An imaging-based diagnosis of venous invasion was established when one of the following criteria were satisfied: 1) tumoral enhancement in the lumen of the vein, 2) tumor protruding through the course of a vein, and 3) distention of the vein due to extension of the gastric tumor Right and left gastric veins, aberrant left gastric vein (ALGV), right and left gastroepiploic veins, superior mesenteric vein (SMV), short gastric veins, and the portal vein were evaluated for tumoral invasion (Figure 1).
A 66-year-old man with gastric cancer extending through the course of short gastric veins. Serial axial contrast-enhanced CT images demonstrating the main tumor (long arrow, a), and tumor infiltrating through the course of short gastric veins (asterisks, a-c).
Although statistical analysis could not be achieved because of the small patient group of our study, survival rates of the patients with ALGV (Figure 3) and short gastric vein (Figure 4) invasion were low.
Although our study had a small patient cohort as a major drawback for further analysis, survival rates of patients with ALGV and short gastric vein invasion were significantly low.
The most significant finding in our study was the survival time of patients with short gastric vein invasion; two of the three patients with short gastric vein invasion died within 1 week after CT.
Thrombosed splenic vein with intact splenic artery induces hypertensive short gastric veins that can develop into varices in the gastric fundal submucosa.
After SAE, blood pressure in short gastric veins is decreased because the blood inflow to spleen is decreased.
(b) Thrombosed splenic vein and intact splenic artery induces hypertensive short gastric veins. It is a potential source of massive bleeding from gastric varices.
Caption: Figure 6: (a) After the Warshaw operation, spleen is supplied by short gastric arteries and left gastroepiploic artery and drained by short gastric veins and left gastroepiploic vein.