Left gastric vein

The left gastric vein (also known as the coronary vein) drains both the anterior and posterior gastric walls. It forms a loop with the right gastric vein at the lesser curvature of the stomach. The left gastric vein travels in the lesser omentum to drain in the portal vein. It also communicates with the lower oesophageal veins through several anastomotic channels.

Gross anatomy

Origin and course

The left gastric vein begins as small venous branches draining the anterior and posterior walls of the lesser curvature of the stomach ⁵. The left gastric vein then ascends along the lesser curvature of the stomach within the lesser omentum  (specifically the hepatogastric ligament) to the oesophageal hiatus where it anastomoses with the oesophageal veins ⁵. The vessel then descends along the gastropancreatic fold draining into the portal vein at the superior border of the pancreas¹. 

Relations

Typically the left gastric vein will travel dorsal to the common hepatic artery and ventral relative to the splenic artery ¹.  

Tributaries

• anterior branches - draining oesophageal veins ⁵
• posterior branches - draining paraesophageal veins ⁵

Variant anatomy

The course and relation to the surrounding vessels of the left gastric vein can vary ^1-3. This includes drainage directly into the liver ^4,7.

Clinical importance

The left gastric vein may be damaged during lymph node dissection or gastrectomy which may cause massive hemorrhage ^1,2. In addition, the vessel is a frequent site for collateralization between the systemic and portal venous systems in instances of portal hypertension as well as splenoportal collateralization in cases of splenic vein occlusion ⁶.