scholarly journals Feasibility of Right Upper Transversal Hepatectomy in the Absence of an Inferior Right Hepatic Vein: New Insights regarding This Complex Procedure

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Fabio Ferrari Makdissi ◽  
Jaime Arthur Pirola Kruger ◽  
Vagner Birk Jeismann ◽  
Paulo Herman
Keyword(s):  
Hepatic Vein ◽  
Postoperative Liver Failure ◽  
Hepatic Veins ◽  
Remnant Liver ◽  
Term Survival ◽  
Venous Reconstruction ◽  
Left Hepatic Vein ◽  
Hepatic Recurrence ◽  
The Right ◽  
Right Hepatic Vein

Background. Right upper transversal hepatectomy (RUTH) is defined as the removal of liver segments 7, 8, and 4A with ligature of the right and middle hepatic veins and is considered one of the most complex techniques of parenchymal-sparing hepatectomies. This procedure can be performed, without venous reconstruction, if collateral veins are present communicating within remnant liver segments to a large inferior right hepatic vein and/or to the left hepatic vein. This venous network could maintain outflow from the inferior right segments (S5, S6) to the left liver when a RUTH is performed, even in the absence of an inferior right hepatic vein. The aim of this study is to present our experience with RUTH without venous reconstruction in patients with and without the presence of an inferior right hepatic vein (IRHV). Methods. Patients submitted to RUTH for treatment of liver metastases were selected from our database. The presence of an IRHV, clinical and surgical characteristics of the patients, immediate outcomes, viability of liver segments 5 and 6, and long-term survival were analyzed. Results. RUTH was successfully performed in four patients. In two patients, IRHV was not present, but intrahepatic communicating veins between proximal right and middle hepatic veins and left hepatic vein were present. No venous reconstructions were performed. Mild congestion of the inferior right segments occurred in the patients where there was no IRHV but no immediate, early, or late complications were observed. Conclusions. RUTH is feasible and can be performed even in the absence of an IRHV, without venous reconstruction. Some degree of congestion of the right inferior liver segments might occur when an IRHV is absent, yet this is not clinically significant when communicating veins are present. Maximum parenchyma preservation might prevent postoperative liver failure and allow repeated resections in case of hepatic recurrence.

scholarly journals Transhepatic Tunneled Catheter Using Left Hepatic Vein: The Last Resort for Dialysis

2021 ◽  
Vol 14 ◽  
pp. 117954762110663
Author(s):  
Masa Abaza ◽  
Sloan E Almehmi ◽  
Ammar Almehmi
Keyword(s):  
Hepatic Vein ◽  
Vascular Access ◽  
Femoral Vein ◽  
Skin Lesions ◽  
Hepatic Veins ◽  
Dialysis Therapy ◽  
Left Hepatic Vein ◽  
Arteriovenous Fistulas ◽  
Clinical Scenarios ◽  
The Right

Vascular access is the Achilles tendon of hemodialysis and is considered the lifeline for patients with end stage renal disease. Arteriovenous fistulas and grafts are the preferred traditional access for performing dialysis therapy. However, some patients exhaust the traditional routes of dialysis vascular access for different reasons. In search for alternatives, other unusual vascular routes have been explored, such as transhepatic and translumbar approaches, as the last resort to preserve life in this unfortunate population. Here, we present the unusual case of a 66-year-old female who ran out of the traditional vascular access options and became catheter dependent via the right femoral vein. However, due to recurrent femoral catheter infections, extensive skin calciphylactic lesions and her body habitus, other routes were explored and the decision was to use the transhepatic approach. Traditionally, the right and middle hepatic veins are used to insert these catheters. However, the use of the left hepatic vein was not reported in the literature. Hence, in order to avoid the skin lesions seen in our patient, the dialysis catheter was inserted using the left hepatic vein. Overall, this case highlights the challenges of securing a reliable vascular access to perform dialysis therapy and brings attention to other vascular dialysis routes in certain clinical scenarios.

