Distal Splenorenal Shunt

What is distal splenorenal shunt?

Distal splenorenal shunt (DSRS) is surgery to ease pressure in your portal vein. The portal vein brings blood from your digestive system to your liver. Surgeons use DSRS to control bleeding and other complications of portal hypertension.

While DSRS can’t cure portal hypertension, it can often help manage symptoms. You typically need regular testing and follow-up care after DSRS to check how you’re doing and help you stay healthy.

What is portal hypertension?

Portal hypertension is high blood pressure that happens when your portal vein becomes narrowed or blocked, most often due to liver damage. High pressure forces blood out of your portal vein and into large new blood vessels (varices) that form within your stomach or esophagus.

As pressure builds, varices swell, and their thin walls grow weaker. They may leak fluid into your belly (abdomen), causing discomfort. They may also burst and bleed, which is a medical emergency.

What does distal splenorenal shunt do?

Distal splenorenal shunt helps prevent or control bleeding by moving (diverting) blood flow away from your portal vein. This relieves pressure and eases swelling while making sure that blood continues flowing to your liver.

During DSRS, your surgeon disconnects the vein of your spleen (splenic vein) from your portal vein. Your surgeon then attaches the splenic vein to the vein of your left kidney (renal vein), creating a new path for blood to flow freely.

Why might I need a distal splenorenal shunt procedure?

Your healthcare provider may recommend DSRS if testing shows you have enlarged or bleeding veins in your stomach or esophagus. Other complications of portal hypertension include fluid buildup in your abdomen (ascites) or swelling in your legs and feet (edema).

Portal hypertension may also cause you to have:

• Blood in vomit or bowel movement (rectal bleeding).
• Gastrointestinal bleeding.
• Hypersplenism (enlarged spleen).
• Low blood oxygen (hypoxemia).
• Kidney failure.
• Mild cognitive impairment (MCI).

What is the difference between DSRS and other splenorenal shunts?

The common goal of splenorenal shunt treatment is to ease pressure in your portal vein and control bleeding. DSRS uses surgery to create a path for blood flow (shunt) using an existing vein. Another procedure, transjugular intrahepatic portosystemic shunt (TIPS) uses a minimally invasive (catheter-based) technique to connect your portal vein directly into the vein that carries blood from your liver to your heart (hepatic vein). Overall, TIPS is more common than DSRS.

Two other splenorenal shunts are:

• Proximal splenorenal shunt: To insert this shunt, surgeons may need to remove your spleen.
• Spontaneous splenorenal shunt (SSRS): SSRS occurs naturally due to advanced liver disease when blood that can’t pass through your liver reverses its flow.

What can I expect before distal splenorenal shunt?

Your provider typically asks about your medical history and does a physical exam. You also receive tests to check your overall health, how well your liver works and the severity of the portal hypertension.

Tests may include:

• Blood tests.
• Liver function tests.
• Chest X-ray.
• Electrocardiogram (EKG).
• Angiogram.
• Upper endoscopy.

Your care team gives you instructions about how to prepare for DSRS, including:

• Which medications to stop.
• What to bring to the hospital.
• When you need to stop eating or drinking.

Talk to your provider about your questions or concerns so you feel comfortable and ready.

What occurs during distal splenorenal shunt?

DSRS typically takes about four hours. First, you receive general anesthesia. You’re asleep during the procedure and don’t feel any pain. Then your surgical care team:

1. Removes the vein that’s attached to your spleen from your portal vein.
2. Attaches the vein to your left kidney.

What can I expect after DSRS?

You typically recover in the hospital for about a week to 10 days. Your care team:

• Places a temporary catheter in your bladder to remove urine.
• Gives you a nasogastric tube (NG) through your nose and stomach for 24 hours to get rid of gas and fluids.
• Inserts an IV in your neck to deliver medication and liquids.
• Sets you up with a pump you manage to control your pain.

Within a week after surgery, you have an angiogram to see if your shunt works properly. You receive solid foods and liquids when you’re able to eat and drink. A dietitian also meets with you before you return home. Your dietitian may recommend a low-sodium, low-fat diet.

What are the risks or complications of distal splenorenal shunt?

Distal splenorenal shunt is generally a safe and effective procedure. In the first month after surgery, you face the highest risk of bleeding again. Your team will work with you to help manage your risk and keep you safe.

How should I manage my recovery after distal splenorenal shunt?

To optimize your recovery, follow the recommendations of your provider and dietitian. Talk to your provider about when you can return to your routine and physical activity.

You continue to have lab tests to check how well your liver is working. Keep your follow-up appointments, so your provider can make sure you are recovering well. Your provider works with you to keep you stable and healthy.

When should I call my healthcare provider?

Contact your healthcare provider or call 911 if you experience concerning symptoms, like:

• Coughing.
• Difficulty breathing.
• Fainting.
• Fever.
• Pain in your chest.
• Sweating more than usual.

A note from Cleveland Clinic

You may feel anxious knowing that you have portal hypertension and face the potential risk of serious complications. Your healthcare provider will work closely with you to monitor any symptoms. At some point, your provider may recommend distal splenorenal shunt if tests find swelling or bleeding, or if you have concerning symptoms. DSRS is a safe, effective treatment that can restore your blood flow and help you feel better overall.