The Liver and Vascular Surgery

Abstract

The anesthesiologist may encounter patients with pre-exist ing liver disease who are scheduled to undergo surgery and anesthesia or may care for patients with postoperative liver dysfunction caused by various intraoperative events. A re view of pre-existing or intraoperative factors that can con tribute to liver dysfunction will enhance the clinician's abil ity to establish a differential diagnosis and course of clinical care. The clinician should become familiar with the prognos tic indicators of perioperative morbidity and mortality in the patient with pre-existing liver disease to carefully weigh the risks and benefits of proceeding with surgery and anesthe sia; the patient and the surgeon should be counseled accord ingly. The first section of this article, on liver dysfunction after vascular surgery, addresses various intraoperative fac tors that may contribute to postoperative hepatic dysfunc tion and reviews the impact of pre-existing liver disease on perioperative morbidity and mortality. Today, more patients undergo transjugular intrahepatic portosystemic shunt (TIPS) procedures than surgical portosystemic shunts. The introduction of liver transplantation into clinical medicine has also reduced surgical portosystemic shunts. The second section of this article, on current status of portosystemic shunts, reviews both surgically and radiographically placed shunts and their current role in caring for patients with portal hypertension.