Posterior Vein Research Articles

Microvascular anatomy of the medial temporal region.

The authors investigated the microvascular anatomy of the hippocampus and its implications for medial temporal tumor surgery. They aimed to reveal the anatomical variability of the arterial supply and venous drainage of the hippocampus, emphasizing its clinical implications for the removal of associated tumors. Forty-seven silicon-injected cerebral hemispheres were examined using microscopy. The origin, course, irrigation territory, spatial relationships, and anastomosis of the hippocampal arteries and veins were investigated. Illustrative cases of hippocampectomy for medial temporal tumor surgery are also provided. The hippocampal arteries can be divided into 3 segments, the anterior (AHA), middle (MHA), and posterior (PHA) hippocampal artery complexes, which correspond to irrigation of the hippocampal head, body, and tail, respectively. The uncal hippocampal and anterior hippocampal-parahippocampal arteries contribute to the AHA complex, the posterior hippocampal-parahippocampal arteries serve as the MHA complex, and the PHA and splenial artery compose the PHA complex. Rich anastomoses between hippocampal arteries were observed, and in 11 (23%) hemispheres, anastomoses between each segment formed a complete vascular arcade at the hippocampal sulcus. Three veins were involved in hippocampal drainage-the anterior hippocampal, anterior longitudinal hippocampal, and posterior longitudinal hippocampal veins-which drain the hippocampal head, body, and tail, respectively, into the basal and internal cerebral veins. An understanding of the vascular variability and network of the hippocampus is essential for medial temporal tumor surgery via anterior temporal lobectomy with amygdalohippocampectomy and transsylvian selective amygdalohippocampectomy. Stereotactic procedures in this region should also consider the anatomy of the vascular arcade at the hippocampal sulcus.

Evaluation of anomalies of major veins of the superficial venous system of lower limb in adults on color doppler: An observational study.

To evaluate the incidence of anomalies in the superficial venous system in lower limb. Triplex ultrasonography in clinically suspected cases of acute or chronic venous disease or congenital malformation was performed on 3189 lower limbs in 2000 patients (bilateral in 1189 and unilateral in 811) from Jan 2020 to Dec 2020. (1) Anomalies of great saphenous vein were observed in 496 cases (15.5%), (2) Anomalies of short saphenous vein were observed in 760 cases (23.8%), (3) Anomalies of accessory saphenous veins were seen in 984 (30.88%), 1501 (47%), 1068 (33.5%) and 774 (24.25%) corresponding to the anterior, posterior, lateral systems and posterior accessory vein of leg, respectively. Anomalies of the superficial venous system in lower limb are very common and must be reported in every doppler study. These anomalous veins may be the cause for residual or recurrent disease in chronic venous insufficiency, which warrants further research.

Difference between type 2 gastroesophageal varices and isolated fundic varices in clinical profiles and portosystemic collaterals.

BACKGROUNDThere is significant heterogeneity between gastroesophageal varices (GOV2) and isolated gastric varices (IGV1). The data on the difference between GOV2 and IGV1 are limited.AIMTo determine the etiology, clinical profiles, endoscopic findings, imaging signs, portosystemic collaterals in patients with GOV2 and IGV1. METHODS Medical records of 252 patients with gastric fundal varices were retrospectively collected, and computed tomography images were analyzed.RESULTSSignificant differences in routine blood examination, Child–Pugh classification and MELD scores were found between GOV2 and IGV1. The incidence of peptic ulcers in patients with IGV1 (26.55%) was higher than that of GOV2 (11.01%), while portal hypertensive gastropathy was more commonly found in patients with GOV2 (22.02%) than in those with IGV1 (3.54%). Typical radiological signs of cirrhotic liver were more commonly observed in patients with GOV2 than in those with IGV1. In patients with GOV2, the main afferent vessels were via the left gastric vein (LGV) (97.94%) and short gastric vein (SGV) (39.18%). In patients with IGV1, the main afferent vessels were via the LGV (75.61%), SGV (63.41%) and posterior gastric vein (PGV) (43.90%). In IGV1 patients with pancreatic diseases, spleno-gastromental-superior mesenteric shunt (48.15%) was a major collateral vessel. In patients with fundic varices, the sizes of gastric/esophageal varices were positively correlated with afferent vessels (LGVs and PGVs) and efferent vessels (gastrorenal shunts). The size of the esophageal varices was negatively correlated with gastrorenal shunts in GOV2 patients. CONCLUSIONSignificant heterogeneity in the etiology and vascular changes between GOV2 and IGV1 is useful in making therapeutic decisions.

