[2] The purpose of the shunt is to divert blood flow away from the liver, reducing the high pressure in the portal venous system and decreasing the risk of bleeding.

Sclerotherapy, a minimally invasive procedure that uses chemicals to shrink varicose veins through endoscopy, was later enhanced with the introduction of variceal band ligation.

Technological advancements also led to pharmacological therapies and interventional radiologic procedures like transjugular intrahepatic portosystemic shunt (TIPS), which is now the preferred treatment for managing portal hypertension.

[9] Patients that undergo portacaval shunting may have an increased risk of HE because blood bypasses the liver and allows unfiltered toxins to enter the bloodstream and reach the brain, causing cognitive dysfunction.

[10] Additionally, increased intestinal absorption of encephalopathogenic substances in combination with the reduced hepatic blood flow may also contribute to the high risk of developing HE.

Compared to portacaval shunting, TIPS is less invasive, safer, and is now the preferred option for patients with advanced liver failure or those at high surgical risk.

[11] Both TIPS and portacaval shunting effectively reduce portal pressure but share the risk of hepatic encephalopathy (HE) due to bypassing the liver's detoxification process.

Additionally, portacaval shunting carries significantly higher morbidity and mortality rates, making TIPS the more favorable option in most cases.