Table 1: Common portosystemic collaterals [1719].

CollateralsAfferentEfferent

Common pathways

Esophageal varicesLeft gastric veinAzygos-hemiazygos veins

Gastric varicesAnterior branch of the left gastric vein (gastroesophageal varices Type 1)
Short gastric and posterior gastric veins (gastroesophageal varices Type 2)
Esophageal or paraesophageal veins

Paraumbilical veinLeft portal veinAnterior abdominal wall veins and iliofemoral veins

Perisplenic, splenoiliacSplenic veinIliac vein

Internal-external mammaryBranches of portal veins, posterior or short gastric veinsSuperior epigastric, inferior epigastric veins, and superficial veins of the thorax

Internal hemorrhoidsInferior mesenteric veinIliac vein

Rectal varicesSuperior rectal veinsMiddle and inferior rectal veins, tributaries of internal iliac and pudendal veins

Gastrorenal shuntGastric varices or posterior or short gastric veinsLeft renal vein

Splenorenal shuntSplenic veinLeft renal vein

Pericholecystic varicesCystic vein or a branch of the right portal veinHepatic vein, intrahepatic portal vein, or anterior abdominal wall collaterals

Mesenteric collateralsSuperior mesenteric vein and inferior mesenteric veinInferior vena cava through the retroperitoneal or pelvic veins (veins of Retzius)

Retroperitoneal collateralsColic or mesenteric branches (veins of Retzius)Retrogastric varices or inferior phrenic veins to left renal vein or directly into the inferior vena cava

Omental varicesSuperior or inferior mesenteric veinsRetroperitoneal or pelvic veins or gastroesophageal veins

Uncommon pathways

Tracheal and bronchial varicesTracheobronchial plexus of veinsPulmonary veins
Bronchial veins
Esophageal/paraesophageal varices

Aberrant left gastric collateralLeft portal veinHepatogastric ligament

Colonic varicesIleocolic, right, middle colic, or sigmoid colic veinRight gonadal vein, right renal vein, and systemic lumbar veins

Jejunal or ileal varicesJejunal and ileal veinsAbdominal wall veins or the veins of Retzius

Duodenal varicesSuperior and inferior pancreaticoduodenal veins, cystic branches of the superior mesenteric veins, gastroduodenal vein, and pyloric veinVeins of Retzius into the inferior vena cava

Pancreatic varicesVentral and dorsal pancreatic veins, pancreaticoduodenal veinsInferior vena cava

Uterovaginal varicesSuperior hemorrhoidal plexusUterine and hypogastric veins to inferior vena cava

Vesical varicesMesenteric veins (commonly root of mesentery)Internal and external iliac veins

Bare area of the liverPortal venous branchesInferior phrenic and right internal thoracic vein

Vertebral collateralsInnominate, vertebral, intercostal, lumbar, and sacral veinsAzygos and internal mammary pathways

Lateral thoracicLateral thoracic, thoracoepigastric, superficial circumflex, long saphenous, and femoral veinsInferior vena cava

Sub-hepatic-porto-iliacMain portal veinIliac veins

Gastrocaval shuntGastric varices or posterior gastric veinLeft inferior phrenic and pericardiophrenic vein to inferior vena cava

Transsplenic shuntSplenic veinsIntercostal veins

Transhepatic shuntIntrahepatic branches of the portal veinInferior vena cava, coronary vein, vertebral plexus, and hemiazygos vein

Right infradiaphragmatic shunt/apex type shuntPeripheral branch of left portal veinInternal thoracic vein and intercostal vein

Left infradiaphragmatic shunt/left triangular ligament shuntPeripheral portal branch of the left lateral segment of liverIntercostal vein or left pericardiophrenic vein to left inferior phrenic vein to inferior vena cava or left triangular ligament to inferior vena cava

Indirect gastrocaval shuntGastric varices or posterior or short gastric veinsInferior phrenic vein

Mesentericorenal shuntMesenteric veinsCapsular renal veins or left renal vein

Mesenteric-gonadal shuntMesenteric veinsRight gonadal vein

Splenocaval/phrenic/ azygos shuntSplenic vein or perisplenic collateralsHypogastric vein into inferior vena cava