Portacaval shunting is a major operation, requiring an abdominal incision.
Blood flow is diverted around the liver, usually by creating a connection between the portal vein and the inferior vena cava. This reduces pressure in the veins draining the liver, decreasing the dilation of variceal veins in the esophagus, which otherwise are prone to rupture and bleeding.
Portocaval shunting has largely been abandoned since the advent of TIPSS (transjugular intrahepatic portosystemic shunting). This procedure does not involve an incision; rather, a catheter is placed into a large vein in the neck through which a shunt is deployed in the veins draining the liver, thus diverting blood flow around the diseased liver.
Portacaval shunting is generally reserved for patients who have failed TIPSS.
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