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Pictorial essay


Gastroesophageal Variceal Filling and Drainage Pathways: An Angiographic Description of Afferent and Efferent Venous Anatomic Patterns.

Ron C GabaPatrick M CoutureJanesh Lakhoo
Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital and Health Sciences System, 1University of Illinois College of Medicine, Chicago, Illinois, USA
Date of Submission: 23-Sep-2015, Date of Acceptance: 25-Oct-2015, Date of Web Publication: 30-Nov-2015.
Corresponding Author:
Corresponding Author

Ron C Gaba

Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital and Health Sciences System, 1740 West Taylor Street, MC 931, Chicago ‑ 60612, Illinois, USA.
E-mail: rgaba@uic.edu

Corresponding Author:
Corresponding Author

Ron C Gaba

Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital and Health Sciences System, 1740 West Taylor Street, MC 931, Chicago ‑ 60612, Illinois, USA.
E-mail: rgaba@uic.edu

DOI: 10.4103/2156-7514.170730 Facebook Twitter Google Linkedin

ABSTRACT


Varices commonly occur in liver cirrhosis patients and are classified as esophageal (EV), gastroesophageal (GEV), or isolated gastric (IGV) varices. These vessels may be supplied and drained by several different afferent and efferent pathways. A working knowledge of variceal anatomy is imperative for Interventional Radiologists performing transjugular intrahepatic portosystemic shunt and embolization/obliteration procedures. This pictorial essay characterizes the angiographic anatomy of varices in terms of type and frequency of venous filling and drainage, showing that different varices have distinct vascular anatomy. EVs typically show left gastric vein filling and "uphill" drainage, and GEVs and IGVs exhibit additional posterior/short gastric vein contribution and "downhill" outflow. An understanding of these variceal filling and drainage pathways can facilitate successful portal decompression and embolization/obliteration procedures.
Keywords: Anatomy, Gastroesophageal Varices, Portal Hypertension, Transjugular Intrahepatic Portosystemic Shunt

Cited in 6 Documents

  1. Joseph D. Morrison, Nasya Mendoza-Elias, Andrew J. Lipnik, R. Peter Lokken, James T. Bui, Charles E. Ray and Ron C. Gaba (2018) Gastric Varices Bleed at Lower Portosystemic Pressure Gradients than Esophageal Varices. Journal of Vascular and Interventional Radiology 29(5):636. doi: 10.1016/j.jvir.2017.10.014
  2. Guangchuan Wang, Dongxiao Meng, Guangjun Huang, Qingshan Pei, Lianhui Zhao, Yongjun Shi, Mingyan Zhang, Hua Feng, Junyong Zhang and Chunqing Zhang (2019) Balloon-Assisted Percutaneous Transhepatic Antegrade Embolization with 2-Octyl Cyanoacrylate for the Treatment of Isolated Gastric Varices with Large Gastrorenal Shunts. BioMed Research International 2019:1. doi: 10.1155/2019/2674758
  3. Ron C. Gaba, Nasya Mendoza-Elias, John H. Schilling and Andrew J. Lipnik (2018) IR Playbook. (Chapter 39):429. doi: 10.1007/978-3-319-71300-7_39
  4. Janesh Lakhoo, James T. Bui, R. Peter Lokken, Charles E. Ray and Ron C. Gaba (2016) Transjugular Intrahepatic Portosystemic Shunt Creation and Variceal Coil or Plug Embolization Ineffectively Attain Gastric Variceal Decompression or Occlusion: Results of a 26-Patient Retrospective Study. Journal of Vascular and Interventional Radiology 27(7):1001. doi: 10.1016/j.jvir.2016.02.019
  5. Dmitry Victorovich Garbuzenko, Nikolay Olegovich Arefyev and Dmitry Vladimirovich Belov (2016) Restructuring of the vascular bed in response to hemodynamic disturbances in portal hypertension. WJH 8(36):1602. doi: 10.4254/wjh.v8.i36.1602
  6. Kai Zhang, Xiaoyan Sun, Guangchuan Wang, Mingyan Zhang, Zhe Wu, Xiangguo Tian and Chunqing Zhang (2019) Treatment outcomes of percutaneous transhepatic variceal embolization versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding. Medicine 98(18):e15464. doi: 10.1097/MD.0000000000015464

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