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 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.

THE EFFECT OF THE LIVER ON PLASMA CHOLESTEROL LEVELS IN THE RAT

1965 ◽  
Vol 43 (5) ◽  
pp. 585-593 ◽  
Author(s):  
J. Tinoco ◽  
R. L. Lyman ◽  
Ruth Okey
Keyword(s):  
Fatty Acid ◽  
Hepatic Vein ◽  
Plasma Cholesterol ◽  
Femoral Vein ◽  
Hepatic Veins ◽  
Cholesteryl Esters ◽  
Blood Samples ◽  
Cholesterol Levels ◽  
Fatty Acid Patterns

Blood samples were taken from the femoral and hepatic veins of the same rat. The blood from the hepatic vein had a higher concentration of glucose than blood from the femoral vein. Plasma from the femoral vein always had a higher level of cholesteryl esters than plasma from the hepatic vein, indicating that the liver was absorbing cholesteryl esters. Fatty acid patterns were determined for plasma cholesteryl esters, triglycerides, and phospholipids; there was little difference in pattern between samples taken from the hepatic vein and samples from the femoral vein.

Duplication of the superior vena cava associated with atrial termination of the left hepatic vein

2012 ◽  
Vol 28 (7) ◽  
pp. 369-374 ◽  
Author(s):  
M Milisavljević ◽  
S Marinković ◽  
D Radak ◽  
M ĆEtković ◽  
G Vuĉurević ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Hepatic Vein ◽  
Right Atrium ◽  
Superior Vena ◽  
Vena Cava ◽  
Cardinal Vein ◽  
Left Hepatic Vein ◽  
Arterial Variations ◽  
Brachiocephalic Trunk ◽  
The Right

Duplication of the superior vena cava (SVC), associated with an aberrant left hepatic vein (LHV), was found in one of the 58 dissected specimens. The right SVC virtually showed a typical appearance. The persistent left SVC, which drained into the right atrium via the enlarged coronary sinus, was formed by the persistence of the left anterior cardinal vein. The LHV opened into the right atrium, due to the persistent left hepatocardiac channel. The left common carotid artery arose from the brachiocephalic trunk as a consequence of a regression of the embryonic aortic sac. The revealed venous and arterial variations seem to be the first reported vascular combination of this type.

Hepatic vein, hepatic parenchymal, and inferior vena caval mechanoreceptors with phrenic afferents

1993 ◽  
Vol 265 (1) ◽  
pp. G15-G20 ◽  
Author(s):  
D. R. Kostreva ◽  
S. P. Pontus
Keyword(s):  
Inferior Vena Cava ◽  
Hepatic Vein ◽  
Inferior Vena ◽  
Vena Cava ◽  
Positive Pressure ◽  
Hepatic Veins ◽  
Hepatic Parenchyma ◽  
Light Pressure ◽  
Inferior Vena Caval ◽  
The Right

Dogs were anesthetized with pentobarbital sodium and placed on positive-pressure ventilation. The right phrenic nerve and/or its C5 branch were prepared for afferent recording. The hepatic veins, hepatic parenchyma, diaphragm, and inferior vena cava were studied for mechanoreceptors using light pressure and stroking as the stimuli. Mechanosensitive areas were found in the hepatic veins, hepatic parenchyma of the right medial lobe, and inferior vena cava. The hepatic vein and inferior vena caval receptors are located in the same 1- to 2-cm region as the sphincters that are found in these vessels. This study presents the first experimental evidence for the existence of hepatic vein receptors, hepatic parenchymal receptors, and inferior vena caval mechanoreceptors with phrenic afferents in the dog. These sensory areas of the circulation may be involved in the neural control of venous return as well as mediating changes in intrahepatic and portal venous blood pressure during normal respiration.