Distribution of atrial low voltage induced by vein of Marshall ethanol infusion.

Systematic and quantitative descriptions of vein of Marshall (VOM)-induced tissue ablation are lacking. We sought to characterize the distribution of low voltage observed in the left atrium (LA) after VOM ethanol infusion. The distribution of ethanol-induced low voltage was evaluated by comparing high-density maps performed before and after VOM ethanol infusion in 114 patients referred for atrial fibrillation ablation. The two most frequently impacted segments were the inferior portion of the ridge (82.5%) and the first half of the mitral isthmus (pulmonary vein side) (92.1%). Low-voltage absence in these typical areas resulted from inadvertent ethanol infusion in the left atrial appendage vein (n = 3), initial VOM dissection (n = 3), or a "no branches" VOM morphology (n = 1). Visible anastomosis of the VOM with roof or posterior veins more frequently resulted in low-voltage extension beyond typical areas, toward the entire left antrum (19.0% vs. 1.9%, p = .0045) or the posterior LA (39.7% vs. 3.8%, p < .001) but with a limited positive predictive value ranging from 29.4% to 43.5%. Ethanol-induced low voltage covered a median LA surface of 3.6% (1.9%-5.0%) and did not exceed 8% of the LA surface in 90% of patients. VOM ethanol infusion typically locates at the inferior ridge and the adjacent half of the mitral isthmus. Low-voltage extensions can be anticipated but not guaranteed by the presence of visible anastomosis of the VOM with roof or posterior veins.

Laparoscopic right hemihepatectomy following a novel optimized portal vein embolization: a video case report

BackgroundThis article is the first report of laparoscopic major hepatectomy of Hepatocellular carcinoma (HCC) following optimized portal vein embolization (oPVE).Case presentationThe patient was diagnosed with a single 3 × 3.5 cm HCC located in segment 5 and 8 detected by enhanced computed tomography and magnetic resonance imaging. The lesion was adjacent to the right anterior and posterior portal veins, making it difficult to confirm the adequate liver functional remnant volume, surgical margin and R0 resection. In addition, the liver cirrhosis induced by a long history of chronic hepatitis B virus increased the potential risk of postoperative liver failure and refractory ascites. Therefore, we conducted a laparoscopic surgery following oPVE, by which the safe tumor margin was ensured and the outcome of the surgery was improved. The patient was discharged on the seventh day after the surgery. The AFP gradually decreased to a normal level during the 90-day follow-up.ConclusionThis case report demonstrates that, in experienced hands for selected patients, laparoscopic hepatectomy after portal vein embolization is feasible and may be an alternative to open liver resection.

Evaluation of renal vascular variations with computed tomography

BackgroundIt is important to know the renal vascular variations before renal surgeries and invasive procedures. The aim of this study is to evaluate the prevalence and types of variation of renal arteries and veins.MethodsThe abdominal CT images of 460 patients, taken between 2019 and 2021, were retrospectively analyzed in axial and coronal planes. The presence and number of accessory renal arteries and early branching in the main renal artery were evaluated. Then, bilateral renal vein variations were investigated. Finally, the compression of the left renal vein by different anatomical structures was evaluated.ResultsOf the 450 patients included in the study, the mean age was 53 years. No variations were detected in 378 renal arteries on the right side (84%) and 392 renal arteries on the left side (87.1%). The most common variation in renal arteries was an accessory inferior hilar artery in 7.5% and 6% rates on the right and left, respectively. An accessory inferior renal polar artery was observed at an overall rate of 1.3%. An accessory superior renal hilar artery was found at 3.3% and 2% rates on the left and the right, respectively. An accessory superior renal polar artery was found at an overall rate of 3.5%. Multiple variations in the renal arteries were observed at a rate of 6.4%. Early branching was observed at a rate of 4.9% on the right and 2.2% on the left. The presence of two and three right renal veins was observed at rates of 13.1% and 0.6%, respectively. Retroaortic and circumaortic left renal veins were found at 3.5% and 4.4% rates, respectively. The compression on the anterior and posterior left renal veins was observed at 4.6% and 0.9% rates, respectively.ConclusionConsidering that variations in renal arteries and veins are too many and of different types to underestimate, a CT examination for the renal vascular anatomy before and at the planning phase of renal surgery or interventional procedures will be of great benefit to avoid potential complications.

