Portacaval anastomosis

A portacaval anastomosis (also known as porto-systemic anastomosis or portal caval system) is a specific type of anastomosis that occurs between the veins of portal circulation and those of systemic circulation. The inferior end of the esophagus and the inferior part of the rectum are some of the most important sites of portal systemic anastomosis.

In portal hypertension, as in the case of cirrhosis of liver, the anastomoses become congested and form venous dilatations. Such dilatation can lead to esophageal varices and rectal hemorrhoids. Caput medusaes can also result.^[1]

Specific types 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	Inferior epigastric vein
Retroperitoneal	(no clinical name)	Right colic vein, middle colic vein, left colic vein	Renal vein, suprarenal vein, paravertebral vein, and gonadal vein
Intrahepatic	Patent ductus venosus	Left branch of portal vein	Inferior vena cava

It can be one of the conditions caused by portal hypertension. A useful mnemonic is that portal hypertension causes problems in the butt, the gut, and caput. A dilated inferior mesenteric vein may or may not be related to portal hypertension.

References

↑ Gray's Anatomy for Students Gray H, Drake R, Vogl W, Mitchell A, Tibbitts R, Richardson P. Philadelphia: Elsevier/Churchill Livingstone; 2010. p. 226

Compendio de Anatomía humana. Testut- LaTarjet

Arteries, arterioles
and capillaries

Inflammation

Arterial occlusive disease /
peripheral artery disease

Arteriosclerosis	Atherosclerosis Foam cell Fatty streak Atheroma Intermittent claudication Critical limb ischemia Monckeberg's arteriosclerosis Arteriolosclerosis Hyaline Hyperplastic Cholesterol LDL Oxycholesterol Trans fat

Stenosis	Carotid artery stenosis Renal artery stenosis

Other	Aortoiliac occlusive disease Degos disease Erythromelalgia Fibromuscular dysplasia Raynaud's phenomenon

Aneurysm / dissection /
pseudoaneurysm

Vascular malformation

Vascular nevus

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 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

Clinically Oriented Anatomy. Keith Moore.

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