title: Analysis of intrahepatic venovenous shunt by hepatic venography.
abstract: 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.
authors.affiliation: Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. saka1119@hama-med.ac.jp
authors.forename: Takanori
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Shohachi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Keisuke
authors.initials: K
authors.lastname: Inaba
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Fukumoto
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Takehara
authors.forename: Hatsuko
authors.initials: H
authors.lastname: Nasu
authors.forename: Mika
authors.initials: M
authors.lastname: Kamiya
authors.forename: Shuhei
authors.initials: S
authors.lastname: Yamashita
authors.forename: Takasuke
authors.initials: T
authors.lastname: Ushio
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakamura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Konno
mesh_terms: 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