Portacaval Shunting for Portal Hypertension

Normal portal venous blood pressure varies between 5 and 10 mmHg. Portal hypertension exists when the pressure gradient between the portal and systemic venous circulation exceeds 5 mmHg. Portal hypertension is a sequela of cirrhosis in more than 90% of cases. Most common clinical manifestations include variceal bleeding, intractable ascites, and hepatic encephalopathy. Decompression of the portal system by the creation of shunts between the portal and systemic veins is a well-recognized option for the treatment of portal hypertension. Various surgical and percutaneous techniques have been used to create these shunts. In this chapter, we will discuss the types of portocaval shunts, their indications and contraindications, a brief technical description of their creation, and their outcomes and complications.