Perforating veins and blood flow in oesophageal varices
McCormack, T.T.; Rose, J.D.; Smith, P.M.; Johnson, A.G.
Lancet 2(8365-66): 1442-1444
1983
ISSN/ISBN: 0140-6736 PMID: 6140542 Document Number: 218103
Blood-flow patterns in esophageal varices were studied by Doppler ultrasound (18 patients) and injection radiography (34 patients). Both techniques demonstrated that blood flow is not always in the expected cephalad direction but is often towards the stomach. Doppler studies indicated that there are functioning perforating veins joining esophageal varices to the periesophageal veins, particularly at the lower end of the esophagus. The presence of these perforators was confirmed by intravariceal injection radiography and also at necropsy. The turbulent flow caused by these veins may explain why variceal rupture commonly occurs just above the gastroesophageal junction. Successful treatment of esophageal varices with the minimum of sclerotherapy treatments may depend on early obliteration of the incompetent perforating veins.