Analysis of intrahepatic venovenous shunt by hepatic venography.
BACKGROUND
The necessity of preserving hepatic venous drainage in hepatectomy and liver transplantation has recently been accepted; however, the hepatic vein (HV) can be removed when an effective intrahepatic venovenous shunt (VV shunt) exists.


METHODS
Occlusion venography of the right HV (RHV) was performed in 51 patients to investigate the VV shunt characteristics.


RESULTS
Twenty patients had a shunt between the RHV and large HVs whose root diameters were >3 mm, such as the superficial or inferior RHV, or the middle HV. Twenty patients had a shunt between the RHV and small HVs with root diameters < or =3 mm. Eleven patients had no shunt. The change in anterior portal vein blood flow after RHV occlusion, evaluated by Doppler ultrasonography, was minimal (5 +/- 3%) in patients with a shunt between the RHV and large HVs, and less than in patients with a shunt between the RHV and small HVs (38% +/- 18%) or without a shunt (50% +/- 17%; P < .0001). A shunt between the RHV and large HV was less frequently seen in those patients with cirrhosis (3/20) than in those without cirrhosis (17/31; P = .0044). The existence of the shunt between the RHV and large HVs was unpredictable, however, from computed tomographic findings or laboratory data.


CONCLUSIONS
A hemodynamically significant VV shunt between the RHV and large HV was observed in fewer than half of the patients and less frequently in cirrhotic patients. Preservation of hepatic venous drainage should be considered in patients without a hemodynamically significant VV shunt in liver surgery.
Sakaguchi
Takanori
T
Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. saka1119@hama-med.ac.jp
Suzuki
Shohachi
S
Inaba
Keisuke
K
Fukumoto
Kazuhiko
K
Takehara
Yasuo
Y
Nasu
Hatsuko
H
Kamiya
Mika
M
Yamashita
Shuhei
S
Ushio
Takasuke
T
Nakamura
Satoshi
S
Konno
Hiroyuki
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D003110:Colonic Neoplasms / Q000601:surgery; D005260:Female; D006391:Hemangioma / Q000601:surgery; D006440:Hemofiltration / Q000379:methods; D006498:Hepatectomy / Q000379:methods; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D018608:Ultrasonography, Doppler