Caudate Vein Research Articles

Anatomical study of the morphometry of portal caudate veins

The caudate lobe is a relatively unknown part of the liver due to its location and many variations. The caudate lobe is a separate entity that is located behind the trunk of the portal vein.It constitutes the hepatic dorsal area that comprises of only segment I. Thus, this lobe can be vascularized by caudate veins (CV) born either from the right branch of the portal vein (PV),from the left branch or from both. Therefore, the work allows us to study the morphometry of caudate veins. Based on the exploitation of vascular mussels of the inferior vena cava and the portal vein after injection-corrosion of the liver, the study conducted from April 2018 to March 2019 involved 41 livers of which 30 were exploited for caudate veins. These were from fresh adult subjects, both sexes free of any hepatobilio-pancreatic pathology or trauma. The injection-corrosion parts of his vascular mussels included the hepatobasement junction and the hepatic pedicle. The PV and its right and left branches provided accessory caudate branches for the caudate lobe at the level of the hepatic hilum. Thus, for all livers, we found 102 branches cauded by accessories. The accessory caudate veins were born either from the left branch of the PV in 28 livers out of 30 (93.37% ), by 1 to 4 vessels with an average distance between its branches and the portal bifurcation being 17 mm with extremes ranging from 7 to 39 mm; either from the right branch of the PV in 23 livers out of 30(76.6%), by 1 to 3 vessels with an average distance of 12.9 mm between its branches and the portal bifurcation, with extremes ranging from 9 to 18 mm. The stem of the portal vein gave branches to the caudate lobe in 11 livers on 30(36.6%),by 1 to 2 vessels whose diameter varied from 1 mm to 3 mm. We studied on 30 liver samples the anatomical variations related to CV. This is a contribution to the fundamental foundations of liver removal surgery because too little work (and often radiological) exists in Africa on the subject. However, this lack of comparative anthropometric data confirms the diversity of anatomical variations in caudate veins. On the therapeutic level these anatomical data contribute to the peri-operative safety of liver surgery.

Topography Of Short Hepatic Veins And Interface Veins For Safe Tunneling During Hanging Maneuver Of Liver

Introduction: During hanging maneuver liver resection, a tunnel is created at the interface of the liver and Inferior venacava (IVC). Gap between the middle and right hepatic vein is known as Fossa venacava. A gap between the Inferior right hepatic vein and the Caudate vein is known as a Vein gap. The Fossa venacava and Vein gap provide a safe plane for the insertion of forceps during tunneling. The aim of this study is to determine the topography of this safe plane. Methods: A cross-sectional study was done. Twenty livers were used in our study. Major hepatic veins, distance of Vein gap, Fossa venacava, and each vessel present at the interface between liver and IVC was measured by a Vernier caliper. All the collected data was entered and analyzed by using Statistical Package for Social Sciences version 20 (SPSS-20). Results: The average length of retro hepatic IVC was 49.5±10.5 mm and the diameter of 25.6±4.4 mm. The inferior right hepatic vein was present in 60% of cases while the Caudate vein was present in 85% of cases. Fossa venacava had an average distance of 12.3±3.46 mm and the Vein gap was 18.9±7.1 mm. Conclusion: While tunneling between IVC and the liver, Fossa venacava could be as small as 4.6 mm. The shortest distance of the Vein gap could be as small as 5.8 mm. The intermediate course of forceps insertion is safer than the right or left course.

Impact of Water and Alcoholic Plant Extracts of Hypericum perforatum on Histological and Some Physiological Features in the Liver of Albino Rats

