Right gastric venous drainage: angiographic analysis in 100 patients

Abstract

Objective: To evaluate the pattern of right gastric venous drainage by use of digital subtraction angiography.

Materials and methods: A series of 100 consecutive patients who underwent right gastric arteriography during transcatheter arterial chemoembolization for hepatocellular carcinoma were included in this study. Angiographic findings were retrospectively analyzed with respect to the presence or absence of the right and aberrant gastric veins, multiplicity of draining veins, aberrant right gastric venous drainage sites, and the termination pattern of aberrant right gastric veins (ARGVs). We also compared the relative size of the right and left gastric veins.

Results: A total of 49 patients collectively had 66 ARGVs. The common drainage sites for the ARGVs included the hepatic segment IV (n = 35) and segment I (n = 15). The termination pattern of ARGV could be classified into 4 different types. The most common type was termination as a superficial parenchymal blush formation in small areas without demonstrable portal branches. A statistically significant difference was found for the dominancy of the right gastric vein in gastric venous drainage between the two groups with or without ARGV (p < 0.05, Fisher's exact test). In the group of patients without ARGV (n = 51), the right gastric vein was equal to (n = 9) or larger than (n = 17) the left gastric vein in 26 patients (26 of 51, 51%).

Conclusion: The incidence of ARGV is higher than expected with four distinct types in its termination pattern. The right gastric vein may play a dominant role in gastric venous drainage.

Keywords: Aberrant gastric vein; Angiography; Gastric vein.

Fig. 1

Normal venous drainage of stomach. A. Right gastric vein draining into main portal vein in 72-year-old man. Right gastric vein drains into main portal vein (arrow), while left gastric vein drains into splenic vein (arrowhead). B. Schematic diagram of right gastric vein draining into main portal vein. Right gastric vein drainage site is more distal to left gastric vein drainage site and on right side of main portal vein. C. Right gastric vein draining into left portal vein trunk in 43-year-old woman. Right gastric vein runs parallel to main portal vein and drains into left portal vein trunk. D. Schematic diagram of right gastric vein draining into left portal vein trunk.

Fig. 2

Coexisting aberrant right and left gastric venous drainage in 46-year-old man. Aberrant right gastric vein drains into superficial areas of hepatic segment IV (black arrows) and aberrant left gastric vein drains into segment II portal branches (white arrow).

Fig. 3

Conjunction type of gastric venous drainage in 60-year-old woman. Right gastric vein (arrow) anastomose with left gastric vein (arrowhead) just before entering main portal vein.

Fig. 4

Termination patterns of aberrant right gastric vein. A. Type I. Aberrant right gastric vein continues smoothly into peripheral portal vein as single channel, hence sequestering territory supplied by aberrant right gastric vein from normal portal supply. B. Type IIa. Aberrant right gastric vein is connected to peripheral portal vein in end-to-end or end-to-side (dotted line) fashion via single collateral channel. C. Type IIb. Aberrant right gastric vein is connected to peripheral portal vein in end-to-end or end-to-side (dotted line) fashion via multiple collateral channels. D. Type IIIa. Aberrant right gastric vein is terminated as small superficial parenchymal blush formation without demonstrable portal branches. E. Type IIIb. Aberrant right gastric vein branches in extrahepatic location and branches are terminated as multifocal small superficial parenchymal blush formation without demonstrable portal branches. F. Type IV. Aberrant right gastric vein forms network around sectional or segmental portal vein, and subsequently drains into it.

Fig. 5

Type I aberrant right gastric vein in 58-year-old woman. Venous phase image of selective right gastric arteriography shows two aberrant right gastric veins, one in type I (arrow) and other in type IIIb (arrowhead).

Fig. 6

Type IIb aberrant right gastric vein in 69-year-old man. Aberrant right gastric vein (arrow) is connected to segment I portal vein in end-to-side fashion via multiple collateral channels.

Fig. 7

Type IV aberrant right gastric vein in 53-year-old man. Three aberrant right gastric veins are seen; one in type IV (white arrow) and two in type III (black arrows). Network formation around umbilical segment of left portal vein is clearly demonstrated (arrowheads).