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Semin intervent Radiol
DOI: 10.1055/s-0045-1802346
Review Article

Understanding Portosystemic Collateral Anatomy

Aaron McBride
1   Division of Interventional Radiology, Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
,
Alex Wallace
1   Division of Interventional Radiology, Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
,
Indravadan Patel
1   Division of Interventional Radiology, Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
,
Merve Ozen
1   Division of Interventional Radiology, Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
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Abstract

Portosystemic collateral pathways are a significant concern in interventional radiology, frequently manifesting in patients with cirrhosis or portal vein thrombosis. These pathways can lead to severe clinical complications, including gastrointestinal bleeding, hepatic encephalopathy, and liver failure. A thorough understanding of the anatomy, hemodynamic alterations, and clinical implications of these shunts is crucial for interventional radiologists to provide effective treatment while minimizing risks. This article reviews the clinical presentations associated with portosystemic shunts, explores the anatomical variants and altered flow dynamics, and discusses the latest endovascular treatment strategies to optimize patient outcomes.

Keywords

interventional radiology - anatomy - portal vein - collateral - portosystemic


Publikationsverlauf

Artikel online veröffentlicht:
20. Februar 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Nardelli S, Riggio O, Turco L. et al. Relevance of spontaneous portosystemic shunts detected with CT in patients with cirrhosis. Radiology 2021; 299 (01) 133-140
    CrossrefPubMedSuche in Google Scholar
  • 2 Pillai AK, Andring B, Patel A, Trimmer C, Kalva SP. Portal hypertension: a review of portosystemic collateral pathways and endovascular interventions. Clin Radiol 2015; 70 (10) 1047-1059
    CrossrefPubMedSuche in Google Scholar
  • 3 Kumamoto M, Toyonaga A, Inoue H. et al. Long-term results of balloon-occluded retrograde transvenous obliteration for gastric fundal varices: hepatic deterioration links to portosystemic shunt syndrome. J Gastroenterol Hepatol 2010; 25: 1129-1135
    CrossrefPubMedSuche in Google Scholar
  • 4 Saad WE. Portosystemic shunt syndrome and endovascular management of hepatic encephalopathy. Semin Intervent Radiol 2014; 31 (03) 262-265
    Thieme ConnectPubMedSuche in Google Scholar
  • 5 Vaz K, Efthymiou M, Vaughan R. et al. Unpacking the challenge of gastric varices: a review on indication, timing and modality of therapy. World J Hepatol 2021; 13 (08) 868-878
    CrossrefPubMedSuche in Google Scholar
  • 6 Philips CA, Ahamed R, Rajesh S, George T, Mohanan M, Augustine P. Beyond the scope and the glue: update on evaluation and management of gastric varices. BMC Gastroenterol 2020; 20 (01) 361
    CrossrefPubMedSuche in Google Scholar
  • 7 Triantafyllou M, Stanley AJ. Update on gastric varices. World J Gastrointest Endosc 2014; 6 (05) 168-175
    CrossrefPubMedSuche in Google Scholar
  • 8 Sabri SS, Saad WE. Anatomy and classification of gastrorenal and gastrocaval shunts. Semin Intervent Radiol 2011; 28 (03) 296-302
    Thieme ConnectPubMedSuche in Google Scholar
  • 9 Sarin SK, Kumar A. Gastric varices: profile, classification, and management. Am J Gastroenterol 1989; 84 (10) 1244-1249
    PubMedSuche in Google Scholar
  • 10 Philips CA, Arora A, Shetty R. et al. A comprehensive review of portosystemic collaterals in cirrhosis: historical aspects, anatomy, and classifications. Int J Hepatol 2016; 2016: 6170243
    CrossrefPubMedSuche in Google Scholar
  • 11 Chikamori F, Shibuya S, Takase Y, Ozaki A, Fukao K. Transjugular retrograde obliteration for gastric varices. Abdom Imaging 1996; 21 (04) 299-303
    CrossrefPubMedSuche in Google Scholar
