Surgical and Radiologic Anatomy

, Volume 39, Issue 3, pp 249–255 | Cite as

CT imaging-based determination and classification of anatomic variations of left gastric vein

  • Yongyou Wu
  • Guangqiang Chen
  • Pengfei Wu
  • Jianbin Zhu
  • Wei peng
  • Chungen Xing
Original Article



Precise determination and classification of left gastric vein (LGV) anatomy are helpful in planning for gastric surgery, in particular, for resection of gastric cancer. However, the anatomy of LGV is highly variable. A systematic classification of its variations is still to be proposed. We aimed to investigate the anatomical variations in LGV using CT imaging and develop a new nomenclature system.


We reviewed CT images and tracked the course of LGV in 825 adults. The frequencies of common and variable LGV anatomical courses were recorded. Anatomic variations of LGV were proposed and classified into different types mainly based on its courses. The inflow sites of LGV into the portal system were also considered if common hepatic artery (CHA) or splenic artery (SA) could not be used as a frame of reference due to variations.


Detailed anatomy and courses of LGV were depicted on CT images. Using CHA and SA as the frames of reference, the routes of LGV were divided into six types (i.e., PreS, RetroS, Mid, PreCH, RetroCH, and Supra). The inflow sites were classified into four types (i.e., PV, SV, PSV, and LPV). The new classification was mainly based on the courses of LGV, which was validated with MDCT in the 805 cases with an identifiable LGV, namely type I, RetroCH, 49.8 % (401/805); type II, PreS, 20.6 % (166/805); type III, Mid, 20.0 % (161/805); type IV, RetroS, 7.3 % (59/805); type V, Supra, 1.5 % (12/805); and type VI, PreCH, 0.7 % (6/805). Type VII, designated to the cases in which SA and CHA could not be used as frames of reference, was not observed in this series.


Detailed depiction of the anatomy and courses of LGV on CT images allowed us to evaluate and develop a new classification and nomenclature system for the anatomical variations of LGV.


Left gastric vein MDCT Anatomic variations Nomenclature Classification 


Compliance with ethical standards


No funding of financial support was received for this research.

Ethical approval

This work complied with the current laws of the PR of China. Ethical approval was gained from the Ethics Committee of the Second Affiliated Hospital of Soochow University (Ethics ID 325).

