The posterior gastric vein was detected angiographically in 94 of 110 patients with portal hypertension (85.5%). The surgical importance of the posterior gastric vein derives from its relatively high incidence, from its being another source of reverse blood flow to the varices, from its having an almost hidden origin from the posterior gastric wall and from the lack of attention to the vessel. The clinical significance of the posterior gastric vein in portal hypertension is emphasized in this article.