Anat Cell Biol.  2024 Dec;57(4):517-522. 10.5115/acb.24.071.

Study of confluence of hepatic veins application in liver transplantation

• Bhingardeo AV
• Chandrupatla M
• Jogi S
• Srirambhatla A
• Ravi KS

• KMID: 2562499
• DOI: http://doi.org/10.5115/acb.24.071

Abstract

Liver has exceptional regeneration capacity which makes live donor liver transplantation a good surgical option for patients waiting for donors. Hepatic veins play major role in transplantation surgeries. Variations of hepatic veins can have great impact on surgical approach and outcome of the surgery. In the present study, total number of hepatic veins, presence and absence of accessory veins and confluence with its varied patterns were studied. We found maximum cases with 2 and 3 major hepatic veins which indicate presence of confluence. Confluence between left and middle hepatic veins was highest with 38% of total 54% of cases with confluence. We also found confluence between middle and accessory hepatic vein which is not mentioned in any present classifications. In addition, we have measured confluence length and diameter which holds significance in hepatic resection and anastomosis. The mean confluence length was 0.88±0.39 cm while mean confluence diameter was 0.57±0.20 cm. We found accessory hepatic veins in 15% of cases. The knowledge of this surgical anatomy and associated variations is of paramount importance in liver transplantation, radiological interventional procedures of liver and hepatic tumor resection procedures.

Keyword

Hepatic veins; Liver transplantation; Middle hepatic vein; Left hepatic vein; Right hepatic vein

Figure

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  Fig. 1 CT images with different number of major hepatic veins. (A) 2 Major hepatic veins. Confluence between LHV and MHV. (B) 3 Major hepatic veins. Absence of confluence. (C) 4 Major hepatic veins. Presence of AHV and absence of confluence. RHV, right hepatic vein; MHV, middle hepatic vein; LHV, left hepatic vein; AHV, accessory hepatic vein; CT, computed tomography.

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  Fig. 2 CT images of categorization of hepatic veins on the basis of confluence (Category-I, Category-II, Category-III) along with schematic presentation. RHV, right hepatic vein; MHV, middle hepatic vein; LHV, left hepatic vein; IVC, inferior vena cava; CT, computed tomography.

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  Fig. 3 CT images of categorization of hepatic veins on the basis of confluence (Category-IV, Category-V, New category) along with schematic presentation. RHV, right hepatic vein; MHV, middle hepatic vein; AHV, accessory hepatic vein; LHV, left hepatic vein; IVC, inferior vena cava; CT, computed tomography.

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  Fig. 4 Incidence of confluence of hepatic veins in different studies.

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  Fig. 5 The categorical incidence of confluence in different studies.

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  Fig. 6 The incidence of accessory hepatic veins in different studies.

Reference

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