Hypericum perforatum, which is known as St. John’s wort (SJW), is a leafy herb that grows in the open areas of the temperate regions throughout the world. Recent research suggests the effectiveness of this plant in treating some diseases, such as cancer, bacterial and viral diseases, and some inflammation-related disorders, and as a neuroprotective agent and an antioxidant. The current study aimed to investigate the Impact of water and alcoholic plant extracts of H. perforatum on histological and some physiological features in the liver of albino rats. 21 male rats were used in the current study. They were divided into groups; each group contains 7 members of animals. The animals were raised a month ago in the animal house before conducting the study to ensure their suitability to the environment of the animal house. Before the start of the study, an appropriate amount of animal blood was obtained through the caudate vein of rats, in order to evaluate the variables of the physiological study before starting treatment with plant extracts. One of the groups (Group 1) was used as a standard control group, receiving only standard water and feed. The other group (Group 2) was treated with St. John's water extract at a concentration of 300 mg/kg/body weight, while the last group (Group 3) was treated with St. John's alcoholic plant extract at a concentration of 300 mg/kg/body weight. Aqueous and alcoholic plant extract were prepared for H. perforatum. Histological slides were prepared from the liver of each group of the study as well as, alkaline phosphatase (ALP), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were evaluated for the rates in each group. Histological examination shows the presence of necrosis in various stages and the presence of Foamy Cells and the occurrence of infiltration of a number of inflammatory cells within the tissue as well as the occurrence of congestion in the central vein and hemorrhage spread throughout the rest of the tissue. We also note the occurrence of necrosis and desquamation of the central vein lining and infiltration of some inflammatory cells in some areas. The effect of treatments on the aminotransferases (AST, ALT) enzymes and the ALP, where appeared as a significant increase of 0.05 in their concentration when comparing the concentrations of each groups before and after treatment with plant extracts. We can conclude that H. perforatum aqueous and alcoholic plant extract can causes mild damages on liver histological features that can be reflected on livers physiological states generally and on the ALT, AST and ALP enzymes specifically.

Recombinant thrombomodulin prevented hepatic ischemia-reperfusion injury by inhibiting high-mobility group box 1 in rats

Recombinant thrombomodulin (rTM) is a novel anticoagulant and anti-inflammatory agent that inhibits secretion of high-mobility group box 1 (HMGB1) from liver. We evaluated the protective effects of rTM on hepatic ischemia-reperfusion injury in rats. Ischemia was induced by clamping the portal vein and hepatic artery of left lateral and median lobes of the liver. At 30 min before ischemia and at 6 h after reperfusion, 0.3 ml of saline (IR group) or 0.3 ml of saline containing 6 mg/kg body weight of rTM (IR-rTM group) was injected into the liver through inferior vena cava or caudate vein. Blood flow was restored at 60 min of ischemia. Blood was collected 30 min prior to induction of ischemia and before restoration of blood flow, and at 6, 12, and 24 h after reperfusion. All the animals were euthanized at 24 h after reperfusion and the livers were harvested and subjected to biochemical and pathological evaluations. Serum levels of ALT, AST, and HMGB1 were significantly lower after reperfusion in the IR-rTM group compared to IR group. Marked hepatic necrosis was present in the IR group, while necrosis was almost absent in IR-rTM group. Treatment with rTM significantly reduced the expression of TNF-α and formation of 4-hydroxynonenal in the IR-rTM group compared to IR group. The results of the present study indicate that rTM could be used as a potent therapeutic agent to prevent IR-induced hepatic injury and the related adverse events.

Anatomical and surgical consequences of tumour compression of the hepatic veins confluence

Aims: Venous drainage pathways that develop in the liver due to the tumor compression of the hepatic veins have been rarely described. The aim of this study was to describe these pathways in patients with tumor obstruction of hepatic veins confluence, according to the extent of obstruction and the presence of accessory veins, and the relevance in the setting of liver resection. Methods: Between 2009 and 2013, 32 patients with compression of at least one main hepatic vein undergoing liver resection were retrospectively selected from a prospective database. Preoperative CT-scans were re-assessed for the extent of hepatic vein compression, presence of accessory veins and collateral veins (both intra hepatic end subcapsular). A 2:1 matched control group was used for comparison of intra operative outcomes. Results: The right hepatic vein was involved in 23 (77%) patients. Two hepatic veins were obstructed in 12 (38%) patients, and all three in 4 (12%). Intra hepatic collaterals were observed in 66% of the patients, mostly between segments 3/4b and 5/4b. Sub-capsular collaterals were observed in 31% of the patients. A right inferior hepatic vein was present in 25% of the patients. Patients with right hepatic vein compression and with an accessory right hepatic vein developed less collateral pathways than patients without (3/7 (43%) vs. 15/16 (94%), p = 0.017). Caudate veins were never observed. There was a significant increase in blood losses (700 mL vs 500 mL, p = 0.0096) and transfusion requirements (transfusion rate 56% versus 13%, p < 0.0001), whereas there was no difference regarding pedicular clamping and operative time. Inferior vena cava clamping was necessary in 11 patients (34%). Conclusions: The development of collateral pathways depends on the type and number of hepatic veins involved and of pre-existing accessory veins. The presence of collateral veins increases blood losses and transfusion rate during liver resection.

