Portal-systemic collateral pathways

In portal hypertension shunting of blood away from the liver into the systemic venous system provides a mechanism for 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 and 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 the inferior mesenteric vein) to upper anal canal veins (haemorrhoids)

Differential diagnosis

Dilatation of splenic veins at the splenic hilum mimicking splenic hilar varices without splenomegaly may occur in situations such as the state of increased perfusion of splenic tissue associated with an immune response 4.

Abdominal and pelvic anatomy
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Article Information

rID: 1910
Section: Anatomy
Synonyms or Alternate Spellings:
  • Varices
  • Porto-systemic collateral pathways
  • Portal-systemic collaterals
  • Porto-systemic collaterals
  • Porto-systemic shunts
  • Porto-systemic shunt

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Cases and Figures

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    Case 1: recanalised paraumbilical vein
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    SMV varices
    Case 2: SMV varices
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    CT Portal
    Case 3: gastro-oesophageal varices
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