Shunts are rarely used because of the complications they may cause. They are done only in medical centers where the surgeon is experienced in doing the procedures.

Shunt surgery may be used for people who:

• Have relatively good liver function and serious complications of portal hypertension, Opens dialog, especially recurrent bleeding from enlarged veins (variceal bleeding).
• Are not good liver transplant candidates because of advanced age, continuing alcohol use, or both.
• Have not had success with other treatments, such as variceal banding for bleeding or diuretics for ascites.
• Have ascites and can't have a transjugular intrahepatic portosystemic shunt (TIPS) or repeated paracenteses, Opens dialog.
• Do not have close access to medical care and cannot quickly return for more variceal banding treatments or paracenteses.

Complications of shunt surgery may include changes in mental function (encephalopathy), such as confusion, memory loss, and irritability. People who have large-diameter portacaval shunts have a 30% to 40% rate of encephalopathy.^{footnote 1}