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Strong Heart and Vascular Center

Division of Vascular Surgery

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Portal Hypertension

What is Portal Hypertension?

The portal vein connects the intestines and the liver, and supplies most of
the liver’s blood and oxygen. Portal hypertension, or high blood pressure in the portal vein results from the presence of scar tissue in a damaged liver.

When a liver becomes damaged, scar tissue replaces dead liver cells and interrupts normal blood flow. This causes blood to back up into the portal vein and increases the blood pressure there as the blood finds alternate routes back to the heart and lungs, usually by forcing its way into the tiny veins of the esophagus and stomach.

The fragile blood vessels of the esophagus and stomach become so stretched by the extra blood flow that they are susceptible to breaking. At this point they are referred to as varices. Although they can appear anywhere in the abdominal area, the varices at the base of the esophagus are the most likely to burst and bleed.

Causes and risk factors for hypertension

Liver damage that leads to hypertension may result from:
  • Hepatitis
  • Blood clots
  • Congenital disorders
  • Cirrhosis (a disease in which the body’s antibodies attack the liver’s bile ducts) Risk factors for cirrhosis include:
    • Alcohol abuse
    • Gender (alcohol-related cirrhosis affects more men than women)
    • Age (most cirrhosis patients are between age 40 and 60)
    • Viral infection (in Africa, the Middle East, and Japan)

     

Symptoms of Portal Hypertension

Portal hypertension itself, has no symptoms. There are only symptoms when complications arise. The symptoms from the complications may include:

  • Bloody vomiting and black, loose stools
  • Accumulation of fluid in the abdomen
  • Encephalopathy - a disease of the brain

Diagnosing Portal Hypertension

Portal hypertension may be suspected if a person with liver disease also has one of the symptoms above. One or more of the following tests may be performed, including:

Treatment Options

Treatment for portal hypertension often begins when varices bleed. This is a medical emergency and once the bleeding is located, one of the following endoscopic procedures may be used remove the varices, including:

  • Schlerotherapy
    (injection of hardening agents to toughen the tissue around the blood vessels)

  • Latex banding
    (tying latex bands around the bleeding varices to shut them off from blood flow)

  • Balloon tamponade
    (temporary inflation of a balloon at the tip of the endoscope to compress the varices)

If endoscopic treatments cannot treat varices effectively the following procedures may be used:

 

  • Stenting - a tiny mesh tube is implanted to reroute blood and relieve pressure on the portal vein. One of the two following procedures may be used to place the stent:
    • Transjugular intrahepatic portosystemic shunt (TIPS)
      a TIPS procedure is performed by a radiologist with x-ray guidance. The stent is placed in the middle of the liver to reroute blood flow around the liver and reduce pressure in the abnormal veins.

    • Distal splenorenal shunt (DSRS)
      A surgeon joins the veins of the spleen and left kidney to preserve blood flow through the portal vein and reduces blood pressure in any esophageal varices.

If the bleeding varices cannot be controlled, or the liver becomes so damaged from scarring that it cannot function, a liver transplant may become necessary.

Our surgeons who treat portal hypertension