Metabolism of Unesterified Fatty Acids (UFA) in Normal Dogs

1958 ◽  
Vol 195 (2) ◽  
pp. 288-290 ◽  
Author(s):  
Paul S. Roheim ◽  
John J. Spitzer
Keyword(s):  
Fatty Acids ◽  
Portal Vein ◽  
Hepatic Vein ◽  
Femoral Artery ◽  
Femoral Vein ◽  
Hepatic Veins ◽  
Blood Samples ◽  
Fat Depots ◽  
Abdominal Region

The source and disappearance of plasma UFA were studied in normal dogs by simultaneous lipid determinations in blood samples from the femoral artery, femoral vein, portal vein and hepatic vein. Marked and consistent veno-arterial and frequent portal vein-arterial differences were found indicating UFA liberation in the leg and in the abdominal region, due to either lipolysis or mobilization from fat depots. Differences between UFA content of the portal and hepatic veins and of the portal vein and femoral artery were also consistent, showing uptake of UFA by the liver. The abdominal region also took up UFA frequently as indicated by arterial-portal differences. Similar changes were not detectable in triglycerides, total and free cholesterols and phospholipids.

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 Intrahepatic cholangiocarcinoma with a tumor thrombus extending from the inferior vena cava to the right atrium: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Genya Hamano ◽  
Shigekazu Takemura ◽  
Shogo Tanaka ◽  
Hiroji Shinkawa ◽  
Takanori Aota ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Hepatic Vein ◽  
Intrahepatic Cholangiocarcinoma ◽  
Right Atrium ◽  
Tumor Thrombus ◽  
Inferior Vena ◽  
Vena Cava ◽  
Left Hepatic Vein ◽  
Total Hepatic Vascular Exclusion ◽  
The Right

Abstract Background Vascular invasion involving a tumor thrombus in the inferior vena cava and/or right atrium is an unfavorable prognostic factor after intrahepatic cholangiocarcinoma resection. We report an intrahepatic cholangiocarcinoma case with a tumor thrombus extending from the left hepatic vein via the inferior vena cava to the right atrium. Case presentation A 58-year-old man with epigastralgia was referred to our hospital after an emergent transcatheter arterial embolization was done following the radiological diagnosis of a ruptured hepatic tumor. The serum concentrations of carcinoembryonic antigen, carbohydrate 19-9, duke pancreatic monoclonal antigen type 2, and cytokeratin-19 fragments were elevated; meanwhile those of alfa-fetoprotein and des-γ-carboxy prothrombin were within normal ranges. A contrast-enhanced computed tomography scan showed a heterogeneously enhanced tumor, 13 cm in diameter, in the left lobe of the liver, enlarged lymph nodes along the lesser curvature of the stomach, and a tumor thrombus extending from the left hepatic vein via the inferior vena cava to the right atrium. We performed a left hemihepatectomy and tumor thrombectomy under total hepatic vascular exclusion to reduce the risk of sudden death. After dissection of the liver parenchyma along the left side of the middle hepatic vein, except for the left hepatic vein, the inferior vena cava just below the right atrium could be clamped by pulling down the left lobe of the liver toward the caudal side. The thrombus could be removed by incising the inferior vena cava under total hepatic vascular exclusion. Microscopic examination showed a tubular adenocarcinoma. Immunohistochemical staining was positive for cytokeratin-7, cytokeratin-19, and epithelial membrane antigen, but negative for arginase-1, glypican-3, and hepatocyte. The patient was pathologically diagnosed with an intrahepatic cholangiocarcinoma with a tumor thrombus in the inferior vena cava. Adjuvant chemotherapy with tegafur/gimeracil/oteracil was administered for 1 year. The patient remained in good health without cancer recurrence for over 4 years after the operation. Conclusion An aggressive surgical approach may be indicated for intrahepatic cholangiocarcinoma with a tumor thrombus in the inferior vena cava and/or right atrium to avoid the risk of impending death.

scholarly journals Characteristics of Surgical Anatomy of the Left Hepatic Vein: Sonographic Findings

