Portacaval shunt
A portacaval shunt, portocaval shunt, or portal-caval shunt is a surgical procedure where a connection (a shunt) is made between the portal vein, which supplies 75% of the liver's blood, and the inferior vena cava, the vein that drains blood from the lower two-thirds of the body. It is typically used for the treatment of portal hypertension.
Less common causes include diseases such as hemochromatosis, primary biliary cirrhosis (PBC), and portal vein thrombosis.[citation needed]
A portacaval anastomosis is analogous in that it diverts circulation; as with shunts and anastomoses generally, the terms are often used to refer to either the naturally occurring forms or the surgically created forms.
Indications
[edit]Portacaval shunting is primarily indicated for uncontrolled upper gastrointestinal bleeding when medical therapy, endoscopic methods, or transjugular intrahepatic portosystemic (TIPS) shunt are not possible.[1] It can also be indicated for a patients with a history of splenectomy, splenic vein or hepatic vein thrombosis, splenorenal shunt, or ascites.[1]
The purpose of the shunt is to redirect blood flow from the portal venous system into the systemic venous system, which leads reduces the pressure gradient in the portal venous circulation, thereby lowering the risk of bleeding.[2]
Types of shunt
[edit]There are two types of portacaval shunts, end-to-side and side-to side shunts. The end-to-side portacaval shunt involves connecting the end of the portal vein to the side of the inferior vena cava, creating a new connection between the two vessels. The side-to-side portacaval shunt involves connecting the side of the portal vein to the side of the inferior vena cava, creating a parallel bypass resulting in less flow disruption and fewer complications. Both surgical procedures results in reducing portal venous pressure by diverting blood flow into the systemic venous circulation. [3]
Risks and complications
[edit]Cirrhotic patients often develop hepatic encephalopathy (HE) following the procedure,[4] sometimes resulting in coma.[5] The high risk of developing HE may be a consequence of increased intestinal absorption of encephalopathogenic substances in combination with the reduced hepatic blood flow.[4]
Additionally, there is an increased risk of morbidity and mortality with surgical shunts compared to radiologic shunting (TIPS), especially in patients with advanced disease.[2]
References
[edit]- ^ a b Crossan, Kaitlyn; Jones, Mark W. (2024), "Portacaval Shunt", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 33085359, retrieved 2024-11-10
- ^ a b Brand, Martin; Prodehl, Leanne (2015-09-18). Cochrane Hepato-Biliary Group (ed.). "Surgical portosystemic shunts versus transjugular intrahepatic portosystemic shunt for variceal haemorrhage". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD001023.pub2.
- ^ Fong, Yuman (2007). Atlas of Upper Gastrointestinal and Hepatic-Pacreato-Biliary Surgery. Berlin, Heidelberg: Springer Berlin Heidelberg. pp. 727–774. ISBN 978-3-540-20004-8.
- ^ a b Iwatsuki S (September 1974). "A case of hepatic encephalopathy after portacaval shunt". The Japanese Journal of Surgery. 4 (3): 183–188. doi:10.1007/bf02468624. PMID 4464374. S2CID 10001207.
- ^ Sarfeh IJ, Rypins EB (April 1994). "Partial versus total portacaval shunt in alcoholic cirrhosis. Results of a prospective, randomized clinical trial". Annals of Surgery. 219 (4): 353–61. doi:10.1097/00000658-199404000-00005. PMC 1243151. PMID 8161260.
External links
[edit]- Portacaval+shunt at the U.S. National Library of Medicine Medical Subject Headings (MeSH)
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