[214 [249 [250

The hemodynamic consequences of portacaval shunts have been studied in great detail, but in light of the limited application of these observations to clinical practice and the waning indications for these types of shunts, these consequences are only briefly reviewed. Total liver blood flow is reduced by portacaval shunt, although hepatic artery flow increases. The compensatory increase in hepatic artery flow is usually greater after side-to-side shunt than after end-to-side shunt, but the total liver blood flow is less. This finding reflects the fact that the hepatic limb of the portal vein is converted to an outflow tract by a side-to-side shunt. Current evidence suggests that, after a side-to-side shunt, no sinusoidal perfusion by portal blood occurs, but hepatic artery flow diverted through the hepatic limb of the portal vein does provide some parenchymal nutrition. The pressure responses are as may be surmised. Pressure in the portal system is greatly reduced, as is sinusoidal pressure after a side-to-side shunt. Sinusoidal pressure remains elevated after an end-to-side shunt.

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