Skip to main content

Table 1 Hemodynamic classification of gastric varices based on portal outflow/efferent system

From: Beyond the scope and the glue: update on evaluation and management of gastric varices

Classification system

Clinical relevance

Kiyosue classification

In Type A, shunt occlusion as the treatment of modality would suffice to control variceal bleeding not controlled with endoscopic therapy. In type B, feasibility of shunt occlusion might be less and hence transjugular intrahepatic portosystemic shunt placement is a better option to obliterate all of the collateral pathways

In type C, transjugular intrahepatic portosystemic shunt placement along with shunt emobilization of large portosystemic shunts could be the best option in ideal candidates

In Type D, in the presence of endoscopic failure, transjugular intrahepatic portosystemic shunt placement could become the best option

Type A: single draining shunt

Type B: single shunt and multiple collateral veins

B1: small collateral veins

B2: medium sized collateral

B3: large collateral veins with high flow without shunt

Type C: more than one shunt present

C1: small sized second shunt that cannot be catheterized

C2: presence of second shunt large enough to be catheterized

Type D: shunt is not present and the varices drain through small collaterals

Saad–Caldwell classification

In Type D, embolization procedures may not suffice to prevent rebleeding or control active bleeding due to the complex anatomy, and hence, transjugular intrahepatic portosystemic shunt placement could become the best option for prevention of further bleeding

Type A: single draining shunt

Type B: single shunt and multiple collateral veins

B1: small collateral veins

B2: medium sized collateral

B3: large collateral veins with high flow without shunt

Type C: more than one shunt present

C1: small sized second shunt that cannot be catheterized

C2: presence of second shunt large enough to be catheterized

Type D: shunt is not present and the varices drain through small collaterals

D1: predominance of systemic vein drainage is not obvious and any vein, out of inferior phrenic, hemiazygos tributaries, and intercostals veins or adrenal veins may be predominant

D2: morphology similar to D1, but predominant systemic venous draining vein is usually 4.3 mm in diameter through unconventional systemic veins

Hirota—BORV classification

In Type A, shunt embolization can help obliterate gastric varices

In Type B, transjugular intrahepatic portosystemic shunt placement with or without shunt embolization can help obliterate varices

In Type C, transjugular intrahepatic portosystemic shunt placement and shunt embolization need to be performed for large shunts for complete variceal disease management

In Type E, an antegrade approach for shunt embolization is more feasible than a retrograde approach since balloon sizes may not be available and the shunt flow is high

Type A: single draining shunt

Type B: single shunt and multiple collateral veins

B1: small collateral veins

B2: medium sized collateral

B3: large collateral veins with high flow without shunt

Type C: more than one shunt present

C1: small sized second shunt that cannot be catheterized

C2: presence of second shunt large enough to be catheterized

Type D: shunt is not present and the varices drain through small collaterals

Type E: gastrorenal shunt too large for balloon occlusion procedures