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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 a major surgical procedure. The procedure involves a large cut 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. This is called portal hypertension (increased pressure and backup of the portal vein). When your liver is very damaged and there are blockages, the blood cannot flow through it easily. The veins can then break open (rupture), causing serious bleeding.
Common causes of portal hypertension are:
- Alcohol abuse
- Blood clots in a vein that flows from the liver to the heart
- Too much iron in the liver
- Viral hepatitis (hepatitis B or C)
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, and 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 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
Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 156.
Shah VH, Kamath PS. Small intestinal motor and sensory function and dysfunction. In: Feldmn M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 90.
Sicklick JK, D'Angelica M, Fong Y. The liver. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. St. Louis, Mo: WB Saunders; 2012: chap 54.
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Joshua Kunin, MD, Consulting Colorectal Surgeon, Zichron Yaakov, Israel. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
