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Portal-systemic collateral pathways

In portal hypertension shunting of blood away from the liver into the systemic venous system provides a mechanism of reducing portal venous pressure.

Spontaneous portal-systemic collateral pathways (also called varices) develop via enlargement of pre-existing anastomoses between the portal and systemic venous system. However these are not sufficient to normalise portal venous pressure.

The main sites of collateral pathways are :

  • distal oesophagus: left gastric (coronary) vein & short gastric veins to distal oesophageal veins
  • splenorenal (lienorenal) ligament: splenic vein to left renal vein - splenorenal shunt
  • retroperitoneum: superior mesenteric veins to retroperitoneal/lumbar veins to the inferior vena cava
  • anterior abdominal wall: paraumbilical vein to subcutaneous periumbilical veins (caput Medusae)
  • anal canal: superior rectal vein (from inferior mesenteric vein) to upper anal canal veins (haemorrhoids)

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