Susceptibility-Weighted Imaging of the Anatomic Variation of Thalamostriate Vein and Its Tributaries.

Background and PurposeThalamostriate vein (TSV) is an important tributary of the internal cerebral vein, which mainly drains the basal ganglia and deep medulla. The purpose of this study was to explore the anatomic variation and quality of TSV and its smaller tributaries using susceptibility-weighted imaging (SWI).MethodsWe acquired SWI images in 40 volunteers on a 3.0T MR system using an 8-channel high-resolution phased array coil. The frequencies of the TSV and its tributaries were evaluated. We classified TSV into types I (forming a venous angle) and II (forming a false venous angle). We classified anterior caudate vein (ACV)into types 1 (1 trunk) and 2 (2 trunks) as well as into types A (joiningTSV), B (joining anterior septal vein), and C (joining the angle of both veins).ResultsThe TSV drains the areas of caudate nucleus, internal capsule,lentiform nucleus, external capsule, claustrum, extreme capsule and the white matter of the frontoparietal lobes,except thalamus. The frequencies of the TSV, ACV and transverse caudate vein (ACV) were 92.5%, 87.5% and 63.8%, respectively. We found TSV types I and II in 79.7%, and 20.3% with significantly different constitution ratios (P< 0.05). The most common types of ACV were type 1 (90.0%) and type A (64.3%).ConclusionThe complex three-dimensional (3D) venous architecture of TSV and its small tributaries manifests great variation, with significant and practical implications for neurosurgery.

Vascular changes caused by deep brain stimulation using double-dose gadolinium-enhanced brain MRI.

We retrospectively analyzed the clinical data of 32 patients with medically intractable idiopathic Parkinson's disease who had undergone staged bilateral deep brain stimulation of the subthalamic nuclei from January 2007 to May 2011. The vascularture of the patients who received two deep brain stimulations was detected using double-dose gadolinium-enhanced brain MRI. The dimensions of straight sinus, superior sagittal sinus, ipsilateral internal cerebral vein in the thalamic branch and ipsilateral anterior caudate vein were reduced. These findings demonstrate that bilateral deep brain stimulation of the subthalamic nuclei affects cerebral venous blood flow.

PTU-083 Caudate lobe resection for colorectal liver metastases: a matched pair analysis

IntroductionTumours located in the caudate lobe can be challenging due to the anatomical relation of segment I with the inferior vena cava (IVC), the presence of multiple small caudate veins,...

Anatomy of the retrohepatic segment of the inferior vena cava and the ostia venae hepaticae with its clinical significance

The present study was undertaken to provide morphological data regarding the retrohepatic segment of the inferior vena cava (RHIVC) and ostia venae hepaticae with an emphasis on the clinical significance of the observations made. This was an observational study conducted on 160 apparently healthy, randomly selected, cadaveric adult human livers fixed in 10% formalin. The distribution of the hepatic venous openings was studied by dividing the interior of the RHIVC into 16 quadrants. These openings were classified as large, medium, small and very small openings based on their diameter and were also classified as single/double/triple/quadruple according to the number of veins opening into them. The median length of RHIVC was 7.3 cm (6.2-8.4) and was directed obliquely with respect to the vertical axis of the liver in 92.5% of cases. A total of 1,376 ostia venae hepaticae were observed, and the median number of openings per liver was 7 (5-9). The right hepatic vein had a single opening in 156 (97.5%) and the left and middle hepatic veins had a common opening in 144 (90%) cases. A longitudinal area on the anterior wall of the RHIVC, to the right side of the midline, was relatively avascular with 10.1% of the venous openings, of which 70% were single openings of the right dorsal vein having a small diameter (0.1-0.5 cm). During liver hanging maneuver, rightward direction of the dissecting forceps would avoid injury to the caudate vein and allow access to the safe avascular space in the RHIVC.

