Detection of intrahepatic veno-venous shunts by three-dimensional venography using multidetector-row computed tomography during angiography

• Published in: Surgery today (Tokyo, Japan) Japan), 2014-04, Vol.44 (4), p.662-667
• Main Authors: Sakaguchi, Takanori, Suzuki, Shohachi, Hiraide, Takanori, Shibasaki, Yasushi, Morita, Yoshifumi, Suzuki, Atsushi, Fukumoto, Kazuhiko, Inaba, Keisuke, Takehara, Yasuo, Nasu, Hatsuko, Kamiya, Mika, Yamashita, Shuhei, Ushio, Takasuke, Konno, Hiroyuki
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular - blood supply; Carcinoma, Hepatocellular - secondary; Carcinoma, Hepatocellular - surgery; Cholangiocarcinoma - blood supply; Cholangiocarcinoma - secondary; Cholangiocarcinoma - surgery; Female; Hepatectomy; Hepatic Veins - abnormalities; Hepatic Veins - diagnostic imaging; Hepatic Veins - surgery; Humans; Image Processing, Computer-Assisted - methods; Imaging, Three-Dimensional - methods; Liver Neoplasms - blood supply; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Multidetector Computed Tomography - methods; Original Article; Phlebography - methods; Surgery; Surgical Oncology; Vascular Surgical Procedures
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-013-0710-6

Purpose The hepatic vein (HV) can be removed during hepatectomy if there is an effective intrahepatic veno-venous shunt (vv-shunt). We evaluated the efficacy of vv-shunt detection by three-dimensional (3D) venography reconstructed from multidetector-row computed tomography (MDCT) during angiography. Methods 3D venography was reconstructed using computer software in 88 patients with intrahepatic tumors. Results We found that 12 patients had one shunt [4 right hepatic vein (RHV)—middle hepatic vein (MHV) and 12 RHV- inferior right hepatic vein (IRHV)] and 1 patient had 2 shunts (RHV-MHV and -IRHV), confirming a clinically efficient vv-shunt in 14.8 % of the patients. In one patient with an RHV-IRHV shunt, the preserved RHV-IRHV shunt worked well and prevented congestion of the postero-caudal subsegment after central bisegmentectomy with partial resection of the RHV ventral trunk for huge hepatocellular carcinoma (HCC). Conclusions Although the vv-shunt detection rate by 3D venography is low, a visualized vv-shunt proved to be efficient. Thus, invasive occlusion venography is avoidable if a vv-shunt is seen on 3D venography.