Aberrant Left Gastric Vein Research Articles

Aberrant left gastric vein: what should surgeons know?

Aberrant left gastric vein is a rare variant and hardly known by surgeons. Its misidentification may lead to accidental bleeding. More importantly, it can also be the root of hypertensive gastropathy in cirrhotic patients and tumor spread in patients with gastric cancer. Here, we describe and provide imaging data of the three patterns of aberrant left gastric veins. Over the past 5years, three cases were noted, each one corresponding to one of the three variants. Aberrant left gastric vein is a rare anatomical entity and has rarely been reported. Its normal anatomy and variants, embryological origins, radiological analysis, and clinical implications are all discussed, bringing light to what surgeons should know when encountering an aberrant left gastric vein. Surgeons should be aware of the types of ALGV, its associated arterial variations, the presence of pseudolesion or not, and the potential atrophy of liver segment.

Aberrant gastric venous drainage and associated atrophy of hepatic segment II: computed tomography analysis of 2021 patients.

To investigate the prevalence and patterns of aberrant gastric venous drainage and associated atrophy of the hepatic segment on contrast-enhanced computed tomography (CT). Two radiologists retrospectively reviewed contrast-enhanced CT images from 2021 patients who underwent cone-beam CT-guided chemoembolization between January 2013 and December 2018. They determined the presence or absence of an aberrant gastric vein(s) and its drainage site by consensus, and qualitatively analyzed the presence or absence of atrophy of segments II or III. In cases of disagreement between the two reviewers regarding the presence of atrophy, quantitative analysis was performed using dedicated software. A total of 31 aberrant right gastric veins were revealed on CT (1.5%), most of which drained into P2 (n = 8), the S2/3 border zone (n = 8), S2 (n = 6), or S4 (n = 5). An aberrant left gastric vein was observed in 21 (1.0%) patients, and P2 was the most common drainage site (n = 13) in these patients. Atrophy of segment II was more frequently observed among patients with aberrant gastric veins than among those without (26.9% versus 4.1%; p < 0.001). In addition, an aberrant gastric vein draining into P2 was most frequently accompanied by segment II atrophy (47.6%). Aberrant right and left gastric veins were observed in 1.5% and 1.0% of patients, respectively. Atrophy of segment II was frequently observed in patients with aberrant gastric veins, especially those that drained into P2.

Aberrant left gastric vein is associated with hepatic artery variations.

To investigate the imaging findings and hepatic artery variations encountered in patients with aberrant left gastric vein (ALGV). A retrospective database search between January 2014 and November 2018 was carried for ALGV. The course and types (1-3) of ALGV, the presence of associated liver lesions, and coexistence of hepatic artery variations were reviewed on CT images. A total of 32 patients (22 men, 68.7%) with a mean age of 52.5years (range 22-76years) were found to have ALGV. The prevalence of ALGV was 0.073%. The most frequent type of ALGV was type 1 (n = 22, 68.7%), followed by type 3 (n = 7, 21.8%) and type 2 (n = 3, 9.3%). We noticed mild-to-severe parenchymal hyperdensity at the posterior aspect of segments II and III in patients with type 1 (n = 20/22) and type 2 (n = 2/3) ALGV consistent with fat sparing due to third inflow effect. Two out of seven patients with type 3 ALGV had main portal vein thrombosis; however, the presence of ALGV maintained left portal vein flow in these patients. Twelve (37.5%) patients had accompanying hepatic artery variation. Left hepatic and right hepatic artery variations were detected in 8 (25%) and 2 (6.25%) of the patients, respectively. In 2 patients, Michels type IV variation was detected. Aberrant left gastric vein is associated with hepatic artery variations, which can be important for preoperative and pretransplant planning.

Computed Tomography-Based Diagnosis of Gastric Vein Invasion in Patients with Gastric Cancer.

The objective of this study was to demonstrate computed tomography (CT)-based diagnosis of venous invasion in patients with gastric cancer and its prognostic value. Medical records and CT examinations of 530 patients with gastric cancer diagnosed after biopsy from February 2003 to December 2015 were included in this retrospective study. An imaging-based diagnosis of venous invasion was established when one of the following criteria were satisfied: 1) tumoral enhancement in the lumen of the vein, 2) tumor protruding through the course of a vein, and 3) distention of the vein due to extension of the gastric tumor. CT-based diagnosis of gastric vein invasion was established in 11/530 patients. Histopathological examination revealed poorly differentiated gastric adenocarcinoma (n=10) and neuroendocrine carcinoma (n=1). The median survival of the patients after the initial CT was 153.5 (range: 6-1275) days. Tumor invasion was observed at the aberrant left gastric vein (n=2), right gastroepiploic and superior mesenteric vein (n=2), gastric vein (n=4), and short gastric vein (n=3). Two of the three patients with short gastric vein invasion died 6 and 7 days after the initial CT, respectively. All draining veins of the stomach can be invaded by gastric cancer; CT can enable diagnosis that may be important for prognosis and surgical planning. The presence of short gastric vein invasion detected by CT may be associated with poor prognosis.