Morphometric analysis of caudate veins for advanced liver surgery

BackgroundAccurate knowledge of the surgical anatomy of the caudate lobe is indispensable in the performance of liver surgery. Although previous cast studies have provided much useful overall information about the locations of the caudate veins, little is known about how to establish the exact locations of the caudate and short hepatic veins prior to surgery. ObjectivesThis study was conducted as a practical morphometric analysis of the caudate veins using preoperative enhanced computed tomography (CT) and intraoperative ultrasound (IOUS). MethodsFrom July 2003 to October 2005, 116 donor hepatectomies were performed for adult living donor liver transplantation. The numbers and locations of visible caudate veins were examined pre- and intraoperatively using CT and IOUS. ResultsIn the 116 patients, a total of 152 caudate veins were detected, which were classified as being of either typical (n= 135) or non-typical (n= 17) type. One caudate vein was detectable in 83 patients (72%), two in 30 patients (26%) and three in three patients (3%). A total of 67% of caudate veins detected by IOUS and 70% detected by CT were located on the ventral 60° of the inferior vena cava (IVC). The remaining veins were scattered on both lateral sides. ConclusionsPreoperative CT and IOUS were useful in providing morphometric information of sizable caudate veins. Precise information on these veins is essential for the safe dissection of the caudate lobe from the IVC in advanced liver surgery.

Fetal development of the retrohepatic inferior vena cava and accessory hepatic veins: Re‐evaluation of the Alexander Barry's hypothesis

The retrohepatic inferior vena cava (IVC) is commonly considered to originate from the right vitelline or omphalomesenteric vein. In contrast, Alexander Barry hypothesized that one of the hepatic veins grows to merge with the subcardinal vein and develops into the retrohepatic IVC. We re-examined fetal development of the retrohepatic IVC and other related veins using serial histological sections of 20 human fetuses between 6 and 16 weeks of gestation. At 6-7 weeks, when a basic configuration of the portal-hepatic vein systems had just been established, one of hepatic veins (i.e., the posterocaudal vein in the present study) had grown caudally to reach the posterocaudal surface of the liver, and notably, extended into the primitive right adrenal gland (five of the eight early-staged fetuses). Because the inferior right hepatic vein (IRHV) and retrohepatic IVC appeared at the same developmental stage, it is likely that any peripheral remnants of the posterocaudal vein would continue to function as primary drainage territory for the IRHV. The caudate vein developed rapidly in accordance with marked caudal and leftward extension of Spiegel's lobe at 12-16 weeks. Thin accessory hepatic veins developed later than the caudate vein and IRHV. The present results supported Barry's hypothesis.

Hepatic caudate vein in Budd-Chiari syndrome: Depiction by using magnetic resonance imaging

To study the visibility of the caudate vein and its diameter on MR imaging in healthy people and in patients with Budd-Chiari syndrome. In this study there were 14 patients with Budd-Chiari syndrome and 54 healthy subjects without hepatic lesion or liver disease, all of whom had upper abdominal enhanced MRI. The visibility of the caudate vein and its diameter on MR images was compared between Budd-Chiari patients and healthy subjects, and among Budd-Chiari patients, the correlation between the visibility of caudate vein and extrahepatic collaterals were compared. Caudate vein was noted in 64% of patients with Budd-Chiari syndrome and in 7% of healthy subjects (P=0.000). The diameter of the caudate vein visualized on MR imaging in Budd-Chiari syndrome was significantly larger than that in healthy group (7.3±3.9 mm vs 2.6±0.6 mm, P=0.037). Among Budd-Chiari patients, both caudate vein and extrahepatic collateral veins were noted in 9 patients, only extrahepatic collateral veins were noted in 4 patients and neither caudate vein nor extrahepatic collateral veins were noted in 1 patient. No correlation was found between the visibility of caudate vein and that of extrahepatic collateral vein in patients with Budd-Chiari (P=0.375). Gadolinium enhanced dynamic MR imaging can visualize hepatic caudate vein frequently. The visibility and dilation of hepatic caudate veins on MR imaging in Budd-Chiari syndrome were more frequent than in control subjects. MR depiction of a caudate vein may help differentiate Budd-Chiari from cirrhosis.

