A Comprehensive Review of Portosystemic Collaterals in Cirrhosis: Historical Aspects, Anatomy, and Classifications

Abstract

Portosystemic collateral formation in cirrhosis plays an important part in events that define the natural history in affected patients. A detailed understanding of collateral anatomy and hemodynamics in cirrhotics is essential to envisage diagnosis, management, and outcomes of portal hypertension. In this review, we provide detailed insights into the historical, anatomical, and hemodynamic aspects to portal hypertension and collateral pathways in cirrhosis with emphasis on the various classification systems.

Sonographic Appearances of the Incidentally Detected Pancreatic Varices in Patients with Portal Hypertension

“…In 4 other cases dilated collateral veins of the superior part of the pancreatic head were communicating with similar channels in the body and tail of the gland. These findings would confirm other observations indicating duodenal bulb as the most common site of varices [15][16][17][18][19] . In the remaining 6 cases varices were detected only in the body and tail of the pancreas.…”

“…Cho et al described widened pancreaticoduodenal veins as a rare example of collateral pathways in portal hypertension [6] . Duodenal varices make up 1 -3% of all varices in patients of portal hypertension [15][16][17][18][19] . These varices are usually found in the deeper layer of the duodenal wall and are hardly visible endoscopically.…”

A Case of Gastric Variceal Bleeding: Diagnosis and Treatment of a Rare Anatomical Variant

“…In more than 80% of cases, the left IPV terminates inferiorly into the left renal vein, forming the gastro-renal shunt. In 15% of cases it may drain instead transversely into the inferior vena cava or left hepatic vein, forming the gastro-caval shunt [4] . In less than 5% of cases IPV can drain into the pericardial vein.…”

A case report of bleeding from a duodenal varix: Rare cause of upper gastrointestinal bleeding

“…The afferent/portal venous feeder usually arises from the pancreaticoduodenal veins (superior or inferior), cystic branches of superior mesenteric veins, pyloric vein, and gastroduodenal vein. The efferent/systemic drainage includes gonadal vein (mostly the right), capsular renal veins, and rarely paravertebral or innominate retroperitoneal veins that ultimately drain into the inferior vena cava [ 10 ]. These communications between the afferent and efferent vessels are called the vein of Retzius [ 11 ].…”