What is the function of the gastric coronary vein?

Arteries and veins make up the human body's vascular system, and veins and arteries appear in different parts of the human body. They are connected to each other and have the same function. Of course, veins, like arteries, are also prone to problems, especially blood clots or varicose veins, which are still very easy to see. So the question is, what practical role does the gastric coronary vein play in clinical practice?

Clinical value

Coronary veins are the anatomical basis for the formation of esophageal varicose bleeding. Completely blocking or completely diverting coronary venous blood flow is the key to treating and preventing esophageal varicose bleeding. Devascularization is an effective method for treating portal hypertension. It effectively controls bleeding by blocking the gastric, esophageal and high esophageal branches of the coronary vein, as well as the short gastric veins and posterior gastric vein. However, there is still a certain recurrence rate of bleeding after disconnection surgery. Incomplete disconnection and the formation of new collateral vessels are the main causes of recurrence of bleeding. Previously, it was believed that omission of the high esophageal branch of the coronary vein was the main factor for incomplete blood flow interruption.

We performed direct portal vein angiography on 31 patients with rebleeding after devascularization and found that in addition to missing the high esophageal branches, rebleeding was also related to the location of the coronary vein opening and multiple coronary veins. The opening of the coronary vein in patients with rebleeding is mainly located in the main trunk of the portal vein. Compared with the opening in the splenic vein, the coronary vein located in the portal vein increases the difficulty of the disconnection operation, and it is difficult to block the main trunk of the coronary vein by conventional surgical operations; the incidence of multiple coronary veins in patients with portal hypertension is 20.54%, which can be manifested as being located together in the main trunk of the portal vein or separately in the main trunk of the portal vein, splenic vein and superior mesenteric vein. Missing any one of them will lead to recurrence of bleeding. Therefore, before the devascularization operation, in addition to being familiar with the general anatomy of the coronary veins, it is also necessary to understand the individual differences of the coronary veins and perform the operation according to the anatomical characteristics of the coronary veins to ensure the thoroughness of the devascularization.

Methods for identifying coronary veins include ultrasound Doppler, CT, MRI, etc. These methods are difficult to show the direction of the coronary veins, and even more difficult to identify the location of the coronary vein opening, and have no guiding role in the implementation of devascularization surgery〔6〕; indirect portal venography is affected by the blood flow of the portal vein to the liver, and the coronary vein display rate is low; direct portal venography is an effective method for displaying coronary veins〔7〕. There are three ways to perform direct portal vein angiography: through the spleen, through the liver, and through the internal jugular vein. The first two ways have the risk of intra-abdominal bleeding and should be used with caution in patients with advanced cirrhosis. The internal jugular vein approach has less trauma, fewer complications, and higher safety.

While understanding the anatomy of the coronary veins and guiding the disconnection surgery, a small-caliber shunt can also be established in the liver to reduce portal vein pressure, improve portal vein circulation, reduce complications of disconnection surgery, prevent the formation of new collateral vessels after disconnection surgery, and further improve the clinical efficacy of treating portal hypertension. Understanding the anatomy of the coronary veins before surgery can also help with coronary vein embolization and coronary shunt surgery, ensuring the safety and thoroughness of embolization therapy and improving the success rate of coronary shunt surgery.