J.Jpn. Surg. Soc.. 80(5): 424-441, 1979

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Original article

STUDIES ON HEPATOFUGAL COLLATERALS IN PORTAL HYPERTENSION

Radiographic studies of abdominal collaterals were made in 102 cases with portal hypertension. There were two types of collaterals; communicating to the esophagogastric varices and not communicating to the varices. The former included the left gastric vein, short gastric veins, retroperitoneal veins, and the inferior phrenic vein, whereas the latter consisted of the paraumbilical veins, the self-established portorenal shunts, the portoazygous shunts, the inferior mesenteric vein, veins from the splenic hilus to the intercostal vein, the patent ductus venosus Arantii, and retroperitoneal veins. Portal pressure, splenic pressure and the diameter of the left gastric vein fluctuated not with the patterns of the collateral circulations communicating to the varices but with collateral patterns not communicating to the varices. Transthoracic esophageal transection and paraesophageal devascularization altered the collateral circulation in the abdominal cavity; the left gastric vein tapered to newly develop collateral pathways via the short gastric veins.
Radiographic studies of collaterals in the thoracic cavity were made in 21 cases. Esophageal varices, paraesophageal veins communicating to the portal system, the azygous system, the superior phrenic vein, the pericardiacophrenic vein, bronchial veins, and the inferior thyroidal vein were demonstrated.
Based on these radiographic findings and the operative effects of the transection and the devascularization, it was concluded that on surgical treatment paraesophageal veins communicating to the hypertensive portal system should be perfectly separated from the esophageal wall to prevent the recurrence of the esophageal varices.

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