Portocaval

Portocaval refers to connections or shunts between the portal venous system and the systemic venous circulation, most commonly between the portal vein and the inferior vena cava. The term encompasses both naturally occurring portosystemic collaterals that develop in response to portal hypertension and surgically created connections intended to decompress the portal venous system.

In portal hypertension, portocaval or portosystemic collaterals form to bypass the liver, allowing blood to return to the systemic circulation. Clinically important examples include esophageal and gastric varices, rectal varices, and caput medusae. These shunts relieve portal pressure but also bypass hepatic filtration, increasing the risk of hepatic encephalopathy.

Surgical portocaval shunts create a direct connection between the portal vein and the inferior vena cava to reduce portal pressure. Common variants include end-to-side or side-to-side anastomoses. While effective at decompressing the portal system, portocaval shunts carry risks such as hepatic encephalopathy, liver dysfunction, and shunt occlusion. Consequently, their use has declined with the advent of less invasive or more liver-sparing approaches.

Modern management of portal hypertension more often employs transjugular intrahepatic portosystemic shunt (TIPS), which creates an intrahepatic channel between a portal vein and a hepatic vein, or selective nonshunt strategies such as distal splenorenal shunts in specific settings. Portocaval considerations also appear in diagnostic assessments, including portal pressure measurements and imaging studies to identify collaterals and shunts.

In summary, portocaval describes connections between portal and systemic venous systems, encompassing both natural collateral pathways in portal hypertension and historical or specialized surgical shunts, with current practice favoring approaches that balance decompression with preservation of hepatic function.