Hepatic Veins

Hepatic-vessel trees are the key structures in the liver. Knowledge of the hepatic-vessel tree is required because it provides information for liver lesion detection in the computer-aided diagnosis (CAD) system. However, hepatic vessels cannot easily be distinguished from other liver tissues in plain CT images. Automated segmentation of hepatic vessels in plain (non-contrast) CT images is a challenging issue. In this paper, an approach to automatic segmentation of hepatic vessels is proposed. The approach consists of two processing steps: enhancement of hepatic vessels and hepatic-vessel extractions. Enhancement of the vessels was performed with two techniques: (1) histogram transformation based on a Gaussian function; (2) multi-scale line filtering based on eigenvalues of a Hessian matrix. After the enhancement of the vessels, candidates of hepatic vessels were extracted by a thresholding method. Small connected regions in the final results were considered as false positives and we...

Survival following major juxtahepatic venous injury is rare in blunt liver trauma despite the use of intracaval shunting. Prolonged liver arterial inflow control, total hepatic venous isolation and lobectomy without shunting was used in a patient to repair a combined vena caval and hepatic venous injury after blunt liver injury. An extended period of normothermic hepatic ischemia was tolerated. Early recognition of retrohepatic venous injury and temporary liver packing to control bleeding and correct hypovolemia are essential before caval occlusion. Hepatic vascular isolation without shunting is an effective simple alternative technique allowing major venous repair in complex liver trauma.

Aneurysms of the inferior vena cava (IVC) include a diverse group of anomalies with distinct anatomic and clinical characteristics. We report a diverticular aneurysm of the suprarenal IVC in a 45-year-old man who presented with extensive IVC and unilateral lower extremity thrombosis. A CT scan revealed an 8 cm smooth-walled mass containing thrombus to the right of the IVC and behind the second portion of the duodenum. At laparotomy a connection between the mass and the suprarenal IVC was established. Biopsy of the wall of the mass revealed vascular smooth muscle, thus establishing the diagnosis of a diverticular IVC aneurysm. MR angiography further disclosed interruption of the infrahepatic vena cava and return of renal vein flow via the azygous and hemiazygous veins. Twelve additional cases of IVC aneurysm are reviewed. A proposed classification of these aneurysms into four types consistent with their anatomic and embryologic characteristics is presented.

In middle hepatic vein dominant livers, the anterior segment of the right lobe of the liver (segments V and VIII) drains mainly into the middle hepatic vein. In these donors, when right lobe grafts are procured without the middle hepatic vein, the graft may harbor large segment V and/or VIII veins that need reconstruction to avoid graft congestion and subsequent graft dysfunction. Draining these middle hepatic vein tributaries using autologous or cryopreserved vessels is a solution, despite the possible difficulties of their preparation. However, these vessels are not always available. Our objective was to evaluate the effectiveness and safety of using a synthetic vascular graft. Between January 2012 and October 2013, eighteen adult recipients underwent living-donor liver transplant using right lobe grafts without the middle hepatic vein at Dar Al Fouad Hospital, 6th of October City, Egypt. All grafts had a large tributary of the middle hepatic vein. Eight-mm ringed expanded polytet...

For hepatic function to be preserved after an extended hemihepatectomy adequate venous drainage of the remaining liver is required. Most metastases close to the confluence of the superior hepatic veins are considered unresectable because hepatic venous outflow after resection would be compromised. In 10-25% of people, the inferior right hepatic vein is of large calibre. Thus the superior hepatic veins may be sacrificed and hepatic function preserved if a large inferior right hepatic vein is present. A patient with involvement of segments 2, 4 and 8 by metastatic colorectal cancer is presented. This patient had a large inferior right hepatic vein, and so was able to undergo an extended left hemihepatectomy with ligation of all superior hepatic veins. Subsequent quality of life was maintained. This case illustrates that an 'unresectable' hepatic lesion can be actually resectable if an alternative venous drainage is present. A pre-operative search for a prominent inferior right...

Doppler interrogation studies of the liver blood flow indicate altered hepatic vein waveforms in association with impaired hepatocellular function. However, little is known about the mechanisms responsible for variations of these parameters in the absence of disease. We aimed to investigate the contribution of heritable and environmental factors to the physiological variability of hepatic vein flow in a twin cohort. Two hundred twenty-eight healthy adult Hungarian twins (69 monozygotic, 45 same-sex dizygotic pairs) underwent Doppler sonography of the hepatic vein. Age- and sex-adjusted heritability of the highest velocity (amplitude of S wave) of hepatic vein flow was negligible. Shared environment contributed to 33% (95% CI, 16%-51%), and unshared environment was responsible for the largest portion (67%; 95% CI, 49%-84%) of the variance. Duration of sports activities was significantly (P < 0.05) related to the magnitude of hepatic vein flow, while other risk factors and lifestyl...

