Angiotensin II for the Treatment of Vasodilatory Shock during Percutaneous Hepatic Perfusion Cases: A Case Report

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.