Left-to-right approach facilitates total hepatectomy with caval flow preservation

Left-to-right approach facilitates total hepatectomy with caval flow preservation

Anatomical Basis of Liver Hanging Maneuver: A Clinical and Anatomical in Vivo Study

Liver Hanging Maneuver (LHM) provides better exposure of the deeper section plane together with Inferior Vena Cava (IVC) protection during right hepatectomies without primary liver mobilization. This study assessed the feasibility and complication rates of LHM focusing on the anatomical distribution of the accessory hepatic veins in the retrohepatic portion of the IVC. From January 2002 to December 2005, LHM was planned in 49 consecutive major hepatectomies. The IVC retrohepatic portion was studied during the anhepatic phase in 17 liver transplantations with IVC preservation. The diameter and location of the vein openings were recorded after IVC division into nine portions. LHM was achieved in 47/49 patients (96%). Bleeding occurred in only one patient (2%) and did not entail procedure interruption. The anatomical study revealed a total of 86 veins present in 17 cases (5.18 +/- 4 per patient) and classified them according to diameter (<3, 3 to 6, and >6 mm), as small (n=40), medium (n=29), and large (n=17), respectively. Nine openings were found in the avascular channel for 6/17 (35%) patients (small n=6, medium n=3, large n=0). LHM is a highly feasible procedure with minor bleeding risks due to the lower density and small diameter of short hepatic veins and caudate veins present in the avascular channel.

Sonography of Budd-Chiari Syndrome

The purpose of this pictorial essay is to review the color Doppler sonographic features of Budd-Chari syndrome. Combining color and spectral data, sonography provides hemodynamic and anatomic information about vessel patency and collateral vessel formation. The diagnosis of Budd-Chari syndrome is based on the involvement of hepatic veins although intrahepatic collateral circulation and dilated caudate veins are also important and frequent signs. Half of the patients will develop regenerative nodules that can simulate hepatocellular carcinoma.

Intermittent Hepatic Vein–Total Vascular Exclusion During Liver Resection: Anatomic and Clinical Studies

Bleeding from hepatic veins remains a problem during liver surgery. Perceived difficulties in the dissection and isolation of these retrohepatic venous structures have limited the widespread use of hepatic vein control during liver resection. The purpose of this study was to delineate the anatomy of the hepatic veins and to apply this knowledge to a series of patients undergoing liver resection with intermittent hepatic vein-total vascular exclusion (IHV-TVE). A detailed description of the hepatic venous anatomy was formulated using 20 cadaveric dissections in conjunction with anatomic descriptions during 30 hepatectomies. With the benefit of improved anatomic knowledge, we evaluated a series of 45 consecutive major liver resections in which hepatic veins were isolated and the technique of IHV-TVE was applied. The hepatocaval ligament must be divided to isolate the right hepatic vein. It was closely associated with a caudate vein 69% of the time. The hepatic veins were isolated in 45 consecutive patients who underwent a major hepatic resection. The portal triad and the hepatic veins were occluded intermittently (20 minutes with 5 minutes of reperfusion) with Rommel tourniquets. Mean total warm ischemic time was 65 +/- 24.5 minutes. Mean estimated blood loss was 864 +/- 514 ml. Eighteen percent of patients required blood transfusions. Complications were identified in 16 patients (35.5%), and the average length of hospital stay was 10.5 +/- 3.4 days. There were no deaths. Detailed anatomic knowledge of the hepatocaval ligament and the hepatic veins allows for safe extrahepatic control of the hepatic veins during major hepatic surgery. The technique was well tolerated and may have limited intraoperative blood loss.

Anatomy of the portal branches and the hepatic veins in the caudate lobe of the liver.

The objective of this study was to analyze the caudate portal branches and their relationships with the hepatic caudate veins and propose a new nomenclature for the caudate branches based on their territory of distribution. We realized the fine dissection of the veins of the caudate lobe in 40 human livers fixed and preserved in formalin. In 15/40 (37.5%) cases there was a single branch to the caudate lobe. In 25/40 (62.5%) cases there was more than one branch, with a posterior caudate branch in 20/40 (50%) cases, an anterior caudate branch in 15/40 (37.5%) cases, a left caudate branch in 14/40 (35%) cases, and a right caudate branch in 8/40 (20%) cases. The most frequent combination detected (11/40, 27.5% of cases) was that of the posterior and anterior branches. The venous drainage of the caudate lobe and its papillary process was provided by the superior caudate hepatic vein in 23/40 (57.5%) cases, by the middle caudate vein in 35/40 (87.5%) cases (which was the only vein in 12/35 cases), and by the inferior caudate vein in 16/40 (40%) cases. In 11/40 (12.5%) cases there were accessory caudate veins, which emptied into the left and intermediate hepatic veins. The portal branches and the hepatic veins related to the caudate process were studied. In conclusion, the new nomenclature analyzes more precisely the distribution of the caudate portal branches.

