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Angioarchitectural Classification of Esophageal Varices and Paraesophageal Veins in Selective Left Gastric Venography

Angioarchitectural Classification of Esophageal Varices and Paraesophageal Veins in Selective... Abstract • An improved radiographic classification of esophageal varices and paraesophageal veins was devised. Esophageal varices were divided into palisading and bar types. Paraesophageal veins were divided into intra-abdominal and thoracoabdominal types, with the latter being further subdivided into right-side-predominant and left-side-predominant types. The existence of the thoracoabdominal paraesophageal veins was significantly related to the preoperative endoscopic findings of the red sign and the form of the esophageal varices. Left-side-predominant paraesophageal veins were likely to drain the splanchnic blood flow to the hemiazygos vein. The largest grade of red sign was found in 88.9% of the patients with combination of bar type and intra-abdominal type and the largest form was in 88.9% of those with palisading and right-side thoracoabdominal types. The pressure gradients across the shunt were significantly lower in the right thoracoabdominal type than in others. Our study suggests that treatment be designed according to the vascular patterns of the lower esophagus. (Arch Surg 1989;124:961-966) References 1. Warren WD, Millikan WJ, Henderson JM, et al: Ten years portal hypertensive surgery at Emory: Results and new perspectives . Ann Surg 1982;195:530-542.Crossref 2. Reynolds TB, Donovan AJ, Mikkelsen WP, et al: Results of a 12-year randomized trial of portacaval shunt in patients with alcoholic liver disease and bleeding varices . Gastroenterology 1981;80:1005-1011. 3. Cohn HO, Resnick RH, Grace ND, et al: Distal splenorenal shunt versus portal-systemic shunt: Current status of a controlled trial . Hepatology 1981;1:151-160.Crossref 4. Sugiura M, Futagawa S: Further evaluation of the Sugiura procedure in the treatment of esophageal varices . Arch Surg 1977;112:1317-1321.Crossref 5. Terblanche J, Northover JMA, Bornman P, et al: A prospective controlled trial of sclerotherapy in the long-term management of patients after esophageal variceal bleeding . Surg Gynecol Obstet 1979;148:323-333. 6. Warren WD, Galambos JT, Riepe SP, et al: Distal splenorenal shunt versus endsocopic sclerotherapy for long-term management of variceal bleeding: Preliminary report of a prospective, randomized trial . Ann Surg 1986;203:454-462.Crossref 7. Kitano S, Terblanche J, Kahn D, et al: Venous anatomy of the lower oesophagus in portal hypertension: practical implications . Br J Surg 1986;73:525-531.Crossref 8. Spence RAJ: The venous anatomy of the lower oesophagus in normal subjects and in patients with varices: An image analysis study . Br J Surg 1984;71:739-744.Crossref 9. Noda T: Angioarchitectural study of esophageal varices with special reference for variceal rupture . Virchows Arch A 1984;404:381-392.Crossref 10. Inokuchi K, Beppu K, Koyanagi N, et al: Fifteen years' experience with left gastric venous caval shunt for esophageal varices . World J Surg 1984;8:716-721.Crossref 11. Japanese Research Society for Portal Hypertension: The general rules for recording endoscopic findings on esophageal varices . Jpn J Surg 1980;10:84-87.Crossref 12. Nordlinger BM, Nordlinger DF, Fulenwider JT, et al: Angiography in portal hypertension: Clinical significance in surgery . Am J Surg 1980;139:132-141.Crossref 13. Smith-Laing G, Camilo ME, Sherlock S, et al: Percutaneous transhepatic portography in the assessment of portal hypertension . Gastroenterology 1980;78:197-205. 14. Hashizume M, Inokuchi K, Tanaka K: Morphology of gastric microcirculation in cirrhosis . Hepatology 1983;3:1008-1012.Crossref 15. Beppu K, Inokuchi K, Koyanagi N, et al: Prediction of variceal hemorrhage by esophageal endoscopy . Gastrointest Endosc 1981;27:213-218.Crossref 16. Kitano S, Koyanagi N, Iso Y, et al: Prevention of recurrence of esophageal varices after endoscopic injection sclerotherapy with ethanolamine oleate . Hepatology 1987;7:810-815.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Angioarchitectural Classification of Esophageal Varices and Paraesophageal Veins in Selective Left Gastric Venography

