A 52-year-old male patient with a history of alcoholism is brought to the emergency room because of a sudden onset of right upper quadrant pain, nausea, blood in the vomitus, and fever. Ultrasound diagnosis reveals a portal vein obstruction caused by liver cirrhosis and accompanied by esophageal varices. Proper portal circulation must be reestablished to alleviate the esophargeal varices, and the attending surgeon decides on an end-to-side portocaval shunt. Which of the following describes the chosen procedure?
(A) anastomosis by communication between the portal vein and the inferior vena cava
(B) anastomosis by prosthetic vascular graft between the inferior vena cava and the superior mesenteric vein © anastomosis by suturing the inferior end of the portal vein to the inferior vena cava
(D) anastomosis of the splenic vein to the left renal vein
(E) placement of an expandable stent between a hepatic vein and the portal vein
Explanation:
©Suturing the inferior end of the portal vein to the inferior vena cava is termed end-to-side portocaval shunt, whereas establishing a communication between the portal vein and the inferior vena cava (choice A) is a side-to-side portocaval shunt. Placing a prosthetic vascular graft between the inferior vena cava and the superior mesenteric vein (choice B) is termed a mesocaval shunt. Anastomosis of the splenic vein to the left renal vein (choice D) is a splenorenal or Warren shunt. Placement of an expandable stent between the hepatic vein and portal vein (choice E) is called a transjugular intrahepatic portosystemic shunt or TIPS.