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Portacaval shunting

Shunt - portacaval; Liver failure - portacaval shunt; Cirrhosis - portacaval shunt

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.

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Hepatic venous circulation

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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 away from the liver. This reduces blood pressure in the portal vein and decreases the risk for 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:

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 and less invasive procedure.

Risks

Risks for anesthesia and surgery in general are:

Risks for this surgery include:

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.

Related Information

Transjugular intrahepatic portosystemic shunt (TIPS)

References

Dudeja V, Ferrantella A, Fong Y. The liver. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 54.

Henderson JM, Rosemurgy AS, Pinson CW. Technique of portosystemic shunting: portocaval, distal splenorenal, mesocaval. In: Jarnagin WR, ed. Blumgart's Surgery of the Liver, Biliary Tract, and Pancreas. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 86.

Shah VH, Kamath PS. Portal hypertension and variceal bleeding. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 92.

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Review Date: 1/15/2021  

Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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