VARIANT OF FETAL TOPOGRAPHY OF THE JUGULAR VEINS

An atypical case of the topography of the left external jugular vein and some extracranial tributaries of the left internal jugular vein in a 7-month-old human fetus is presented. The left external jugular vein is formed by two tributaries: the anterior (submandibular vein) and the posterior (posterior auricular vein), it fl ows into the left subclavian vein. The confl uence of the left lateral saphenous vein into the left external jugular vein, the absence of the left anterior jugular and occipital veins, and the absence of the anastomosis of the mandibular and the deep facial vein were found. The described case of the fetal topography of the left jugular veins will be of interest to both morphologists and fetal surgeons.

Neurovascular Anatomic Locations and Surgical Safe Zones When Approaching the Posterior Glenoid and Scapula: A Quantitative and Qualitative Cadaveric Anatomy Study

PurposeTo characterize the qualitative anatomy of posterior scapula structures encountered with the Judet approach and to perform a quantitative evaluation of these structures’ anatomic locations, including their relationships to osseus landmarks to identify safe zones.MethodsTwelve fresh-frozen cadaveric shoulders (mean age, 55.2 years; range 41-64 years; 5 left, 7 right) were dissected. A coordinate measuring machine was used to collect the coordinates of anatomic landmarks, structures at risk during surgical approach to the posterior scapula, and the footprints of muscle attachments on the posterior scapula. These coordinates were analyzed for their relationships with clinically relevant anatomy.ResultsThe suprascapular nerve was a mean of 20.3 mm (18.9-21.7 mm) medial to the glenoid 9-o’clock position. The posterior circumflex artery and vein were a mean of 100.0 mm (92.2-107.7 mm) lateral to along the lateral border of the scapula from the inferior angle of the scapula and a mean of 41 mm (34.2-47.9 mm) medial along the lateral scapular border from the 6-o’clock position on the glenoid rim. The long head of the triceps covers a mean of 132 mm2, and it was found to be contiguous with the glenoid capsule at the 6-o’clock position.ConclusionsA safe zone exists 19 mm medially from the glenoid 9-o’clock position to the suprascapular nerve and a minimum of 34.2 mm medially along the lateral scapular border from the glenoid 6 o’clock to the posterior circumflex scapular artery.Clinical RelevanceThe modified Judet approach is a minimally invasive surgery that reduces surgical trauma but necessitates precise knowledge of scapular neurovascular anatomy. Surgeons should be aware of these intervals to help avoid these structures when working near the posterior shoulder. This study may allow us to define neurovascular safe zones when this approach is used.

Right top pulmonary vein is a venous anomaly of which surgeons should be aware in subcarinal dissection for thoracoscopic esophagectomy: a case report and literature review

BackgroundA right top pulmonary vein (RTPV) that crosses behind the right main or intermediate bronchus is a variation of the superior posterior pulmonary vein in the right upper lobe. Damage or ligation of this abnormal vessel can lead to massive intraoperative bleeding and serious complications, such as congestion of the posterior segment of the right upper lobe and cardiac tamponade. Subcarinal lymph node dissection is mandatory in radical thoracoscopic esophagectomy for esophageal cancer, and the RTPV is an anomalous vessel of which thoracic surgeons should be aware.Case presentationA 70-year-old man underwent thoracoscopic esophagectomy for esophageal cancer (T3N1M0). An anomaly of the superior posterior pulmonary vein in the right lobe was recognized on preoperative computed tomography imaging. With simulation and intraoperative navigation using three-dimensional imaging of the same view as that observed during the operation, radical subcarinal dissection could be performed with preservation of the RTPV.ConclusionIn our review of the relevant literature, the incidence of RTPV ranged from 0.28 to 9.3%, and its mean vascular diameter was 7.0 mm at the maximum and 2.2 ± 0.72 mm at the minimum, with the right superior pulmonary vein being a relatively common inflow site. Our case in which the RTPV ran dorsal to the right main bronchus is very rare. In radical subcarinal dissection of thoracoscopic esophagectomy, it is important to recognize the posterior pericardial plane and release the ventral fixation of these lymph nodes to free space for the back side. This is also true in the case of RTPV, which should be noted to avoid injury. In cases involving an RTPV larger than 4.5 mm, ligation should be avoided, and preoperative recognition of the exact run of this abnormal vessel using three-dimensional imaging can be very useful.

