The left gastric artery is the smallest coeliac trunk branch but carries the highest clinical significance in portal hypertension, the left gastric (coronary) vein draining parallel to it is the primary drainage pathway into the azygos system, producing oesophageal varices when portal pressure rises. In total gastrectomy, the left gastric artery is divided at its coeliac origin.
| Origin | Coeliac trunk (directly) |
|---|---|
| Course | Ascends retroperitoneally to the oesophageal hiatus, curves along the lesser curvature of the stomach toward the pylorus in the lesser omentum |
| Branches |
|
The left gastric (coronary) vein is the primary variceal collateral in portal hypertension, its blood flows from the portal system retrograde through the coronary vein and left gastric territory into the oesophageal veins, producing oesophageal varices. TIPS (transjugular intrahepatic portosystemic shunt) reduces portal-azygos gradient and prevents variceal bleeding.
Retrograde left gastric vein flow producing oesophageal varices managed with band ligation, beta-blockade, and TIPS.
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