Perforating veins and blood flow in oesophageal varices

Blood-flow patterns in oesophageal 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 oesophageal varices to the peri-oesophageal veins, particularly at the lower end of the oesophagus. 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 gastrooesophageal junction. Successful treatment of oesophageal varices with the minimum of sclerotherapy treatments may depend on early obliteration of the incompetent perforating veins.