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Portacaval shunting

Definition

Portacaval shunting is a surgical treatment to create new connections between two blood vessels in your liver if you have very bad liver problems.

Alternative Names

Shunt - portacaval

Description

Portacaval shunting is a major surgical procedure. The procedure requires a large cut in the belly area (abdomen). The surgeon then tries to make 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 helps divert blood flow around the liver. This reduces blood pressure in the area and decreases the risk of liver vein rupture and bleeding.

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, the blood cannot flow through it easily. This is called portal hypertension (increased pressure and backup at the portal vein).

Common causes of portal hypertension are:

• Alcohol abuse
• Blood clots
• Too much iron in the liver (hemachromatosis)
• Viral hepatitis

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)
• Clotting in a vein that carries blood from the liver to the heart (Budd-Chiari syndrome)

Portacaval shunting allows your blood to flow better in your liver, stomach, esophagus, and intestines, and then back to your heart.

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 any anesthesia are:

• Problems breathing
• Reactions to medications

Risks for any surgery are:

• Bleeding
• Heart attack or stroke
• Infection

Complications from this procedure include:

• Bleeding
• 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.

Patients with severe liver disease that is getting worse should be evaluated for liver transplant.

References

Shah VH, Kamath PS. Portal Hypertension and Gastrointestinal Bleeding. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: WB Saunders; 2010:chap 90.

Rikkers LF. Surgical Complications of Cirrhosis and Portal Hypertension. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008: chap 53.