title: Hepatic venous drainage: how much can we learn from imaging studies? Anatomic-functional classification derived from three-dimensional computed tomography reconstructions.
abstract: 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.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany. arnold.radtke@uksh-kiel.de
authors.forename: Arnold
authors.initials: A
authors.lastname: Radtke
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: George
authors.initials: G
authors.lastname: Sgourakis
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: Tobias
authors.initials: T
authors.lastname: Schroeder
authors.forename: Fuat H
authors.initials: FH
authors.lastname: Saner
authors.forename: Susanne
authors.initials: S
authors.lastname: Beckebaum
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
authors.forename: Dieter C
authors.initials: DC
authors.lastname: Broering
authors.forename: Massimo
authors.initials: M
authors.lastname: Malago
mesh_terms: 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*