A Comprehensive Approach to Hepatic Vascular Disease.

The liver has a complex vascular supply, which involves the inflow of oxygenated blood through the hepatic artery (systemic circulation) and deoxygenated blood through the portal vein (portal circulation), as well as the outflow of deoxygenated blood through the hepatic veins to the inferior vena cava. A spectrum of vascular variants can involve the liver. Some of these variants may result in areas of enhancement that can mimic more serious pathologic conditions. In this article, the authors discuss a spectrum of variants and pathologic conditions that may involve the liver vasculature. These include variants, anomalies, and diseases involving the portal vein, such as rudimentary portal vein, thrombosis, cavernous transformation, thrombotic angiitis, thrombophlebitis, transient hepatic attenuation difference or transient hepatic intensity difference, portal venous aneurysm, and portal vein gas. The hepatic artery can be involved by various diseases, including thrombosis, stenosis, and aneurysm or pseudoaneurysm. Unusual "third inflow" sources of venous inflow are also discussed, including aberrant right gastric vein, aberrant left gastric vein, epigastric-paraumbilical veins, and cholecystic vein. A spectrum of variants and diseases involving the inferior vena cava and hepatic veins, including thrombosis, Budd-Chiari syndrome, veno-occlusive disease, stenosis, torsion, congestive hepatopathy, and peliosis hepatis, are discussed. Vascular shunts are illustrated, including portosystemic shunts (intra- and extrahepatic), arterioportal shunt, shunts of hereditary hemorrhagic telangiectasia, and acquired arteriovenous fistula. Familiarity with the pathogenesis and imaging features of these vascular entities can aid radiologic diagnoses and guide appropriate patient management. ©RSNA, 2017.

Imaging of aberrant left gastric vein and associated pseudolesions of segments II and III of the liver and mimickers.

We present imaging findings of aberrant left gastric vein (ALGV) and associated pseudolesions and mimickers including metastases and focal nodular hyperplasia. ALGV is formed due to interrupted involution of anastomotic omental veins, and it can drain into left portal vein or segments II and III of the liver as third inflow. Focal fat, focal fat sparing, and perfusion changes can be seen due to the presence of ALGV, which can mimic metastasis in cancer patients. ALGV may also serve as a pathway for direct tumor spread into the liver in patients with gastric cancer. Magnetic resonance imaging can be used as a problem solving tool in the presence of equivocal findings on ultrasonography and computed tomography.

Hepatobiliary and pancreatic: Aberrant left gastric vein

Hepatobiliary and pancreatic: Aberrant left gastric vein

Portal Vein Occlusion with Aberrant Left Gastric Vein Functioning as a Hepatopetal Collateral Pathway

A rare case of an aberrant left gastric vein functioning as a hepatopetal collateral as a result of portal vein occlusion is presented herein. The portal venous phase of multislice computed tomography clearly demonstrated this anatomic variation and provided a reliable vascular "road map" for percutaneous transhepatic portal venous stent placement. Portal hypertension associated with extensive gastrojejunal varices improved dramatically after stent placement.

Aberrant left gastric vein directly draining into the liver

An aberrant left gastric vein found in dissection is reported here. The right gastric vein did not exist and only the left gastric vein originating from the lesser curvature of the stomach was present. It directly entered the liver without typically joining the trunk of the portal vein. After giving off a small branch to the liver parenchyma, the left gastric vein merged into the left branch of the portal vein. This aberrant left gastric vein may correspond to the phylogenetic and ontogenetic “left portal vein.” The aberrant left gastric vein is considered to play an important role as a portal collateral pathway of the portal system, which is critical not only in anatomy but also in clinical diagnosis. Clin. Anat. 13:134–137, 2000. © 2000 Wiley-Liss, Inc.

Aberrant Left Gastric Vein Directly Draining into Left Portal Venous System

A 66-year-old man with early gastric cancer and liver cirrhosis was diagnosed by preoperative angiography as having an aberrant left gastric vein communicating directly with the left lateral portal vein system. This communication was confirmed during operation for the gastric cancer. Our report is the first of an aberrant left gastric vein showing direct communication with the left portal vein system.

Aberrant left gastric vein directly draining into left portal venous system

Aberrant left gastric vein directly draining into left portal venous system

Aberrant left gastric vein directly draining into left portal venous system

A 66-year-old man with early gastric cancer and liver cirrhosis was diagnosed by preoperative angiography as having an aberrant left gastric vein communicating directly with the left lateral portal vein system. This communication was confirmed during operation for the gastric cancer. Our report is the first of an aberrant left gastric vein showing direct communication with the left portal vein system