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Portacaval shunting

  • Definition
    • Portacaval shunting is a surgical treatment to create new connections between two blood vessels in your abdomen. It is used to treat people who have severe liver problems.

  • Alternative Names
    • Shunt - portacaval

  • Description
    • Portacaval shunting is major surgery. It involves a large cut (incision) in the belly area (abdomen). The surgeon then makes a connection between the portal vein (which supplies most of the liver's blood) and the inferior vena cava (the vein that drains blood from most of the lower part of the body.)

      The new connection diverts blood flow way from the liver. This reduces blood pressure in the portal vein and decreases the risk of a tear (rupture) and bleeding from the veins in the esophagus and stomach.

  • Why the Procedure Is Performed
    • Normally, blood coming from your esophagus, stomach, and intestines first flows through the liver. When your liver is very damaged and there are blockages, blood cannot flow through it easily. This is called portal hypertension (increased pressure and backup of the portal vein.) The veins can then break open (rupture), causing serious bleeding.

      Common causes of portal hypertension are:

      When portal hypertension occurs, you may have:

      • Bleeding from veins of the stomach, esophagus, or intestines (variceal bleeding)
      • Buildup of fluid in the belly (ascites)
      • Buildup of fluid in the chest (hydrothorax)

      Portacaval shunting diverts part of your blood flow from the liver. This improves blood flow in your stomach, esophagus, and intestines.

      Portacaval shunting is most often done when transjugular intrahepatic portosystemic shunting (TIPS) has not worked. TIPS is a much simpler, less invasive procedure.

  • Risks
    • Risks for anesthesia and surgery in general are:

      • Allergy to medicines, problems breathing
      • Bleeding, blood clots, or infection

      Risks of this surgery include:

      • Liver failure
      • Worsening of hepatic encephalopathy (a disorder that affects concentration, mental status, and memory; may lead to coma)
  • After the Procedure
    • People with liver disease are at a much higher risk for complications after surgery.

      People with severe liver disease that is getting worse may need to be considered for liver transplant.

  • References
    • Roddenbery SA, Rosemurgy AS. Technique of portocaval shunting. In: Jarnagin WR, Blumgart LH, eds. Blumgart's Surgery of the Liver, Biliary Tract and Pancreas. 5th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 76B.