scholarly journals Preserving inferior right hepatic vein enabled bisegmentectomy 7 and 8 without venous congestion: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Masayoshi Terayama ◽  
Kyoji Ito ◽  
Nobuyuki Takemura ◽  
Fuyuki Inagaki ◽  
Fuminori Mihara ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hepatic Vein ◽  
Three Dimensional ◽  
Venous Drainage ◽  
Injection Technique ◽  
Remnant Liver ◽  
Right Hepatectomy ◽  
Dimensional Simulation ◽  
The Right ◽  
Right Hepatic Vein

Abstract Background In hepatectomy, the preservation of portal perfusion and venous drainage in the remnant liver is important for securing postoperative hepatic function. Right hepatectomy is generally indicated when a hepatic tumor involves the right hepatic vein (RHV). However, if a sizable inferior RHV (IRHV) exists, hepatectomy with preservation of the IRHV territory may be another option. In this case, we verified the clinical feasibility of anatomical bisegmentectomy 7 and 8 with RHV ligation, averting the right hepatic parenchyma from venous congestion, utilizing the presence of the IRHV. Case presentation A 70-year-old man was presented with a large hepatic tumor infiltrating the RHV on computed tomography during a medical checkup. The patient was diagnosed with hepatocellular carcinoma (HCC), T2N0M0, stage III. Right hepatectomy was first considered, but multi-detector computed tomography (MDCT) also revealed a large IRHV draining almost all of segments 5 and 6, suggesting that IRHV-preserving liver resection may be another option. The calculated future remnant liver volumes were 382 mL (26.1% of the total volume) after right hepatectomy and 755 mL (51.7% of the total volume) after anatomical bisegmentectomy 7 and 8; therefore, we scheduled IRHV-preserving anatomical bisegmentectomy 7 and 8 considering the prevention of postoperative liver failure and increased chance of performing repeat resections in cases of recurrence. Preoperative three-dimensional simulation using MDCT clearly revealed the portal perfusion area and venous drainage territories by the RHV and IRHV. There was an issue with invisibility of the anatomical resection line of segments 7 and 8, which was completely dissolved by intraoperative ultrasonography using Sonazoid and the portal dye injection technique with counter staining. The postoperative course in the patient was uneventful, without recurrence of HCC, for 30 months after hepatectomy. Conclusions IRHV-preserving anatomical bisegmentectomy 7 and 8 is a safe and feasible procedure utilizing the three-dimensional simulation of the portal perfusion area and venous drainage territories and the portal dye injection technique.

scholarly journals Three-dimensional Computed Tomography Scan Analysis of Anatomical Variations in the Hepatic Veins

2016 ◽  
Author(s):  
Wenli Xu ◽  
Chonghui Li ◽  
Weidong Duan ◽  
Jiahong Dong
Keyword(s):  
Hepatic Vein ◽  
Malignant Tumors ◽  
Liver Volume ◽  
Three Dimensional ◽  
Anatomical Variations ◽  
Hepatic Veins ◽  
Common Trunk ◽  
Drainage Volume ◽  
The Right ◽  
Right Hepatic Vein

Abstract Objectives: Hepatic venous anatomy is a significant component of liver segmental anatomy, and its high variability is a challenge for hepatobiliary surgeons. Methods: This was a retrospective study of 98 consecutive patients with no cirrhosis or malignant tumors. IQQA-Liver software was used to display and analyze three-dimensional (3D) images of the hepatic veins and their branches and variations. Results: The average liver volume was 1272.65±322.04 ml;the left hepatic veins drained the smallest parts (21.13±5.41%) of the liver compared with the right (35.58±12.41%) and middle hepatic veins (34.64±8.76%). The most common pattern was that the left hepatic veins shared a common trunk with the middle hepatic veins in 51cases (52.0%). The visualization rate of the inferior right hepatic vein (IRHV) was 43.9%, and its drainage volume was 179.27±128.79 ml. In 11.2% of patients, the drainage volume for the IRHV was larger than for the right hepatic vein (RHV). The patterns of the left hepatic and middle hepatic veins were also observed and classified. Umbilical hepatic veins appeared in 75cases (76.5%), and anterior fissure hepatic veins appeared in 74 cases (75.5%).The rate of the presence of a separate segment 4 vein was 15.3%, and 77 patients had obvious superficial veins. There was a statistically significant correlation between the diameter of the IRHVs and the drainage volume of the IRHVs and RHVs. Conclusion: More detailed information about the anatomical features and variations of hepatic venous veins in Chinese people was provided using 3D reconstructions, and this will assist in more precise liver surgeries.

