Anatomy of the common trunk of the middle and left hepatic veins: application to liver transplantation

Abstract

An anastomosis between the common trunk of the middle and left hepatic veins of the receiver and the cranial portion of the inferior vena cava of the donor is one of the techniques for restoration of hepato-caval continuity in orthotopic liver transplantation. This technique avoids dissection of the retrohepatic vena cava and total caval clamping. The aim of this study was to define the feasibility of this technique by a morphologic and biometric study of the common trunk of the middle and left hepatic veins on the basis of 64 injection-corrosion hepatic specimens and 21 fresh subjects. A common trunk for the middle and left hepatic veins was present in 54 of 64 cases (84%) with a length of 3 to 17 mm. The diameter of the new ostium constructed by section 0.5 cm proximal to the junction of the middle and left hepatic veins was 23.9 +/- 2.3 mm, which approximated to that of the vena cava where it traversed the diaphragm (24.4 +/- 2.0 mm). These findings confirmed that restoration of hepato-caval continuity by anastomosis between the common trunk of the middle and left hepatic veins of the receiver and the cranial portion of the vena cava of the graft is possible without incongruence. This study makes no assumptions about the hemodynamic effects associated with the smallest diameter of the true ostium of the common trunk at its opening into the inferior vena cava. In this study, the morphology of the common trunk was comparable to that observed by Nakamura. Further, we propose an anatomo-clinical classification allowing evaluation of the facility of vascular control of the common trunk in terms of the number and location of the collateral veins.

Functional venous anatomy for right-lobe grafting and techniques to optimize outflow

“…A common trunk formed by the left hepatic vein and MHV is found in 70% of patients, and an intimate relationship exists between the two in 100% of patients, even when they join the IVC independently. 17 It can be challenging to separate these structures, and aggressive attempts could leave the remnant without adequate outflow. Because these concerns have not yet been realized in practice does not mean they are theoretical.…”

Right lobe living donor liver transplantation: A review

“…16,28,47,84 The midhepatic vein is undoubtedly beneficial for the RL graft, and the remnant left lobe is probably not hurt by its absence, but its intimate relationship with the left hepatic vein is dangerous. 98,99 The left hepatic vein could be injured during dissection or narrowed by the closure of the orifice of the midhepatic vein, leaving the remnant left lobe with compromised outflow. The midhepatic vein should remain with the left lobe.…”

Review of 13 fetal cases with hepatic veins opening variously into the inferior vena cava within the diaphragm

“…6 In the absence of IVC or when it continues with the azygos vein, the VHs have to pass through the CO on the diaphragm to reach the right atrium. 3,6,9 Reviewing the general characteristics of 13 (7 males, 6 females) fetuses with hepatic veins opening into the IVC above the diaphragm showed that gestational ages of the fetuses ranged between 21 to 40 weeks. To the best of our knowledge, there are no publications in the literature that investigated these variations in the fetal period.…”