Anatomy of the common trunk of the middle and left hepatic veins: application to liver transplantation

An anastomosis between the common trunk of the middle and left hepatic vein s of the receiver and the cranial portion of the inferior vena cava of the donor is one of the techniques for restoration of hepato-caval continuity i n orthotopic liver transplantation. This technique avoids dissection of the retrohepatic vena cava and total caval clamping. The aim of this study was to define the feasibility of this technique by a morphologic and biometric study of the common trunk of the middle and left hepatic veins on the basi s of 64 injection-corrosion hepatic specimens and 21 fresh subjects. A comm on trunk for the middle and left hepatic veins was present in 54 of 64 case s (84%) with a length of 3 to 17 mm, The diameter of the new ostium constru cted by section 0.5 cm proximal to the junction of the middle and left hepa tic veins was 23.9 +/- 2.3 mm, which approximated to that of the vena cava where it traversed the diaphragm (24.4 +/- 2.0 mm). These findings confirme d that restoration of hepato-caval continuity by anastomosis between the co mmon trunk of the middle and left hepatic veins of the receiver and the cra nial portion of the vena cava of the graft is possible without incongruence . This study makes no assumptions about the hemodynamic effects associated with the smallest diameter of the true ostium of the common trunk at its op ening into the inferior vena cava. In this study, the morphology of the com mon trunk was comparable to that observed by Nakamura. Further, we propose an anatomo-clinical classification allowing evaluation of the facility of v ascular control of the common trunk in terms of the number and location of the collateral veins.