scholarly journals Combined resection of the hepatic venous confluence following preoperative embolization of the right hepatic vein for liver tumor invading three hepatic veins

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S213
Author(s):  
Takashi Mizuno ◽  
Tomoki Ebata ◽  
Tsuyoshi Igami ◽  
Shunsuke Onoe ◽  
Nobuyuki Watanabe ◽  
...  
Keyword(s):  
Hepatic Vein ◽  
Liver Tumor ◽  
Hepatic Veins ◽  
Preoperative Embolization ◽  
Combined Resection ◽  
The Right ◽  
Right Hepatic Vein

Extended Left Hepatectomy by Severing All Major Hepatic Veins with Reconstruction of the Right Hepatic Vein

Surgery Today ◽  
2004 ◽  
Vol 34 (5) ◽  
pp. 482-484 ◽  
Author(s):  
Yoshihiro Sakamoto ◽  
Junji Yamamoto ◽  
Tomoo Kosuge ◽  
Yasuhiko Sugawara ◽  
Makoto Seki ◽  
...  
Keyword(s):  
Hepatic Vein ◽  
Hepatic Veins ◽  
Left Hepatectomy ◽  
The Right ◽  
Right Hepatic Vein

Successful treatment of conversion chemotherapy for initially unresectable synchronous colorectal liver metastasis

2020 ◽  
Author(s):  
Lungwani Muungo
Keyword(s):  
Liver Metastasis ◽  
Colorectal Liver Metastasis ◽  
Surgical Intervention ◽  
Liver Volume ◽  
Sigmoid Colon Cancer ◽  
Remnant Liver ◽  
Future Remnant Liver ◽  
The Right ◽  
Synchronous Colorectal Liver Metastasis ◽  
Right Hepatic Vein

A 72-year-old woman with a sigmoid colon cancer anda synchronous colorectal liver metastasis (CRLM), whichinvolved the right hepatic vein (RHV) and the inferiorvena cava (IVC), was referred to our hospital. Themetastatic lesion was diagnosed as initially unresectablebecause of its invasion into the confluence of theRHV and IVC. After she had undergone laparoscopicsigmoidectomy for the original tumor, she consequentlyhad 3 courses of modified 5-fluorouracil, leucovorin,and oxaliplatin (mFOLFOX6) plus cetuximab. Computedtomography revealed a partial response, and theconfluence of the RHV and IVC got free from cancerinvasion. After 3 additional courses of mFOLFOX6 pluscetuximab, preoperative percutaneous transhepaticportal vein embolization (PTPE) was performed tosecure the future remnant liver volume. Finally, a righthemihepatectomy was performed. The postoperativecourse was uneventful. The patient was dischargedfrom the hospital on postoperative day 13. She hadneither local recurrence nor distant metastasis 18 moafter the last surgical intervention. This multidisciplinarystrategy, consisting of conversion chemotherapy usingFOLFOX plus cetuximab and PTPE, could contributein facilitating curative hepatic resection for initiallyunresectable CRLM.Key words: Initially unresectable; Colorectal liver metastasis;Conversion chemotherapy; Cetuximab; Percutaneoustranshepatic portal vein embolization

Extended left trisectionectomy severing all hepatic veins preserving segment 6 and inferior right hepatic vein

2008 ◽  
Vol 34 (2) ◽  
pp. 247-251 ◽  
Author(s):  
M.A. Machado ◽  
T. Bacchella ◽  
F.F. Makdissi ◽  
R.T. Surjan ◽  
M.C. Machado
Keyword(s):  
Hepatic Vein ◽  
Hepatic Veins ◽  
Left Trisectionectomy ◽  
Right Hepatic Vein
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