• An improved radiographic classification of esophageal varices and paraesophageal veins was devised. Esophageal varices were divided into palisading and bar types. Paraesophageal veins were divided into intra-abdominal and thoracoabdominal types, with the latter being further subdivided into right-side-predominant and left-side-predominant types. The existence of the thoracoabdominal paraesophageal veins was significantly related to the preoperative endoscopic findings of the red sign and the form of the esophageal varices. Left-side-predominant paraesophageal veins were likely to drain the splanchnic blood flow to the hemiazygos vein. The largest grade of red sign was found in 88.9% of the patients with combination of bar type and intra-abdominal type and the largest form was in 88.9% of those with palisading and right-side thoracoabdominal types. The pressure gradients across the shunt were significantly lower in the right thoracoabdominal type than in others. Our study suggests that treatment be designed according to the vascular patterns of the lower esophagus.
(Arch Surg 1989;124:961-966)