shunt between the portal circulation and the hepatic vein , reducing portal
hypertension. Complications may include bleeding, sepsis, heart failure, organ
perforation, shunt thrombosis, and progressive liver failure
6. SURGICAL MANAGEMENT
Surgical decompression. Surgical Bypass Procedures of the portal circulation
can prevent variceal bleeding if the shunt remains patent.
The distal splenorenal shunt made between the splenic vein and the left renal
vein after splenectomy. A mesocaval shunt is created by anastomosing the
superior mesenteric vein to the proximal end of the vena cava or to the side of
the vena cava using grafting material.
The goal of distal splenorenal and mesocaval shunts is to drain only a portion of
venous blood from the portal bed to decrease portal pressure; thus, they are
considered selective shunts.
The liver continues to receive some portal flow, and the incidence of
encephalopathy may be reduced.
These procedures are extensive and are not always successful because of
secondary thrombosis in the veins used for the shunt as well as complications
(eg, encephalopathy.
Partial portacaval shunts with interposition grafts are as effective as other shunts
but are associated with a lower rate of encephalopathy
If the cause of portal hypertension is the rare Budd-Chiari syndrome or other
venous obstructive disease, a portacaval or a mesoatrial shunt may be
performed The mesoatrial shunt is required when the infrahepatic vena cava is
thrombosed and must be bypassed.