β-Cyclodextrin and Oligoarginine Peptide-Based Dendrimer-Entrapped Gold Nanoparticles for Improving Drug Delivery to the Inner Ear.

Here, we developed a safe and highly effective nanocarrier using β-cyclodextrin (β-CD) and oligoarginine peptide (Arg8)-modified dendrimer-entrapped gold nanoparticles (Au@CD-PAMAM-Arg8), with a diameter of 5 nm, for improved delivery of dexamethasone (Dex) to the inner ear. The properties and in vivo distribution of the Au@CD-PAMAM-Arg8 were assessed in vitro, and a streptomycin (SM) ototoxicity model was used in vivo. Flow cytometry analysis of HEIOC1 cells treated with Au@CD-PAMAM-Arg8 and Au @CD-PAMAM at different time intervals indicated that cell uptake efficiency of the drug delivery carrier Au@CD-PAMAM-Arg8 was higher than that of Au @CD-PAMAM. Au@CD-PAMAM-Arg8 carrying Dex (Au@CD-PAMAM-Arg8/Dex) were mainly distributed in hair cells, the spiral ganglion, lateral wall, and nerve fibers and had stronger protective effects on the inner ear than Dex administration alone. In vivo tracer tests revealed that tympanic injection was significantly more effective than posterior ear injection, muscle injection, and tail vein injection, whereas clinical retro-auricular injection could not increase the efficiency of drug delivery into the ear. Electrocochleography results showed that Au@CD-PAMAM-Arg8/Dex significantly improved hearing in C57/BL6 mice after SM exposure. These findings indicate that Au@CD-PAMAM-Arg8 may be the useful drug carriers for the treatment of inner ear diseases.

Boyden's triad in the left lung: an interesting phenomenon.

Boyden's triad of the right lung was first proposed in 2021. Here, we report 5 cases of this malformation found in the left lung. A total of 5280 patients with pulmonary lesions underwent three-dimensional computed tomography bronchography and angiography between January 2019 and January 2021, prior to surgery; 5 cases of this malformation were identified in the left lung. Bronchovascular patterns were analysed in each patient. The incidence rate of Boyden's triad in the left lung was 0.1%. This malformation was further divided into B3 on B4+5 type and B3 on B4 type. In B3 on B4+5 type, B3 was shifted downwards on the common trunk of B4+5, and A3 arose from the common trunk of A4+5 running alongside B3. In B3 on B4 type, B3 was shifted downwards on B4. A4 and A5 appeared separately. A3 arose from A4, running alongside B3; A5 arose from the common trunk of A8 - 10, and there was also an extraordinary 'posterior vein' (V. post): V1+2c. The incidence of V. post was 0.17%. An additional 'fissure' lies longitudinally between S1+2 and S3+4+5, nearly perpendicular to the oblique fissure, dividing the upper lobe into 'two lobes'. The B3 downwards-shifting malformation can be found on both lungs, and this is the first description of Boyden's triad in the left lung; it appears to be much rarer than that in the right lung, with some accompanying unique variations.

Unusual Course of Posterior Intercostal Vein at the 3rd Intercostal Space – A Case Report

The posterior intercostal veins drain the thoracic wall and lie in the costal grooves along with the intercostal arteries and nerves posterior to the thoracic sympathetic chain. During routine dissection of the posterior mediastinum of a formalin-fixed male cadaver in the Anatomy department of an undergraduate and postgraduate teaching medical college in India, a large-sized posterior intercostal vein was identified crossing anterior to the thoracic sympathetic chain at the level of the 3rd intercostal space on the right side. The presence of such variation may hinder the surgical procedure of the posterior mediastinum and will pose an increased risk of intraoperative or postoperative bleeding. Knowledge of such variation is necessary to avoid laceration of the posterior intercostal vein, which is the potential cause of bleeding in the region of the thorax.