2020 ◽  
Vol 13 (2) ◽  
pp. 103-108
Author(s):  
Andrew Sergeevich Moshkin ◽  
Nikolay Nikolaevich Sheverdin
Keyword(s):  
Hepatic Vein ◽  
Treatment Options ◽  
Average Diameter ◽  
Surgical Anatomy ◽  
Individual Characteristics ◽  
Diagnostic Methods ◽  
Hepatic Veins ◽  
Main Trunk ◽  
Left Hepatic Vein ◽  
Vein Formation

Introduction. The development of modern surgery requires the advancement of expertise about individual characteristics of large vessels development. The expansion of surgical treatment options of liver diseases determines the necessity of more detailed information about the anatomy of the portal, biliary and arterial systems, and about the anatomy of the hepatic veins in particular.The aim of research was to study characteristics of the left hepatic vein formation based on ultrasound examination findings.Materials and methods. The study included 39 outpatients, 11 males and 28 females, aged 17-84. Using ultrasound imaging methods, the authors determined linear dimensions, variations and angles of junction of the veins forming the left hepatic vein.Results. The main six variations of the left hepatic vein were determined as follows: variation I was observed in 9 cases (23.1%), variation II - in 7 cases (17.9%), variation III - in 11 cases (28.2%), variation IV - in 6 cases (15.4%), variation V - in 5 cases (12.8%), variation VI - in 1 case (2.6%). The angle of junction of the veins I and III at the site of their entry into the main trunk of the venous system was from 19-21 degrees to 80-85 degrees; the angle of junction of the vein II was from 21 degrees to 61.6 degrees. Deviation of veins in the plane perpendicular to the rest veins ranged from 32 degrees to 81.7 degrees. Additional veins entered at the angles from 22.5 degrees to 45 degrees. When observing, the vein diameter for veins I and II was from 1.3 mm to 4.8 mm, and for vein III - from 1.5 mm to 3.5 mm. There were additional veins determined with an average diameter equal 2.25 mm 0.25 mm. The size of the trunk of the left hepatic vein directly corresponded to a diameter of 2 mm to 7.7 mm.Conclusion. The presented variations are of major importance for modern diagnostic methods, they also expand the understanding of the anatomical variations in the left lobar vein formation, which should be taken into account by surgeons during liver operations.

Hepatic Congestion Induced by Partial Occlusion of the Hepatic Veins in Healthy Dogs

1968 ◽  
Vol 26 ◽  
pp. 116-117
Author(s):  
F. R. Dawoud ◽  
J. J. Ghidoni
Keyword(s):  
Hepatic Vein ◽  
Jugular Vein ◽  
Light And Electron Microscopy ◽  
Vena Cava ◽  
Middle Lobe ◽  
External Jugular Vein ◽  
Hepatic Veins ◽  
Hepatic Congestion ◽  
Before And After ◽  
The Right

The inferior vena cava and hepatic veins of twenty randomly selected normal dogs (22-27 kg) were exposed through a right transthoracic, transdiaphragmatic incision. The small hepatic vein from the middle lobe of the liver was routinely ligated. After the hepatic vein draining the left 3 lobes of the liver was catheterized from the right external jugular vein, a tape was passed around that hepatic vein. The pressure in the intrahepatic part of the hepatic vein was measured and recorded before and after reducing the main left hepatic vein to the size of the catheter by tying the tape. The catheter was cut short and inserted into the jugular vein to establish limited hepatic drainage through a lumen of known and constant cross section; the catheters were accessible for additional pressure measurements. The animals were killed according to a predetermined schedule at 1, 3, 7, and 15 days. Specimens for light and electron microscopy were taken from the congested and uncongested lobes of the liver. Tissues were fixed in cold cacodylate buffered 5% glutaraldehyde and postfixed with osmium. Tissue blocks were rapidly dehydrated and embedded in a mixture of Maraglas, D.E.R. 732, and DDSA.

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