  • 12 Kiyosue H, Mori H, Matsumoto S, Yamada Y, Hori Y, Okino Y. Transcatheter obliteration of gastric varices: Part 2. Strategy and techniques based on hemodynamic features. Radiographics 2003; 23 (04) 921-937 , discussion 937
    CrossrefPubMedSuche in Google Scholar
  • 13 Kiyosue H, Mori H, Matsumoto S, Yamada Y, Hori Y, Okino Y. Transcatheter obliteration of gastric varices. Part 1. Anatomic classification. Radiographics 2003; 23 (04) 911-920
    CrossrefPubMedSuche in Google Scholar
  • 14 Hiraga N, Aikata H, Takaki S. et al. The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration. J Gastroenterol 2007; 42 (08) 663-672
    CrossrefPubMedSuche in Google Scholar
  • 15 Fukuda T, Hirota S, Sugimoto K, Matsumoto S, Zamora CA, Sugimura K. “Downgrading” of gastric varices with multiple collateral veins in balloon-occluded retrograde transvenous obliteration. J Vasc Interv Radiol 2005; 16 (10) 1379-1383
    CrossrefPubMedSuche in Google Scholar
  • 16 Saad WE, Lippert A, Saad NE, Caldwell S. Ectopic varices: anatomical classification, hemodynamic classification, and hemodynamic-based management. Tech Vasc Interv Radiol 2013; 16 (02) 158-175
    CrossrefPubMedSuche in Google Scholar
  • 17 Miyaaki H, Ichikawa T, Taura N, Miuma S, Isomoto H, Nakao K. Endoscopic management of esophagogastric varices in Japan. Ann Transl Med 2014; 2 (05) 42
    PubMedSuche in Google Scholar
  • 18 Matsumoto A, Hamamoto N, Nomura T. et al. Balloon-occluded retrograde transvenous obliteration of high risk gastric fundal varices. Am J Gastroenterol 1999; 94: 643-649
    CrossrefPubMedSuche in Google Scholar
  • 19 Sato T, Akaike J, Toyota J. et al. Clinicopathological features and treatment of ectopic varices with portal hypertension. Int J Hepatol 2011 2011; 960720
    PubMedSuche in Google Scholar
  • 20 Yipeng W, Cong L, Sizhe W. et al. Effectiveness and safety of endoscopic treatment for duodenal variceal bleeding: a systematic review. Eur J Gastroenterol Hepatol 2021; 33: 461-469
    CrossrefPubMedSuche in Google Scholar
  • 21 Al-Osaimi AM, Sabri SS, Caldwell SH. Balloon-occluded Retrograde Transvenous Obliteration (BRTO): Preprocedural Evaluation and Imaging. Semin Intervent Radiol 2011; 28: 288-295
    Thieme ConnectPubMedSuche in Google Scholar
  • 22 Ravilla J, Doantrang D. Colonic varices as an unsettling cause of lower gastrointestinal bleeding. Cureus 2024; 16 (05) e60490
    PubMedSuche in Google Scholar
  • 23 Al Khalloufi K, Laiyemo AO. Management of rectal varices in portal hypertension. World J Hepatol 2015; 7 (30) 2992-2998
    CrossrefPubMedSuche in Google Scholar
  • 24 Shudo R, Yazaki Y, Sakurai S, Uenishi H, Yamada H, Sugawara K. Clinical study comparing bleeding and nonbleeding rectal varices. Endoscopy 2002; 34 (03) 189-194
    Thieme ConnectPubMedSuche in Google Scholar
  • 25 Furuichi Y, Kage M, Ohta M. et al. Guidelines for the diagnosis and treatment of idiopathic portal hypertension, extrahepatic portal obstruction, and Budd-Chiari syndrome in Japan. Hepatol Res 2024; 54 (11) 952-969
    CrossrefPubMedSuche in Google Scholar
  • 26 Korean Association for the Study of the Liver (KASL). KASL clinical practice guidelines for liver cirrhosis: varices, hepatic encephalopathy, and related complications. Clin Mol Hepatol 2020; 26 (02) 83-127
    CrossrefPubMedSuche in Google Scholar
  • 27 Kim HC, Miyayama S, Lee EW. et al. Interventional radiology for bleeding ectopic varices: individualized approach based on vascular anatomy. Radiographics 2024; 44 (08) e230140
    CrossrefPubMedSuche in Google Scholar
  • 28 Kaplan DE, Ripoll C, Thiele M. et al. AASLD Practice Guidance on risk stratification and management of portal hypertension and varices in cirrhosis. Hepatology 2024; 79 (05) 1180-1211
    CrossrefPubMedSuche in Google Scholar
  • 29 Lee EW, Eghtesad B, Garcia-Tsao G. et al. AASLD Practice Guidance on the use of TIPS, variceal embolization, and retrograde transvenous obliteration in the management of variceal hemorrhage. Hepatology 2024; 79 (01) 224-250
    CrossrefPubMedSuche in Google Scholar