Hepatic venous drainage: how much can we learn from imaging studies? Anatomic-functional classification derived from three-dimensional computed tomography reconstructions.
BACKGROUND
The knowledge of "venous dominance" is essential to prevent serious venous congestion in live donor liver transplantation and extended liver resections.


OBJECTIVE
The purpose of our study was to delineate our proposed anatomic-functional classification of hepatic venous drainage.


METHODS
One hundred forty consecutive live liver donor candidates underwent three-dimensional computed tomography reconstructions and three-dimensional virtual hepatectomies. Five different venous dominance types were defined on drainage volumes or territories. "Risky" configurations were identified and classified.


RESULTS
The right hepatic vein (RHV) was dominant for the entire liver and right hemiliver (RHH) in most (83.5%) cases irrespective of the presence of inferior (accessory) hepatic veins (IHVs). The middle hepatic vein (MHV) was dominant for the total liver (TL) in 15.5% of cases and for the RHH in 27% of cases. The left hepatic vein was almost always (92%) dominant for the left hemiliver. When associated with a large IHV drainage volume, a RHV/IHV complex dominant for the TL led to a RHH dominant MHV (mean 59.5%RHH) if the IHV was not reconstructed.


CONCLUSIONS
Our proposed anatomic-functional classification provides a valuable insight into hepatic vein dominance patterns. RHH venous drainage patterns at "high risk" for venous congestion include (1) a dominant MHV for the TL and (2) a dominant RHV/IHV complex with a large IHV drainage volume.
Radtke
Arnold
A
Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany. arnold.radtke@uksh-kiel.de
Sotiropoulos
Georgios C
GC
Sgourakis
George
G
Molmenti
Ernesto P
EP
Schroeder
Tobias
T
Saner
Fuat H
FH
Beckebaum
Susanne
S
Broelsch
Christoph E
CE
Broering
Dieter C
DC
Malago
Massimo
M
D000328:Adult; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006503:Hepatic Veins / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods; D008099:Liver / Q000098:blood supply* / Q000378:metabolism* / Q000473:pathology; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*