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. 2010 Jun 27;89(12):1518-25.
doi: 10.1097/TP.0b013e3181dd6bac.

Hepatic venous drainage: how much can we learn from imaging studies? Anatomic-functional classification derived from three-dimensional computed tomography reconstructions

Arnold Radtke  1 , Georgios C Sotiropoulos, George Sgourakis, Ernesto P Molmenti, Tobias Schroeder, Fuat H Saner, Susanne Beckebaum, Christoph E Broelsch, Dieter C Broering, Massimo Malago
Affiliations

Hepatic venous drainage: how much can we learn from imaging studies? Anatomic-functional classification derived from three-dimensional computed tomography reconstructions

Arnold Radtke et al. Transplantation. .

Abstract

Background: The knowledge of "venous dominance" is essential to prevent serious venous congestion in live donor liver transplantation and extended liver resections.

Aims: The purpose of our study was to delineate our proposed anatomic-functional classification of hepatic venous drainage.

Methods: One hundred forty consecutive live liver donor candidates underwent three-dimensional computed tomography reconstructions and three-dimensional virtual hepatectomies. Five different venous dominance types were defined on drainage volumes or territories. "Risky" configurations were identified and classified.

Results: The right hepatic vein (RHV) was dominant for the entire liver and right hemiliver (RHH) in most (83.5%) cases irrespective of the presence of inferior (accessory) hepatic veins (IHVs). The middle hepatic vein (MHV) was dominant for the total liver (TL) in 15.5% of cases and for the RHH in 27% of cases. The left hepatic vein was almost always (92%) dominant for the left hemiliver. When associated with a large IHV drainage volume, a RHV/IHV complex dominant for the TL led to a RHH dominant MHV (mean 59.5%RHH) if the IHV was not reconstructed.

Conclusions: Our proposed anatomic-functional classification provides a valuable insight into hepatic vein dominance patterns. RHH venous drainage patterns at "high risk" for venous congestion include (1) a dominant MHV for the TL and (2) a dominant RHV/IHV complex with a large IHV drainage volume.

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