title: Use of 3-dimensional computed hepatic venous visualization for graft outflow venoplasty in adult left living-donor liver transplant.
abstract: OBJECTIVE
  A surgeon must be aware of hepatic vascular variations to safely perform living-donor liver transplant. The ramification patterns of the hepatic veins with tributaries for left lobe graft outflow venoplasty should be evaluated preoperatively with 3-dimensional computed tomography of the donor.
  
  
  METHODS
  Twenty-four potential donors were examined between October 1999 and July 2006 for living-donor liver transplant using the left lobe. They underwent triphasic helical computed tomography of the liver on a multidetector helical computed tomographic scanner. All images, including 2-dimensional reformation and 3-dimensional reconstructed models with maximum intensity projection and volume rendering, were sent to a workstation for postprocessing.
  
  
  RESULTS
  The ramification patterns of the left and middle hepatic vein were classified into 2 groups; they formed a common trunk (type 1), which had 3 variations; type 1A (13 cases): in which the left hepatic vein and the middle hepatic vein without any tributaries on their confluence; type 1B (8 cases): in which there was venous confluence in the left hepatic vein with the left superficial vein and middle hepatic vein; type 1C (2 cases): in which the hepatic venous confluence in the left hepatic vein and middle hepatic vein and the left superficial vein directly joining into the inferior vena cava; type 2 (1 case) had the left hepatic vein and middle hepatic vein joining into the inferior vena cava separately; type 1B underwent 2 venoplasty procedures, but the others underwent only a single venoplasty.
  
  
  CONCLUSIONS
  We demonstrated the anatomic interrelation of the hepatic veins for hepatic outflow venoplasty of adult left lobe living-donor liver transplant with 3-dimensional computed tomography scanning to help surgeons preoperatively determine the appropriate technique or form of reconstruction.
authors: Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. turahashi@jichi.ac.jp
authors: Taizen
authors: T
authors: Urahashi
authors: Hideo
authors: H
authors: Katsuragawa
authors: Masakazu
authors: M
authors: Yamamoto
authors: Yoshiyuki
authors: Y
authors: Ihara
authors: Yukihiro
authors: Y
authors: Sanada
authors: Taiichi
authors: T
authors: Wakiya
authors: Koichi
authors: K
authors: Mizuta
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy; D006503:Hepatic Veins / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007564:Japan; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010690:Phlebography / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011857:Radiographic Image Interpretation, Computer-Assisted; D054079:Vascular Malformations / Q000000981:diagnostic imaging*; D014656:Vascular Surgical Procedures