How should we treat short hepatic veins and paracaval branches in anterior hepatectomy using the hanging maneuver without mobilization of the liver? An anatomical and experimental study.

This study investigates the relevant anatomy for applying the hanging maneuver to hepatectomy by an anterior approach, where liver mobilization is not possible. Using 176 cadaveric livers, we morphometrically investigated the distribution of venous openings within the retrohepatic portion of the inferior vena cava (IVC); next, we conducted a series of experiments to identify which course for insertion of a pair of forceps preserved the thickest of these veins. After anterior dissection of the liver, we carried out an anterior incision along a plane within an area free of venous openings in the IVC. The area free of venous openings was between the thickest caudate vein and the inferior right hepatic vein (IRHV), and averaged 16.2 mm in width. When forceps were inserted along the rightward course connecting the right inferior angle of the right lobe and the same pocket-like space between the terminals of the middle and right hepatic veins, the caudate vein was very likely to be preserved, whereas the IRHV was not. In contrast, the leftward course connecting the gallbladder fossa and the pocket-like space provided an almost opposite incidence of damage. The portal territory of the hilar bifurcation was most likely to be damaged during a virtual incision along an avascular plane; however, the caudate branch of left portal origin was rarely damaged. The rightward course may be the best method for forceps insertion in cases where there is no IRHV. To preserve the caudate vein and the IRHV, taping on the right side of the IRHV and retracting to the right, or changing the direction of the forceps from leftward to rightward when the tip of the forceps is anterior to the IVC is recommended. The hanging maneuver by an anterior approach without mobilization is convenient for right or left hepatectomy for large tumors or hardened liver.

An anatomical study of short hepatic veins, with special reference to delineation of the caudate lobe for hanging maneuver of the liver without the usual mobilization.

The present study was designed to anatomically assess a very recently reported hanging maneuver of the liver without mobilization, in which forceps are inserted blindly between the inferior vena cava (IVC) and liver parenchyma. We dissected 56 formalin-fixed livers (1) to determine whether preservation of the caudate vein (the largest vein draining Spiegel's lobe) and inferior right hepatic vein (IRHV) was possible and (2) to identify the territories drained by other, non-preserved short hepatic veins. A potential space for insertion of the forceps was found between the openings of the caudate vein and IRHV; however, if preservation of both veins is absolutely necessary, we recommended protecting the IRHV, such as by taping and retracting it. We classified the other short hepatic veins into two categories, i.e., those draining the left portal vein territory and those draining the right territory. The distributions of the openings of the veins in these territories overlapped. Clear delineation of the left caudate lobe according to the drainage veins appeared to be difficult when the liver was divided along a straight line in front of the IVC.

High dorsal drainage routes of Spiegel's lobe.

The venous drainage from Spiegel's lobe to the terminal portion of the hepatic veins has been described in the literature, but its morphology remains unclear. We examined 42 dissected liver specimens and 38 cast specimens. In 8 of the 42 dissected liver specimens and 5 of the 38 cast specimens we found atypical but thick (over 3 mm) caudate veins that drained Spiegel's lobe and emptied into the terminal portion (along the most proximal 5-mm course) of the middle hepatic vein (MHV) or the inferior vena cava (IVC) near the MHV terminal (less than 10 mm from the MHV). We termed these the superior caudate vein. This vein ran upward between the caudate portal branches of the left and hilar bifurcation origins or through the territory of the left origin. The superior caudate vein, consistently coexisted with the typical vein(s). We also found several analogues of the superior caudate vein, such as the cranially shifted opening of the typical caudate vein and relatively thick proximal tributaries of the MHV from Spiegel's lobe. Although the superior caudate vein, if present, seemed to have a large role in the venous drainage of the lobe, its incidence seemed to be too low for clinical relevance.