Portacaval shunting is a treatment for high blood pressure within a vein that flows into the liver. Such high blood pressure is called portal hypertension.

Portacaval shunting is a major operation. The procedure requires a surgical cut in the belly area (abdomen). The surgeon 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 helps divert blood flow around the liver. This reduces blood pressure in the area and decreases the risk of liver vein rupture and bleeding.

Liver diseases such as cirrhosis can lead to portal hypertension.

Portacaval shunting is generally reserved for patients with portal hypertension who have failed transjugular intrahepatic portosystemic shunting (TIPS), a less invasive procedure.

Complications from this procedure include:

• Bleeding
• Liver failure
• Worsening of hepatic encephalopathy (a disorder where concentration, mental status, and memory are affected; may lead to coma)

Portacaval shunting is generally a procedure used to prolong life until other measures can be taken. Patients with chronic progressive liver disease who are good candidates should be evaluated for liver transplant. Patients with liver disease have a greatly increased risk of complications after surgery.

Shah VH, Kamath PS. Portal Hypertension and Gastrointestinal Bleeding. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: WB Saunders; 2006:chap 87.

Rikkers LF. Surgical Complications of Cirrhosis and Portal Hypertension. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap 53.