Correlation between endoscopic and angiographic findings in patients with esophageal and isolated gastric varices

Background/Aim:The correlation between angiographic vascular patterns and e ndoscopic findings in portal hypertension is not sufficiently known, and kn owledge of the vascular anatomy may contribute to an improvement in endosco pic embolization and transjugular retrograde obliteration procedures. We pr opose a new vascular map that should prove useful for this purpose. Methods : Between April 1985 and December 1997 we performed percutaneous transhepat ic portography in a selected group of 75 patients (16 women and 59 men), ag ed 43-71 years, from whom informed consent was obtained. All patients had b een diagnosed endoscopically as having either esophageal or isolated gastri c varices. According to the Child-Pugh classification, class A, B, and C ci rrhosis was seen in 19, 40, and 16 patients, respectively. We created a vas cular map of esophageal and isolated gastric varices, based on the opacific ation of the portal venous collaterals on percutaneous transhepatic portogr aphy. We compared the patients in both variceal groups in terms of portal v enous pressure, main blood supply, and drainage routes. Results: We found t hat the portal collateral system was divided into two systems: the portoazy gos venous system and the portophrenic venous system. The former contribute d to the formation of esophageal and cardiac varices and the latter to the formation of isolated gastric varices located at the fundus or at both the cardia and fundus. The left gastric vein participated as blood supply in 70 % of the isolated gastric varices and in 100% of the esophageal varices (p < 0.01). The posterior gastric vein participated as blood supply in 70% of the isolated gastric varices and in 24% of the esophageal varices (p < 0.01 ). We classified the main blood drainage routes of isolated gastric varices functionally into three types: gastrorenal shunt (85%), gastrophrenic shun t (10%), and gastropericardiac shunt (5%). The portal venous pressure in pa tients with esophageal varices was 358 +/- 66 mm H2O, whereas in patients w ith isolated gastric varices it was 262 +/- 44 mm H2O (P < 0.01). Conclusio n: We suggest that this new vascular map will be useful in endoscopic embol ization and transjugular retrograde obliteration procedures for esophageal and isolated gastric varices. Copyright (C) 2001 S. Karger AG, Basel.