedure, supporting the potential for an alternative mechanism for this profound vasoplegia.
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