A Comprehensive Review of Portosystemic Collaterals in Cirrhosis: Historical Aspects, Anatomy, and Classifications

Table 1

Common portosystemic collaterals [17–19].

Collaterals	Afferent	Efferent
Common pathways
Esophageal varices	Left gastric vein	Azygos-hemiazygos veins
Gastric varices	Anterior 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 vein	Left portal vein	Anterior abdominal wall veins and iliofemoral veins
Perisplenic, splenoiliac	Splenic vein	Iliac vein
Internal-external mammary	Branches of portal veins, posterior or short gastric veins	Superior epigastric, inferior epigastric veins, and superficial veins of the thorax
Internal hemorrhoids	Inferior mesenteric vein	Iliac vein
Rectal varices	Superior rectal veins	Middle and inferior rectal veins, tributaries of internal iliac and pudendal veins
Gastrorenal shunt	Gastric varices or posterior or short gastric veins	Left renal vein
Splenorenal shunt	Splenic vein	Left renal vein
Pericholecystic varices	Cystic vein or a branch of the right portal vein	Hepatic vein, intrahepatic portal vein, or anterior abdominal wall collaterals
Mesenteric collaterals	Superior mesenteric vein and inferior mesenteric vein	Inferior vena cava through the retroperitoneal or pelvic veins (veins of Retzius)
Retroperitoneal collaterals	Colic or mesenteric branches (veins of Retzius)	Retrogastric varices or inferior phrenic veins to left renal vein or directly into the inferior vena cava
Omental varices	Superior or inferior mesenteric veins	Retroperitoneal or pelvic veins or gastroesophageal veins
Uncommon pathways
Tracheal and bronchial varices	Tracheobronchial plexus of veins	Pulmonary veins; Bronchial veins; Esophageal/paraesophageal varices
Aberrant left gastric collateral	Left portal vein	Hepatogastric ligament
Colonic varices	Ileocolic, right, middle colic, or sigmoid colic vein	Right gonadal vein, right renal vein, and systemic lumbar veins
Jejunal or ileal varices	Jejunal and ileal veins	Abdominal wall veins or the veins of Retzius
Duodenal varices	Superior and inferior pancreaticoduodenal veins, cystic branches of the superior mesenteric veins, gastroduodenal vein, and pyloric vein	Veins of Retzius into the inferior vena cava
Pancreatic varices	Ventral and dorsal pancreatic veins, pancreaticoduodenal veins	Inferior vena cava
Uterovaginal varices	Superior hemorrhoidal plexus	Uterine and hypogastric veins to inferior vena cava
Vesical varices	Mesenteric veins (commonly root of mesentery)	Internal and external iliac veins
Bare area of the liver	Portal venous branches	Inferior phrenic and right internal thoracic vein
Vertebral collaterals	Innominate, vertebral, intercostal, lumbar, and sacral veins	Azygos and internal mammary pathways
Lateral thoracic	Lateral thoracic, thoracoepigastric, superficial circumflex, long saphenous, and femoral veins	Inferior vena cava
Sub-hepatic-porto-iliac	Main portal vein	Iliac veins
Gastrocaval shunt	Gastric varices or posterior gastric vein	Left inferior phrenic and pericardiophrenic vein to inferior vena cava
Transsplenic shunt	Splenic veins	Intercostal veins
Transhepatic shunt	Intrahepatic branches of the portal vein	Inferior vena cava, coronary vein, vertebral plexus, and hemiazygos vein
Right infradiaphragmatic shunt/apex type shunt	Peripheral branch of left portal vein	Internal thoracic vein and intercostal vein
Left infradiaphragmatic shunt/left triangular ligament shunt	Peripheral portal branch of the left lateral segment of liver	Intercostal vein or left pericardiophrenic vein to left inferior phrenic vein to inferior vena cava or left triangular ligament to inferior vena cava
Indirect gastrocaval shunt	Gastric varices or posterior or short gastric veins	Inferior phrenic vein
Mesentericorenal shunt	Mesenteric veins	Capsular renal veins or left renal vein
Mesenteric-gonadal shunt	Mesenteric veins	Right gonadal vein
Splenocaval/phrenic/ azygos shunt	Splenic vein or perisplenic collaterals	Hypogastric vein into inferior vena cava