In patients with cirrhosis and other forms of advanced liver disease, recurrent variceal bleeding is a potentially life-threatening condition. Varices form in a patient with a diseased liver when cirrhosis prevents normal blood flow into the liver. As pressure in the portal system builds, varices, or alternative vessels, form, often at the base of the esophagus, in the stomach, small intestine, or colon.
Varices grow until pressure is so high that the vessels rupture.
By lowering portal hypertension, the risk of ruptured varices and hemorrhage is reduced. In the procedure, a catheter is placed in the right jugular vein and threaded through the right atrium into the major hepatic vein. A long needle, inserted through the catheter, pierces the wall of the hepatic vein to reach an adjacent major portal vein branch. A flexible guide wire and catheter are advanced into the main portal vein, through which measurement of hemodynamics and portal venography take place. This real-time assessment of portal pressures and flow allows the creation of the smallest possible shunt to reduce the pressure below the bleeding threshold.