Measurement of fractional lipogenesis by mass isotopomer distribution analysis (MIDA) of fatty acids or cholesterol labeled from [13C]acetate assumes constant enrichment of lipogenic acetyl-CoA in all hepatocytes. This would not be the case if uptake and release of acetate by the liver resulted in transhepatic gradients of acetyl-CoA enrichment. Conscious dogs, prefitted with transhepatic catheters, were infused with glucose and [1,2-13C2]acetate. Stable concentrations and enrichments of acetate were measured in artery (17 μM, 36%), portal vein (61 μM, 5.4%), and hepatic vein (17 μM, 1.0%) and were computed for mixed blood entering the liver (53 μM, 7.4%). We also measured balances of propionate and butyrate across gut and liver. All gut release of propionate and butyrate is taken up by the liver. The threefold decrease in acetate concentration and the sevenfold decrease in acetate enrichment across the liver strongly suggest that the enrichment of lipogenic acetyl-CoA decreases acr...

These studies were conducted to assess the relationship between visceral adipose tissue free fatty acid (FFA) release and splanchnic FFA release. Steady-state splanchnic bed palmitate ([9,10-(3)H]palmitate) kinetics were determined from 14 sampling intervals from eight dogs with chronic indwelling arterial, portal vein, and hepatic vein catheters. We tested a model designed to predict the proportion of FFAs delivered to the liver from visceral fat by use of hepatic vein data. The model predicted that 15 +/- 2% of hepatic palmitate delivery originated from visceral lipolysis, which was greater (P = 0.004) than the 11 +/- 2% actually observed. There was a good relationship (r(2) = 0.63) between the predicted and observed hepatic palmitate delivery values, but the model overestimated visceral FFA release more at lower than at higher palmitate concentrations. The discrepancy could be due to differential uptake of FFAs arriving from the arterial vs. the portal vein or to release of FFAs ...

The purpose of this study was to investigate the correlation between hepatic venous pressure gradient (HVPG) and in vivo viscoelasticity of the liver and spleen before and after transjugular intrahepatic portosystemic shunt (TIPS) implantation. Ten patients with portal hypertension were examined twice by 3-dimensional multifrequency magnetic resonance elastography as well as prior and subsequent TIPS intervention; HVPG was also measured during TIPS placement. Five harmonic vibrations (25-60 Hz) were transferred to the abdominal region and recorded for the reconstruction of 2 viscoelastic constants, |G | and φ, corresponding to the magnitude and the phase angle of the complex shear modulus G of the liver and spleen. All patients had cirrhosis, yielding high |G*| values in the liver (8.34 ± 2.18 kPa) and spleen (8.44 ± 1.36kPa). In both organs, a decrease of |G*| after TIPS placement was observed (liver: 8.34 ± 2.18kPa vs 7.02 ± 1.46 kPa, P = 0.01; spleen: 8.44 ± 1.36 kPa vs 7.06 ± 1....

Hepatic venous outflow obstruction (HVOO) is a critical complication after living donor liver transplantation (LDLT). This study aimed to evaluate the incidence of HVOO and the risk factors for HVOO in adults. From 2005 to 2015, 430 adult LDLT patients (right lobe graft: 270 cases, left lobe graft: 160 cases) were enrolled and divided into no-HVOO (n = 413) and HVOO (n = 17) groups. Patient demographics and surgical data were compared, and risk factors for HVOO were analyzed. Furthermore, the long-term outcomes of percutaneous interventions as treatment for HVOO were assessed. HVOO occurred in 17 patients (4.0%). The incidence of HVOO in patients receiving a left lobe graft was significantly higher than in those receiving a right lobe graft (8.1% vs. 1.5%, p = 0.001). The body weight and caliber of hepatic vein anastomosis in the HVOO group were significantly lower compared with the no-HVOO group (p = 0.02 and 0.008, respectively). Multivariate analysis revealed that only left lobe ...

