What is the distal splenorenal shunt procedure?

A distal splenorenal shunt is a surgical procedure. During the surgery, the vein from the spleen (called the splenic vein) is detached from the portal vein and reattached to the left kidney (renal) vein. This surgery selectively reduces the pressure in your varices (the large, swollen veins that develop across the stomach and esophagus) and controls the bleeding and clotting.

Fig 1: Portal hypertension before the distal splenorenal shunt surgery is performed.

Varices develop across the esophagus and stomach from the pressure in the portal vein. The backup of pressure also causes the spleen to become enlarged.

Fig 2: After the distal splenorenal shunt surgery is performed.

The vein from the spleen is disconnected from the portal vein and reconnected to the top of the left renal vein. The left gastric vein is disconnected from the portal vein and tied off.

The blood flows from the varices through the splenic vein, to the left renal vein and empties into the inferior vena cava. The blood flow to the liver is maintained through the portal vein.

Why do I need to have the distal splenorenal shunt procedure?

X-rays and blood tests confirm that you have variceal bleeding due to portal hypertension. Portal hypertension is a condition characterized by increased pressure in the portal vein (the vein that carries blood from the digestive organs to the liver). Your physician has chosen the distal splenorenal shunt procedure to treat this condition. This procedure helps control the bleeding in the varices, without taking the blood flow away from your liver, which could make your liver disease worse.

Last reviewed by a Cleveland Clinic medical professional on 11/06/2017.


  • J. Michael Henderson JM, Boyer TD, Kutner MH, et al. Distal Splenorenal Shunt Versus Transjugular Intrahepatic Portal Systematic Shunt for Variceal Bleeding: A Randomized Trial. Gastroenterology 130(6):1643–51.
  • Jenkins RL, Gedaly R, Pomposelli JJ, et al. Distal splenorenal shunt: role, indications, and utility in the era of liver transplantation. Arch Surg. 1999 Apr;134(4):416-20.
  • Elwood DR, Pomposelli JJ, Pomfret EA, et al. Distal splenorenal shunt: preferred treatment for recurrent variceal hemorrhage in the patient with well-compensated cirrhosis. Arch Surg. 2006 Apr;141(4):385-8.

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