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Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1989.01410080097016
Publisher site
See Article on Publisher Site

Abstract

Abstract • An improved radiographic classification of esophageal varices and paraesophageal veins was devised. Esophageal varices were divided into palisading and bar types. Paraesophageal veins were divided into intra-abdominal and thoracoabdominal types, with the latter being further subdivided into right-side-predominant and left-side-predominant types. The existence of the thoracoabdominal paraesophageal veins was significantly related to the preoperative endoscopic findings of the red sign and the form of the esophageal varices. Left-side-predominant paraesophageal veins were likely to drain the splanchnic blood flow to the hemiazygos vein. The largest grade of red sign was found in 88.9% of the patients with combination of bar type and intra-abdominal type and the largest form was in 88.9% of those with palisading and right-side thoracoabdominal types. The pressure gradients across the shunt were significantly lower in the right thoracoabdominal type than in others. Our study suggests that treatment be designed according to the vascular patterns of the lower esophagus. (Arch Surg 1989;124:961-966) References 1. Warren WD, Millikan WJ, Henderson JM, et al: Ten years portal hypertensive surgery at Emory: Results and new perspectives . Ann Surg 1982;195:530-542.Crossref 2. Reynolds TB, Donovan AJ, Mikkelsen WP, et al: Results of a 12-year randomized trial of portacaval shunt in patients with alcoholic liver disease and bleeding varices . Gastroenterology 1981;80:1005-1011. 3. Cohn HO, Resnick RH, Grace ND, et al: Distal splenorenal shunt versus portal-systemic shunt: Current status of a controlled trial . Hepatology 1981;1:151-160.Crossref 4. Sugiura M, Futagawa S: Further evaluation of the Sugiura procedure in the treatment of esophageal varices . Arch Surg 1977;112:1317-1321.Crossref 5. Terblanche J, Northover JMA, Bornman P, et al: A prospective controlled trial of sclerotherapy in the long-term management of patients after esophageal variceal bleeding . Surg Gynecol Obstet 1979;148:323-333. 6. Warren WD, Galambos JT, Riepe SP, et al: Distal splenorenal shunt versus endsocopic sclerotherapy for long-term management of variceal bleeding: Preliminary report of a prospective, randomized trial . Ann Surg 1986;203:454-462.Crossref 7. Kitano S, Terblanche J, Kahn D, et al: Venous anatomy of the lower oesophagus in portal hypertension: practical implications . Br J Surg 1986;73:525-531.Crossref 8. Spence RAJ: The venous anatomy of the lower oesophagus in normal subjects and in patients with varices: An image analysis study . Br J Surg 1984;71:739-744.Crossref 9. Noda T: Angioarchitectural study of esophageal varices with special reference for variceal rupture . Virchows Arch A 1984;404:381-392.Crossref 10. Inokuchi K, Beppu K, Koyanagi N, et al: Fifteen years' experience with left gastric venous caval shunt for esophageal varices . World J Surg 1984;8:716-721.Crossref 11. Japanese Research Society for Portal Hypertension: The general rules for recording endoscopic findings on esophageal varices . Jpn J Surg 1980;10:84-87.Crossref 12. Nordlinger BM, Nordlinger DF, Fulenwider JT, et al: Angiography in portal hypertension: Clinical significance in surgery . Am J Surg 1980;139:132-141.Crossref 13. Smith-Laing G, Camilo ME, Sherlock S, et al: Percutaneous transhepatic portography in the assessment of portal hypertension . Gastroenterology 1980;78:197-205. 14. Hashizume M, Inokuchi K, Tanaka K: Morphology of gastric microcirculation in cirrhosis . Hepatology 1983;3:1008-1012.Crossref 15. Beppu K, Inokuchi K, Koyanagi N, et al: Prediction of variceal hemorrhage by esophageal endoscopy . Gastrointest Endosc 1981;27:213-218.Crossref 16. Kitano S, Koyanagi N, Iso Y, et al: Prevention of recurrence of esophageal varices after endoscopic injection sclerotherapy with ethanolamine oleate . Hepatology 1987;7:810-815.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Aug 1, 1989

References