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Shunt - portacaval
Portacaval shunting is a surgical treatment to create new connections between two blood vessels in your liver if you have very bad liver problems.
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.
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:
When portal hypertension occurs, you may have:
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 for any anesthesia are:
Risks for any surgery are:
Complications from this procedure include:
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.
Shah VH, Kamath PS. Portal Hypertension and Gastrointestinal Bleeding. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtranâ€™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.
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