A portacaval shunt is a major surgical procedure that’s used to create a new connection between blood vessels in your liver. Your doctor will recommend this procedure if you have severe liver problems.
When you’re healthy, blood from your stomach, intestines, and esophagus flows through the liver. The portal vein, also known as the hepatic portal vein, carries blood from the digestive system to the liver.
However, if your liver is severely damaged, the blood won’t flow through it at a healthy rate. This causes the blood to back up, increasing pressure at the portal vein. This results in a condition known as portal hypertension.
There are a number of potential underlying causes of portal hypertension, including:
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, or ascites
- fluid buildup in the chest
- Budd-Chiari syndrome, or blood clots in the vein that transports blood from the liver to the heart
- jaundice, or yellowing of the skin
Portacaval shunting improves the flow of blood between your liver, esophagus, stomach, and intestines.
To determine if you have a liver disease and need a portacaval shunt, your doctor may recommend one or more of the following tests:
Possible symptoms of portal hypertension are:
- gastrointestinal bleeding, which is indicated by blood in the stool (or black tarlike 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 levels or a decreased white blood cell (WBC) count
You’ll be given general anesthetic so that you’re asleep and don’t feel any discomfort during this surgical procedure.
Your surgeon will make a large incision in your abdomen and will connect the portal vein to the inferior vena cava. This blood vessel 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.
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
All forms of surgery carry some risks, including:
Potential complications specifically connected to a portacaval shunt include:
Though most healthy people do not have any problems with general anesthesia, there’s a small risk of complications and, though rarely, death. These risks are largely dependent upon your general health and the type of procedure you’re 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
- allergies to food or medications
- alcohol use
If you have such medical complications or you’re an older adult, you may be more at risk of the following rare complications.
- heart attack
- lung infection
- temporary mental confusion
Anesthesia awareness is the unintended awakening or awareness of a person who’s been given general anesthesia. This may happen if you haven’t been given enough general anesthesia.
It’s very rare, though. According to the Mayo Clinic, it only happens in one or two people out of every 10,000. 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, tranquilizers, opiates, or cocaine
- regular alcohol use