Portal Hypertension Clinic

Portal hypertension is high blood pressure in the portal vein, which brings blood from your child’s intestine to their liver. It happens when something blocks the flow of blood to or through the liver.

Blood flow may be blocked by:

• Problems in the portal vein, such as blood clots or narrowed places
• Diseases that harden the liver, which keep blood from moving through easily

By itself, portal hypertension does not always need treatment. But it can lead to other health problems that do require care.

• Endoscopic banding

  Endoscopic banding is a method to prevent or treat bleeding varices. A doctor passes an endoscope through your child’s mouth into your child’s esophagus to see varices and place rubber bands around them. This is also called endoscopic variceal ligation. 

• Sclerotherapy

  Sclerotherapy is another way to prevent or treat bleeding varices. A doctor, guided by ultrasound, uses a needle to inject dye so they can see the blood vessel and inject medicine to shrink the blood vessel. We use sclerotherapy if a child’s esophagus is too small for the special tools needed for endoscopic banding.

• Treatment for ascites

  Diuretics may help reduce fluid if it builds up in your child’s belly. If these medicines aren’t enough, the doctor may use a needle or catheter to remove the fluid (paracentesis).

• Shunt

  A shunt is a small tube that drains fluid from the body or sends fluid in a new direction. If blood cannot travel easily through your child’s portal vein and liver, doctors may use a shunt to redirect some blood. This lowers pressure in the portal vein. Types of shunts we use include:

  • Transjugular intrahepatic portosystemic shunt (TIPS) — The doctor makes a tunnel through your child’s liver to connect the portal vein to a vein that carries blood from the liver to the heart (hepatic vein).
  • Distal splenorenal shunt — The surgeon detaches the vein for the spleen (splenic vein) from the portal vein. Then the surgeon connects the splenic vein to the vein of the left kidney.
  • Mesocaval shunt — The surgeon detaches the vein for the small intestine (superior mesenteric vein, SMV) from the portal vein. Then they connect the SMV to the main vein that carries blood from the trunk and lower body to the heart (inferior vena cava).
  • Portacaval shunt — The surgeon makes a bridge from the portal vein to the inferior vena cava.
  • Meso-Rex shunt — The surgeon makes a bridge from the SMV to the liver. This may be an option if your child’s liver works well enough to receive the usual amount of blood but their portal vein is blocked.
• Advanced treatment for liver disease through our Hepatology Program

  Our Hepatology Program treats the whole range of liver diseases and will provide the most advanced care to manage any condition affecting your child’s liver.

• Transition to our Liver Transplant Program

  Many children with portal hypertension will never need a liver transplant, but some will. If your child does, the Portal Hypertension Clinic team will make your transition to the Liver Transplant Program as smooth and seamless as we can for your family. Seattle Children’s has the only liver transplant program for children in the Pacific Northwest and some of the best outcomes in the country.