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Medical condition

Portacaval anastomosis
Other names	Porto-systemic anastomosis Portal caval system

A portacaval anastomosis or portocaval anastomosis is a specific type of circulatory anastomosis that occurs between the veins of the portal circulation and the vena cava, thus forming one of the principal types of portasystemic anastomosis or portosystemic anastomosis, as it connects the portal circulation to the systemic circulation, providing an alternative pathway for the blood. When there is a blockage of the portal system, portocaval anastomosis enables the blood to still reach the systemic venous circulation. The inferior end of the esophagus and the superior part of the rectum are potential sites of a harmful portocaval anastomosis.

In portal hypertension, as in the case of cirrhosis of the liver, the anastomoses become congested and form venous dilatations. Such dilatation can lead to esophageal varices and anorectal varices. Caput medusae can also result.

A portacaval shunt is analogous in that it diverts circulation; as with shunts and anastomoses generally, the terms are often used to refer to either the naturally occurring forms or the surgically created forms.

Presentation

Clinical presentations of portal hypertension include:

Region	Name of clinical condition	Portal circulation	Systemic circulation
Esophageal	Esophageal varices	Esophageal branch of left gastric vein	Esophageal branches of azygos vein
Rectal	Rectal varices	Superior rectal vein	Middle rectal veins and inferior rectal veins
Paraumbilical	Caput medusae	Paraumbilical veins	Superficial epigastric vein
Retroperitoneal	Splenorenal shunt	Splenic vein	Renal vein, suprarenal vein, paravertebral vein, and gonadal vein
Retroperitoneal	(no clinical name)	Right colic vein, middle colic vein, left colic vein	Retroperitoneal veins of Retzius
Intrahepatic	Hepatic pseudolesions	Perihepatic veins of Sappey	Superior epigastric vein
Intrahepatic	Patent ductus venosus	Left branch of portal vein	Inferior vena cava

A dilated inferior mesenteric vein may or may not be related to portal hypertension. Other areas of anastomosis include the bare area of the liver as it connects to the diaphragm, the posterior portion of the gastrointestinal tract as it touches the posterior abdominal wall, the posterior surface of the pancreas, and the inferior part of the esophagus.

References

Sato, Takahiro; Akaike, Jun; Toyota, Jouji; Karino, Yoshiyasu; Ohmura, Takumi (2011). "Clinicopathological Features and Treatment of Ectopic Varices with Portal Hypertension". International Journal of Hepatology. 2011: 960720. doi:10.4061/2011/960720. PMC 3170857. PMID 21994879.
Gray's Anatomy for Students Gray H, Drake R, Vogl W, Mitchell A, Tibbitts R, Richardson P. Philadelphia: Elsevier/Churchill Livingstone; 2010. p. 226
D'Souza, Donna. "Portal-systemic collateral pathways | Radiology Reference Article | Radiopaedia.org". radiopaedia.org. Retrieved 2016-08-12.
"Surgicomania: Portal Hypertension". surgicomania.blogspot.co.uk. 2009-11-23. Retrieved 2016-08-12.
Khader.O.Thabet, Mohammed Al. "Hepatic pseudolesion near falciform ligament | Radiology Reference Article | Radiopaedia.org". radiopaedia.org. Retrieved 2016-08-12.

Cardiovascular disease (vessels)

Arteries, arterioles
and capillaries

Inflammation	Arteritis Aortitis Buerger's disease
Arteriosclerosis	Atherosclerosis Foam cell Fatty streak Atheroma Cholesterol LDL Oxycholesterol Trans fat Monckeberg's arteriosclerosis Hyaline arteriolosclerosis Hyperplastic arteriolosclerosis
Peripheral artery disease	Stenosis Carotid artery stenosis Renal artery stenosis Aortoiliac occlusive disease Critical limb ischemia Degos disease Erythromelalgia Fibromuscular dysplasia Hepatic artery thrombosis Intermittent claudication Raynaud's phenomenon
Aneurysm / dissection / pseudoaneurysm	torso: Aortic aneurysm Abdominal aortic aneurysm Thoracic aortic aneurysm Aneurysm of sinus of Valsalva Aortic dissection Aortic rupture Coronary artery aneurysm head / neck Intracranial aneurysm Intracranial berry aneurysm Carotid artery dissection Vertebral artery dissection Familial aortic dissection
Vascular malformation	Arteriovenous fistula Arteriovenous malformation Telangiectasia Hereditary hemorrhagic telangiectasia Generalized essential telangiectasia
Vascular nevus	Cherry hemangioma Halo nevus Spider angioma

Veins

Inflammation	Phlebitis
Venous thrombosis / Thrombophlebitis	primarily lower limb Deep vein thrombosis abdomen Hepatic veno-occlusive disease Budd–Chiari syndrome May–Thurner syndrome Portal vein thrombosis Renal vein thrombosis upper limb / torso Mondor's disease Paget–Schroetter disease Pulmonary embolism head Cerebral venous sinus thrombosis Post-thrombotic syndrome
Varicose veins	Gastric varices Portacaval anastomosis Caput medusae Esophageal varices Hemorrhoid Varicocele
Other	Chronic venous insufficiency Chronic cerebrospinal venous insufficiency Superior vena cava syndrome Inferior vena cava syndrome Venous ulcer

Arteries or veins

Blood pressure

Hypertension	Hypertensive heart disease Hypertensive emergency Hypertensive nephropathy Essential hypertension Secondary hypertension Renovascular hypertension Benign hypertension Pulmonary hypertension Systolic hypertension White coat hypertension
Hypotension	Orthostatic hypotension Shock (circulatory)

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