A new coccoid family (Hemiptera: Coccomorpha) for an unusual species of scale insect on Podocarpus macrophyllus (Podocarpaceae) from southern China.

A new family, Qinococcidae Wu, fam. n., is established for the species Qinococcus podocarpus gen. n. and sp. n., collected from southern China under the bark of Podocarpus macrophyllus (Podocarpaceae). The adult female and male, egg, and all immature instars including the male pupa of Q. podocarpus sp. n. are described and illustrated. The new family is diagnosed mainly on the adult male possessing an inverted -like post-tergite and unusual venation of the fore wing, with a pterostigma, posterior cubital vein and bifurcate anterior flexing patch. A key to all the developmental stages is provided.

Idiopathic Ventricular Arrhythmias Originating from Different Portions of the Coronary Venous System: Prevalence, Electrocardiographic Characteristics, Catheter Ablation, and Complications.

(1) Background: To determine the prevalence, electrocardiographic characteristics, mapping, and ablation of IVAs arising from the CVS. (2) Methods: Detailed activation and pace mapping of the CVS IVAs was performed before attempted radiofrequency ablation (RFCA). (3) Results: The IVAs originating from the vicinity of the CVS represented approximately 5.27% (164/3113) of all IVAs; 94.51% (155/164) cases were accessed at the earliest identified site and 83.54% (137/164) IVAs were successfully ablated. The main coronary vein group had a relatively short procedure time, short fluoroscopy time, fewer radiofrequency lesions prior to success, and less Swartz sheath support. IVAs originating from the CVS had distinct ECG characteristics: Rs, RS or rS (with s or S) wave in lead V1 indicate the Vas arising from the proximal portion of the anterior interventricular vein (AIV) and summit-CV; Rs (with s or S) wave in leads V5–V6 indicate the Vas arising from the adjacent regions of the distal great cardiac vein 1 (DGCV1); positive wave (R, Rs or r) In lead I indicate the VAs ori”inat’ng from Summit-CV and posterior wall subgroup (including middle cardiac vein [MCV], posterior lateral vein [PLV], coronary sinus [CS]). Compared with the IVAs originating from the endocardial mitral annulus, a PdW > 45 ms, an IDT > 74 ms, and an MDI > 0.50 indicate a CVS origin of the IVAs. The common peri-procedure complications were CV dissection (6.45%, 10/155), CV rupture (1.29%, 2/155), coronary artery spasm (1.29%, 2/155), coronary artery stenosis (0.65%, 1/155), pericardial effusion (0.65%, 1/155) and tamponade (1.29%, 2/155). Stenosis of coronary arteries was not observed at the adjacent ablation site in the CVS during follow-up. (4) Conclusions: vAs arising from the CVS are not a rare phenomenon. Several ECG and procedure characteristics could help regionalize, map, and ablate the origin of IVAs from different portions of the CVS. RFCA within the CVS was relatively effective and safe.

Demonstration of the right-side boundary of the caudate lobe in a liver cast.

There have been historical arguments about the boundary of the caudate lobe of the liver. Kumon M first advocated the definition of the caudate lobe based on the portal segmentation of the liver in 1985, and classified it into three parts, Spiegel lobe, paracaval portion and caudate process. Prof. Couinaud defined the dorsal liver as a union of segments I and IX in 1994, based on the spatial position to the major hepatic veins, hilar plate and inferior vena cava. In Couinaud's classification, right-side of the dorsal liver is supplied by the branches from the posterior and anterior sections. In the present study using a liver cast, we found a paracaval branch of the portal vein branching from the right portal vein on the dissecting plain along the Rex-Cantlie's line. We also found several branches from the posterior portal vein to the right-side of the paracaval portion, but they should be defined to belong to the posterior sections.

Extent of Left Atrial Fibrosis Correlates with Descending Aorta Proximity at 3D Late Gadolinium Enhancement Cardiac MRI in Patients with Atrial Fibrillation.

