Volumetric analyses of venous variations in the left liver using 3D-CT venography.

Objective: Knowledge of intrahepatic vascular variations, especially in hepatic venous anatomy, is inevitable for carrying out liver surgery safely. However, vascular anatomy of the right liver or right side tributaries of the MHV has been focused in various studies and there have been only a few reports on the left liver.

Methods: Sixty consecutive living donors for liver transplantation in a single institute were reviewed. Ramification patterns and drainage volume of each venous tributary were evaluated using 3D-CT venography.

Results: Four characteristic venous tributaries; left superficial vein (LSV), umbilical fissure vein (UFV), and superior/inferior veins of Segment IV (V4sup/4inf) were detected on 3D-CT. Of these, LSV and UFV were sometimes rather thick overwhelming the LHV trunk and drained more than 20% of the left liver in 11 (18.3%) and 4 patients (6.7%), respectively. In such cases, proportions of Segment II (LSV drainage area) or Segment III+IV (UFV drainage area) were significantly large compared with those in typical venous ramification cases.

Conclusions: Clinically significant findings on venous variations in the left liver were described. Preoperative volumetric assessment of the draining areas of these veins is useful in surgical decision making on venous reconstruction and/or extent of liver resection.