What is a Portacaval Shunt?

    A portacaval shunt is a major surgical procedure that is used to create a new connection between blood vessels in your liver. Your doctor will recommend this procedure if you are suffering from severe liver problems.

    What the Treatment Addresses

    When you’re healthy, blood from your stomach, intestines, and esophagus flows through the liver. The portal vein (or “hepatic portal vein”) carries blood from the digestive system to the liver.

    However, if your liver is severely damaged, the blood will not flow through it at a healthy rate. This causes the blood to back up, increasing pressure at the portal vein. This causes a condition known as portal hypertension. There are a number of potential underlying causes of portal hypertension, including:

    • blood clots
    • alcohol abuse
    • too much iron in the liver
    • viral hepatitis

    In turn, portal hypertension can lead to more serious health issues, including:

    • bleeding from the veins in the esophagus, stomach, or intestines
    • fluid buildup in the stomach
    • fluid buildup in the chest
    • Budd-Chiari syndrome (clots in the vein that transports blood from the liver to the heart)
    • jaundice (yellowing of the skin)
    • vomiting

    Portacaval shunting improves the flow of blood between your liver, esophagus, stomach, and intestines.

    Pre-Procedure Diagnosis and Tests

    To determine if you have a liver disease and need a portacaval shunt, your doctor may recommend one or more of the following tests:

    • a liver function test
    • blood tests for viral hepatitis
    • liver biopsy
    • endoscopy

    Possible symptoms of portal hypertension are:

    • gastrointestinal bleeding, which is indicated by blood in the stool, or black tar-like stools, or vomiting blood
    • ascites, which is an accumulation of fluid in the abdominal area
    • encephalopathy, which is confusion or forgetfulness caused by poor liver function
    • low platelet (a type of blood cell) levels or a decreased white blood cell count

    The Portacaval Shunt Procedure

    You will be given general anesthetic so that you are asleep and do not feel any discomfort during this surgical procedure. Your surgeon will make a large incision in your abdomen, and will connect the portal vein (the short vein that supplies the liver with blood) to the inferior vena cava (the blood vessel that takes blood from the organs and lower limbs to the heart). By making this new connection, blood will bypass the liver and reduce the blood pressure in the liver.

    Benefits of the Treatment

    This procedure has a number of benefits, including:

    • reducing hypertension in the liver
    • reducing the risk of bleeding
    • reducing the risk of rupturing the blood vessels

    Potential Risks of the Procedure

    Anesthetics Risks

    Though most healthy people do not have any problems with general anesthesia, there is a small risk of complications and, though rarely, death. These risks are largely dependent upon your general health and the type of procedure you are undergoing. Some factors may increase your risk of complications, such as:

    • medical conditions involving your lungs, kidneys, or heart
    • family history of adverse reactions to anesthesia
    • sleep apnea
    • obesity
    • allergies to food or medications
    • alcohol use
    • smoking

    If you have such medical complications or are elderly you may be more at risk of the following complications, though these are rare:

    • heart attack
    • lung infection
    • stroke
    • temporary mental confusion
    • death

    Anesthesia Awareness

    Anesthesia awareness is the unintended awakening or awareness of a patient during general anesthesia. This may happen if you have not been given enough general anesthesia. It is very rare, though—according to the Mayo Clinic, it only happens in one or two people out of every 1,000 (Mayo Clinic, 2010). Should this happen, you will wake very briefly and may be aware of your surroundings but will feel no discomfort.

    On extremely rare occasions some people will experience severe pain, which can lead to chronic emotional and psychological problems. Factors that may increase the risk of anesthesia awareness include:

    • emergency surgery
    • disorders of the lung or heart
    • long-term use of sedatives or tranquilizers
    • regular alcohol use
    • long-term use of opiates, tranquilizers, or cocaine
    • daily alcohol use

    Risks of the Surgery

    All forms of surgery carry some risks, including:

    • stroke
    • heart attack
    • infection

    Potential complications specifically connected to a portacaval shunt include:

    • hemorrhage (a sudden large loss of blood)
    • liver failure

    What to Expect After the Treatment

    If you are suffering from liver disease (such as cirrhosis) you are at an increased risk of post-surgery complications. These include:

    • bleeding
    • liver failure
    • encephalopathy—a disease of the brain that affects the brain’s structure and function

    If you suffer from chronic progressive liver disease, your doctor may evaluate you for a liver transplant.