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Portal Supply and Venous Drainage of the Caudate Lobe in the Healthy Human Liver: Virtual Three-Dimensional Computed Tomography Volume Study

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Abstract

Objective

The venous vascular anatomy of the caudate lobe is exceptional. The purpose of this study was to assess portal inflow and venous outflow volumes of the caudate lobe.

Methods

Extrahepatic (provided by the first-order branches) versus intrahepatic (provided by the second- to third-order branches) portal inflow, as well as direct (via Spieghel veins) versus indirect (via hepatic veins) venous drainage patterns were analyzed in virtual 3-D liver maps in 140 potential live liver donors.

Results

The caudate lobe has a greater intrahepatic than extrahepatic portal inflow volume (mean 55 ± 26 vs. 45 ± 26%: p = 0.0763), and a greater extrahepatic than intrahepatic venous drainage (mean 54–61 vs. 39–46%). Intrahepatic drainage based on mean estimated values showed the following distribution: middle > inferior (accessory) > right > left hepatic vein.

Conclusions

Sacrifice of extrahepatic caudate portal branches can be compensated by the intrahepatic portal supply. The dominant outflow via Spieghel veins and the negligible role of left hepatic vein in caudate venous drainage may suggest reconstruction of caudate outflow via Spieghel veins in instances of extended left hemiliver live donation not inclusive of the middle hepatic vein. The anatomical data and the real implication for living donors must be further verified by clinical studies.

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Abbreviations

LDLT:

Live donor liver transplantation

BD:

Bile duct (biliary)

CL:

Caudate lobe

CT:

Computed tomography

3-D:

Three-dimensional

HV:

Hepatic vein

IHV:

Inferior (accessory) hepatic vein

IOUS:

Intraoperative ultrasonography including color doppler

IVC:

Inferior vena cava

LCL:

Left caudate lobe called segment I

LHV:

Left hepatic vein

MHV:

Middle hepatic vein

PV:

Portal vein

RCL:

Right caudate lobe called segment IX

RHV:

Right hepatic vein

SHV:

Short hepatic veins called Spieghel veins

Spieghel veins:

Provide a direct extrahepatic outflow of the caudate lobe into IVC

TLV:

Total liver volume

Venous connections:

Microveins providing indirect intrahepatic outflow of the caudate lobe into the main hepatic vein system

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Acknowledgements

This study was supported by the Grant Nr: 117/1-1:A2.2 from the German Society for Research (Deutsche Forschungsgemeinschaft).

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany

    T. Benkö, A. Paul, S. Nadalin & A. Radtke

  2. Department of Surgery, Furness General Hospital, Dalton Ln, Barrow-in-Furness, Cumbria, LA14 4LF, UK

    G. Sgourakis

  3. Department of Surgery, North Shore University Hospital, Manhasset, NY, USA

    E. P. Molmenti

  4. MeVis Center for Medical Diagnostic Systems and Visualization, University of Bremen, Bremen, Germany

    H. O. Peitgen

  5. Department of General, Visceral and Transplant Surgery, University Hospital Tubingen, Tubingen, Germany

    S. Nadalin & A. Radtke

  6. Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany

    T. Schroeder

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  1. T. Benkö
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  2. G. Sgourakis
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Correspondence to G. Sgourakis.

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Benkö, T., Sgourakis, G., Molmenti, E.P. et al. Portal Supply and Venous Drainage of the Caudate Lobe in the Healthy Human Liver: Virtual Three-Dimensional Computed Tomography Volume Study. World J Surg 41, 817–824 (2017). https://doi.org/10.1007/s00268-016-3791-8

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  • DOI: https://doi.org/10.1007/s00268-016-3791-8

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