Distal splenorenal shunt procedure
Encyclopedia
In medicine
, a distal splenorenal shunt procedure (DSRS), also splenorenal shunt procedure and Warren shunt, is a surgical procedure in which the distal splenic vein
(a part of the portal venous system) is attached to the left renal vein
(a part of the systemic venous system
). It is used to treat portal hypertension
and its main complication (esophageal varices
).
from the portal venous system
), as it improves the outcome.
(TIPS) versus a DSRS is thought to be approximately similar, but still an area of intensive research.
Both TIPS and DSRS lead to decreased rates of variceal bleeding at the expense of hepatic encephalopathy
; however, TIPS appears to have more shunt dysfunction and lead to more encephalopathy and bleeds. DSRS appears to be more cost effective than TIPS
.
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, a distal splenorenal shunt procedure (DSRS), also splenorenal shunt procedure and Warren shunt, is a surgical procedure in which the distal splenic vein
Splenic vein
In anatomy, the splenic vein is the blood vessel that drains blood from the spleen.It joins with the superior mesenteric vein, to form the hepatic portal vein and follows a course superior to the pancreas, alongside of the similarly named artery, the splenic artery.It collects branches from the...
(a part of the portal venous system) is attached to the left renal vein
Renal vein
The renal veins are veins that drain the kidney. They connect the kidney to the inferior vena cava.It is usually singular to each kidney, except in the condition "multiple renal veins".It also divides into 2 divisions upon entering the kidney:...
(a part of the systemic venous system
Systemic venous system
In human anatomy, the systemic venous system refers to veins that drain into the right atrium without passing through two vascular beds In human anatomy, the systemic venous system refers to veins that drain into the right atrium without passing through two vascular beds In human anatomy, the...
). It is used to treat portal hypertension
Portal hypertension
In medicine, portal hypertension is hypertension in the portal vein and its tributaries.It is often defined as a portal pressure gradient of 10 mmHg or greater.-Causes:Causes can be divided into prehepatic, intrahepatic, and posthepatic...
and its main complication (esophageal varices
Esophageal varices
In medicine , esophageal varices are extremely dilated sub-mucosal veins in the lower esophagus...
).
Splenopancreatic and gastric disconnection (SPGD)
DSRS is typically done with splenopancreatic and gastric disconnection (ligation of the gastric veins and pancreatic veins (that drain into the portal vein) and complete detachment of the splenic veinSplenic vein
In anatomy, the splenic vein is the blood vessel that drains blood from the spleen.It joins with the superior mesenteric vein, to form the hepatic portal vein and follows a course superior to the pancreas, alongside of the similarly named artery, the splenic artery.It collects branches from the...
from the portal venous system
Portal venous system
In human anatomy, the hepatic portal system is the system of veins comprising the hepatic portal vein and its tributaries. It is also called the portal venous system, although it is not the only example of a portal venous system, and splanchnic veins, which is not synonymous with hepatic portal...
), as it improves the outcome.
Comparison to TIPS
Survival with a transjugular intrahepatic portosystemic shuntTransjugular intrahepatic portosystemic shunt
A Transjugular Intrahepatic Portosystemic Shunt is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein...
(TIPS) versus a DSRS is thought to be approximately similar, but still an area of intensive research.
Both TIPS and DSRS lead to decreased rates of variceal bleeding at the expense of hepatic encephalopathy
Hepatic encephalopathy
Hepatic encephalopathy is the occurrence of confusion, altered level of consciousness and coma as a result of liver failure. In the advanced stages it is called hepatic coma or coma hepaticum...
; however, TIPS appears to have more shunt dysfunction and lead to more encephalopathy and bleeds. DSRS appears to be more cost effective than TIPS
Transjugular intrahepatic portosystemic shunt
A Transjugular Intrahepatic Portosystemic Shunt is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein...
.
External links
- Distal Splenorenal Shunt Procedure (Cleveland ClinicCleveland ClinicThe Cleveland Clinic is a multispecialty academic medical center located in Cleveland, Ohio, United States. The Cleveland Clinic is currently regarded as one of the top 4 hospitals in the United States as rated by U.S. News & World Report...
) - has some schematics that show what is done in the procedure. - Portal Hypertension (Mohawk Valley Vascular Center) - has some schematics that show what is done in the procedure.