Pathophysiological management of gastric varices: From hemodynamics to targeted therapies

Table 1 Classification of gastric varices based on venographic and angiographic findings

Classification	Basis	Types/grades	Key features	Clinical relevance
Hirota classification	BRTO findings	Grade 1-5	Grade 1-2: Good opacification, minimal collaterals. Grade 3 Partial opacification with collaterals. Grade 4-5: Poor/no opacification, extensive collaterals or large shunt	Predicts the feasibility and success of BRTO; higher grades = lower success
Fukuda classification	Dominance of afferent (feeding) veins on angiography	Type 1-4	Type 1 Left gastric vein dominant. Type 2 mixed (LGV + posterior/short gastric). Type 3 complex bilateral supply. Type 4 right-sided dominance	Helps identify inflow patterns and guides selective embolization
Matsumoto classification	Flow dynamics in gastrorenal shunt and LGV	Type 1-2	Type 1 portosystemic flow present. Type 2 portosystemic flow absent. Subtypes based on flow in LGV: A (hepatopetal)/B (hepatofugal)	Predicts worsening of esophageal varices after BRTO (higher risk in Type 1B)

BRTO: Balloon-occluded retrograde transvenography; LGV: Left gastric vein.