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.
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.
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 for anesthesia and surgery in general are:
Risks for this surgery include:
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.
Reviewed By: Michael M. Phillips, MD, Clinical 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.