To investigate middle hepatic vein (MHV) management in adult living donor liver transplantation and safer remnant volumes (RV). There were 59 grafts with and 12 grafts without MHV (including 4 with MHV-5/8 reconstructions). All donors underwent our five-step protocol evaluation containing a preoperative protocol liver biopsy Congestive vs non-congestive RV, remnant-volume-body-weight ratios (RVBWR) and postoperative outcomes were evaluated in 71 right graft living donors. Dominant vs non-dominant MHV anatomy in total liver volume (d-MHV/TLV vs nd-MHV/TLV) was constellated with large/small congestion volumes (CV-index). Small for size (SFS) and non-SFS remnant considerations were based on standard cut-off- RVBWR and RV/TLV. Non-congestive RVBWR was based on non-congestive RV. MHV and non-MHV remnants showed no significant differences in RV, RV/TLV, RVBWR, total bilirubin, or INR. SFS-remnants with RV/TLV < 30% and non-SFS-remnants with RV/TLV ≥ 30% showed no significant difference...

Measurement of fractional lipogenesis by mass isotopomer distribution analysis (MIDA) of fatty acids or cholesterol labeled from [(13)C]acetate assumes constant enrichment of lipogenic acetyl-CoA in all hepatocytes. This would not be the case if uptake and release of acetate by the liver resulted in transhepatic gradients of acetyl-CoA enrichment. Conscious dogs, prefitted with transhepatic catheters, were infused with glucose and [1, 2-(13)C(2)]acetate. Stable concentrations and enrichments of acetate were measured in artery (17 microM, 36%), portal vein (61 microM, 5. 4%), and hepatic vein (17 microM, 1.0%) and were computed for mixed blood entering the liver (53 microM, 7.4%). We also measured balances of propionate and butyrate across gut and liver. All gut release of propionate and butyrate is taken up by the liver. The threefold decrease in acetate concentration and the sevenfold decrease in acetate enrichment across the liver strongly suggest that the enrichment of lipogenic ...

The relationship between the various haemodynamic abnormalities observed in cirrhosis and their prognostic value remains unclear. We report haemodynamic measurements on 96 patients with alcoholic cirrhosis (mean Childs-Pugh Score, CPS, 9.0 +/- 0.2, mean age 55.6 +/- 1.0 years) and assess their value in predicting variceal bleeding and death during a mean follow-up of 19.3 +/- 1.5 months. Baseline CPS correlated with hepatic venous pressure gradient (HVPG) (p = 0.001), azygos blood flow (p < 0.05), cardiac index (p < 0.05), and inversely with mean arterial pressure (p < 0.01) and systemic vascular resistance index (p < 0.05). Renal blood flow was not related to any haemodynamic parameter or CPS. Thirty-eight patients died during follow-up, and 16 had a variceal bleed. Death (p = 0.001) and variceal bleeding (p < 0.05) were more likely in patients with HVPG > 16 mmHg than in those with HVPG < 16 mmHg, and variceal bleeding was more likely in patients with HVPG &gt...

Background—Propranolol and isosorbide-5-mononitrate (ISMN) are increasingly used in the prophylaxis of variceal haemorrhage in cirrhosis. However, recent studies have suggested that these drugs may compromise renal function, possibly by reducing renal blood flow.Aims—To assess the acute effects of propranolol and ISMN on renal blood flow and other haemodynamic parameters in cirrhosis.Patients and methods—Twenty six cirrhotic patients were given either 80 mg propranolol, 20 mg ISMN, or a combination of the two drugs. Unilateral renal blood flow (RBF), azygos blood flow (AZBF), hepatic venous pressure gradient (HVPG), mean arterial pressure (MAP), and heart rate (HR) were recorded prior to and one hour after drug administration.Results—Propranolol caused a reduction in HR (p<0.005), AZBF (p<0.01), and HVPG (p=0.05), but no change in MAP or RBF (454.1 (77.3) versus 413.9 (60.3) ml/min). ISMN reduced MAP (p<0.005) and HVPG (p<0.01), but had no effect on HR, AZBF, or RBF (302...

The purpose of our study was to describe the imaging findings in incidentally discovered intrahepatic portal venous shunts. Intrahepatic portal venous shunts are uncommon hepatic vascular anomalies that are often not associated with manifestations of liver disease or symptoms. They are most often solitary and in the left hepatic lobe. Identification of 25 intrahepatic portal venous shunts at a single institution over 6 years suggests that they may be more common than previously known and that with an increasing use of imaging, they may be identified more often in the future.