Systemic venous blood return via the portal vein

Area of Science:

• Vascular Surgery
• Abdominal Imaging
• Anatomy

Background:

• Inferior vena cava (IVC) obstruction leads to the development of collateral circulation.
• Classical classification divides collateral patterns into three groups based on IVC obstruction level: infrarenal, middle caval, and upper caval.

Observation:

• The portal vein is a significant component of collateral pathways in IVC obstruction.
• Potential collateral routes involving the portal vein exist at all three levels of IVC obstruction.

Findings:

• Six cases illustrate the role of the portal vein in collateral circulation following IVC obstruction.
• The portal vein actively contributes to venous decompression across infrarenal, middle caval, and upper caval obstruction sites.

Implications:

• Understanding these portal venous collaterals is crucial for managing IVC obstruction.
• This knowledge aids in surgical planning and interventional radiology procedures for venous thromboembolic disease.