Arantius' ligament approach to the left hepatic vein and to the common trunk.

Abstract

During fetal development, the ductus venosus (ductus venosus Arantii) connects the umbilical portion of the left branch of the portal vein to the inferior vena cava, shunting oxygenated umbilical cord blood away from the liver. After birth the duct obliterates and persists as the ligamentum venosum or Arantius’ ligament. Because of its functional role, it is commonly believed that the ligament runs from the left branch of the portal vein to the vena cava itself. But attention to anatomical detail demonstrates that the fibers of the ligament insert either on the left hepatic vein or at the junction between the left hepatic and the middle hepatic veins (Figs. 1, 2). We describe a maneuver that takes advantage of the insertion of the ligamentum venosum to isolate and tape the left hepatic vein, or the common trunk of the middle and left hepatic veins. This maneuver is useful to pass a vessel loop to prepare for in situ left lobe splitting or for pediatric living donor liver transplantation. With further dissection, the maneuver can be used to encircle the common trunk of the left and middle hepatic veins to prepare for harvesting of the left liver for living donor or split liver transplantation or for selective hepatic vein occlusion during liver resections.