To determine whether the distance between the descending aorta and left atrial (LA) wall correlates with the amount of fibrosis quantified in the posterior left inferior pulmonary vein (LIPV) area of the LA in patients with atrial fibrillation (AF). In this retrospective study, patients with AF underwent cardiac MRI in sinus rhythm prior to a pulmonary vein isolation procedure (July 2018 to February 2020). The mean distance (distancemean) and shortest distance (distanceshort) between the descending aorta and the LA wall were measured on three-dimensional (3D) contrast-enhanced MR angiograms; distancemean was defined as the average of five measurements at different levels between the descending aorta and the LA wall. The extent of LA fibrosis, both global fibrosis and regional fibrosis within the LIPV area, was derived from postprocessed, 3D, late gadolinium-enhanced images. Associations between the extent of fibrosis and the proximity of the descending aorta were analyzed by using correlative and multivariable analyses. A total of 47 (mean age, 60 years ± 8 [standard deviation]; 31 men) patients were included for analysis. The extent of fibrosis in the posterior LIPV area was correlated with the distancemean (r s = -0.48; P < .01) and distanceshort (r s = -0.49; P < .01). Patients with a short distance between the descending aorta and LA wall (defined as a distanceshort < 2 mm) had a higher percentage of fibrosis in the posterior LIPV area than patients with a distanceshort greater than 2 mm (38.7% ± 22.7 vs 21.2% ± 17.8; P < .01). The distance between the descending aorta and LA was correlated with the extent of quantified fibrosis within the posterior LIPV area.Keywords: MRI, Cardiac, Left Atrium Supplemental material is available for this article. © RSNA, 2022.

Left Gastric Vein Width Is an Important Risk Factor for Exacerbation of Esophageal Varices Post Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Varices in Cirrhotic Patients.

Background and Objectives: Balloon-occluded retrograde transvenous obliteration (BRTO) could be currently one of the best therapies for patients with gastric varices. This study examined the exacerbation rates for esophageal varices following BRTO for gastric varices in patients with hepatic cirrhosis. Materials and Methods: We enrolled 91 cirrhotic patients who underwent BRTO for gastric varices. In total, 50 patients were examined for exacerbation rates of esophageal varices following BRTO. Esophageal varices and their associated exacerbation were evaluated by upper gastrointestinal endoscopy. Patients were allocated into two groups according to the main inflow tract for gastric varices: (1) 37 patients in the left gastric vein (LGV) group with an LGV width of more than 3.55 mm, and (2) 13 patients in the non-LGV group who had short gastric vein or posterior gastric vein. Moreover, treatment outcomes were retrospectively analyzed. Results: LGV width (p < 0.01) was the major risk factor for the deterioration of esophageal varices post BRTO. In addition, LGV was the most common inflow tract, and the LGV group contained 74% (37/50) of patients. The exacerbation rates of esophageal varices at 1, 2, 3, and 4 years post BRTO were 40%, 62%, 65%, and 68%, respectively. The comparison of the exacerbation rates for esophageal varices following BRTO according to inflow tract showed that the exacerbation rates were significantly higher in the LGV group than those of the non-LGV group (p = 0.03). In more than half of the subjects, LGV was the main inflow tract for gastric varices, and this group experienced more frequent exacerbations of esophageal varices following BRTO compared to patients with different inflow tract sources. Conclusion: Careful attention should be paid to the LGV width when BRTO is performed for gastric varices.

Efficacy of Platysmamyocutaneous Flap in Oral Defects.

Clinicians are baffling for reconstruction of small- to medium-sized defects of the oral cavity since time immemorial, each and every flap has its own limitations, ideal flap should be pliable, easily transferrable that can result in a better restoration of form and function of oral mucosa, we have platysma for the same purpose. We aim to provide surgical technique of the superiorly-based platysma myocutaneous flap with a single neck incision in this study, as well as the flap design, results, and complications associated with age, gender, the recipient site, and the size of the defect. Study included 20 patients with oral potentially malignant disorders operated under local anaesthesia with wide local excision and reconstruction with platysma myocutaneous flap at a single tertiary care centre. The association between the variables was calculated using Chi-square tests and paired t tests. P < .05 was considered significant. Five cases of dehiscence were found at varied sites and flap viability was significantly influenced by location of skin paddle. In between anterior jugular vein and posterior external jugular vein it was 100% viable while on and posterior to the vein, had skin paddle loss. Significant improvement in mouth opening was also seen in Oral Sub-mucous Fibrosis patients. The platysma flap is a technique sensitive, and its results are promising for the reconstruction of oral defects.