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Hino S, Kakutani H, Ikeda K, Uchiyama Y, Sumiyama K, Kuramochi A, Kitamura Y, Matsuda K, Arakawa H, Kawamura M, Masuda K, Suzuki H (2002) Hemodynamic assessment of the left gastric vein in patients with esophageal varices with color Doppler EUS: factors affecting development of esophageal varices. Gastrointest Endosc 55:512–517CrossRefPubMedGoogle Scholar
  2. 2.
    Kawasaki K, Kanaji S, Kobayashi I, Fujita T, Kominami H, Ueno K, Tsutida S, Ohno M, Ohsawa M, Fujino Y, Tominaga M, Nakamura T (2010) Multidetector computed tomography for preoperative identification of left gastric vein location in patients with gastric cancer. Gastric Cancer 13:25–29CrossRefPubMedGoogle Scholar
  3. 3.
    Kumano S, Tsuda T, Tanaka H, Hirata M, Kim T, Murakami T, Sugihara E, Abe H, Yamashita H, Kobayashi N, Mochizuki T (2007) Preoperative evaluation of perigastric vascular anatomy by 3-dimensional computed tomographic angiography using 16-channel multidetector-row computed tomography for laparoscopic gastrectomy in patients with early gastric cancer. J Comput Assist Tomogr 31:93–97CrossRefPubMedGoogle Scholar
  4. 4.
    Lee SW, Shinohara H, Matsuki M, Okuda J, Nomura E, Mabuchi H, Nishiguchi K, Takaori K, Narabayashi I, Tanigawa N (2003) Preoperative simulation of vascular anatomy by three-dimensional computed tomography imaging in laparoscopic gastric cancer surgery. J Am Coll Surg 197:927–936CrossRefPubMedGoogle Scholar
  5. 5.
    Matsuki M, Kani H, Tatsugami F, Yoshikawa S, Narabayashi I, Lee SW, Shinohara H, Nomura E, Tanigawa N (2004) Preoperative assessment of vascular anatomy around the stomach by 3D imaging using MDCT before laparoscopy-assisted gastrectomy. AJR Am J Roentgenol 183:145–151CrossRefPubMedGoogle Scholar
  6. 6.
    Matsuki M, Tanikake M, Kani H, Tatsugami F, Kanazawa S, Kanamoto T, Inada Y, Yoshikawa S, Narabayashi I, Lee SW, Nomura E, Okuda J, Tanigawa N (2006) Dual-phase 3D CT angiography during a single breath-hold using 16-MDCT: assessment of vascular anatomy before laparoscopic gastrectomy. AJR Am J Roentgenol 186:1079–1085CrossRefPubMedGoogle Scholar
  7. 7.
    Miyaki A, Imamura K, Kobayashi R, Takami M, Matsumoto J, Takada Y (2012) Preoperative assessment of perigastric vascular anatomy by multidetector computed tomography angiogram for laparoscopy-assisted gastrectomy. Langenbecks Arch Surg 397:945–950CrossRefPubMedGoogle Scholar
  8. 8.
    Natsume T, Shuto K, Yanagawa N, Akai T, Kawahira H, Hayashi H, Matsubara H (2011) The classification of anatomic variations in the perigastric vessels by dual-phase CT to reduce intraoperative bleeding during laparoscopic gastrectomy. Surg Endosc 25:1420–1424CrossRefPubMedGoogle Scholar
  9. 9.
    Rebibo L, Chivot C, Fuks D, Sabbagh C, Yzet T, Regimbeau JM (2012) Three-dimensional computed tomography analysis of the left gastric vein in a pancreatectomy. HPB 14:414–421CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Roi DJ (1993) Ultrasound anatomy of the left gastric vein. Clin Radiol 47:396–398CrossRefPubMedGoogle Scholar
  11. 11.
    Schmidt B, Yoon SS (2013) D1 versus D2 lymphadenectomy for gastric cancer. J Surg Oncol 107:259–264CrossRefPubMedGoogle Scholar
  12. 12.
    Tamura S, Takeno A, Miki H (2011) Lymph node dissection in curative gastrectomy for advanced gastric cancer. Int J Surg Oncol 2011:748745. doi: 10.1155/2011/748745 PubMedPubMedCentralGoogle Scholar
  13. 13.
    Terayama N, Matsui O, Tatsu H, Gabata T, Kinoshita A, Hasatani K (2004) Focal sparing of fatty liver in segment II associated with aberrant left gastric vein. Br J Radiol 77:150–152CrossRefPubMedGoogle Scholar
  14. 14.
    Zhang JS, Li L, Liu SL, Cheng W, Diao M, Hou WY, Zhang J, Li SL, Liu Y, Wang HB, Ming AX (2012) Gastroportal shunt for portal hypertension in children. J Pediatr Surg 47:253–257CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2016

Authors and Affiliations

  • Yongyou Wu
    • 1
  • Guangqiang Chen
    • 2
  • Pengfei Wu
    • 3
  • Jianbin Zhu
    • 2
  • Wei peng
    • 1
  • Chungen Xing
    • 1
  1. 1.Department of General SurgeryThe Second Affiliated Hospital of Soochow UniversitySuzhouPeople’s Republic of China
  2. 2.Department of RadiologyThe Second Affiliated Hospital of Soochow UniversitySuzhouPeople’s Republic of China
  3. 3.Department of General SurgeryThe People’s Hospital of RugaoRugaoPeople’s Republic of China

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