LAUSR

“Downhill” esophageal varices distributed predominantly in the proximal esophagus are unusual causes of hematemesis, comprising 0.1% of all cases of variceal hemorrhage. They are seen in up to 30% of cases of superior vena cava (SVC) obstruction from benign and malignant causes. The pathophysiology of their formation and management is different from that of the more usual “uphill” varices commonly seen that result from portal hypertension. These varices are caused by the formation of collaterals caused by obstruction of the superior vena cava. Their distribution in the esophagus varies relative to the level of SVC obstruction with the azygos vein. Patients with end-stage renal disease (ESRD) who are receiving long-term dialysis are particularly at risk for SVC obstruction/stenosis from the sustained use of indwelling