Morbidity Analysis of Left Hepatic Trisectionectomy for Hepatobiliary Disease and Live Donor

Introduction: Despite remarkable advances in surgical techniques and perioperative management, left hepatic trisectionectomy (LHT) remains a challenging procedure with a somewhat higher postoperative morbidity compared with less-extensive resections. The aims of this study were to analyze the short- and long-term outcomes of LHT and to identify factors associated with postoperative morbidity of this technically demanding surgical procedure. Method: The medical records of 52 patients who underwent LHT between June 2005 and October 2019 at a single institution were retrospectively reviewed. Results: Hepatocellular carcinoma was the most common indication for surgery (n=21), followed by hilar cholangiocarcinoma (n=14), intrahepatic cholangiocarcinoma (n=9), and other pathologies (including colorectal liver metastasis, hepatolithiasis, gallbladder cancer, living donor, hemangioma, and multilocular biliary cyst; n=8). The rates of postoperative morbidities of Clavian-Dindo grade 3 or higher and 90-day mortality were 38.5% and 1.9%, respectively. The overall 1-,3-,and 5-year survival rates were 80.8%, 62.6%, and 45.5%, respectively. Preoperative portal vein embolization (p=0.017), an American Society of Anesthesiologists fitness grade > II (p=0.008), operation time (p=0.014), extent of surgery by concomitant extrahepatic bile duct resection (p=0.043) and lymphadenectomy (p=0.005), and the number of tumors (p=0.012) were independent predictors of postoperative morbidity on multivariable analysis. Conclusions: The success of LHT is dependent on a reliable preoperative evaluation of liver function and the anatomic features of right posterior portal vein variants and hepatic veins toward the posterior sector, active and appropriate preoperative management for obstructive cholangitis and compensatory hypertrophy of the future remnant posterior sector, and the experience of the surgeon.

Anatomical variability of superficial veins of the lower limb in human fetuses

Background. Modern minimally invasive methods have radically changed the clinical landscape of varicose vein surgery and shortened recovery time after surgery. All these changes became possible thanks to the constant deepening of knowledge about the topographical and anatomical features of the great and small saphenous veins in different periods of human ontogenesis. Objective is to find out the topographical and anatomical relationships of the great and small saphenous veins in human fetuses of 4-8 months. Methods. The research was carried out on preparations of the lower extremities of 26 human fetuses of 81.0-310.0 mm parietal-coccygeal length (PCL) without external signs of anatomical deviations or anomalies in the development of bone, fascial-muscular, and vascular-nervous structures of the lower extremities using macromicroscopic preparation, injection of vessels and morphometry. Results. In human fetuses of 4-8 months, the great saphenous vein passes directly under the fascia of the lower leg, partly in the subcutaneous tissue, since the formation of the latter is continuing at this stage of ontogenesis. In the majority of the examined fetuses, a classical version of the topography of the great and small saphenous veins of the right and left lower limbs was observed. In some cases, variability in the number of inflows of superficial veins, additional saphenous veins, and various anastomoses between additional and great and small saphenous veins was revealed. The most interesting, from our point of view, were the anatomical variants of the superficial veins of the lower limb in fetuses of 180.0, 195.0, 220.0, and 265.0 mm PCL. Conclusions. In the fetal stage of human ontogenesis, the anatomical variability of the superficial veins of the lower limbs was established, which is characterized by the variability of the shape, topography, and bilateral asymmetry of the inflows of the great and small saphenous veins and the formation of venous anastomoses. In one case, a left anterior additional saphenous vein was detected, and in two fetuses, a left posterior additional saphenous vein was detected. The coincidence of the topography of the subcutaneous veins of the right and left lower extremities was noted in 87.5% of the fetuses. Significant gender differences in the topography of the large and small subcutaneous veins in human fetuses were not found. The revealed variants of the fetal topography of the great and small saphenous veins are important for the correct interpretation of phlebographic research data and the individual strategy of the most rational method of surgical intervention.