Identification of hepatic venous territories in liver resection by using color Doppler ultrasonography - Report of two cases

Objective. Resection of the hepatic vein because of the proximity of tumors may result in increased congestion in the noncancerous parenchyma, which i n turn may lead to functional hepatic volume loss and postoperative hepatic failure, especially in a case of low hepatic reserve. However, to our know ledge, no technique for estimating the extent of dependent hepatic venous t erritories before hepatic resection has been established. We examined the p ossibility of using color Doppler ultrasonography for this purpose. Methods . A color Doppler system and a linear array transducer equipped with multip le Doppler frequencies ranging from 7 to 13 MHz were used intraoperatively. Two patients with hepatocellular carcinomas were examined. By tracking ent ire branches of the targeted vessel, from the trunk to the terminal branche s extending to the liver surface, it was possible for the boundaries of the dependent areas to be projected and marked on the liver surface with eithe r ink or electrocautery. Results. In both cases, this method was effective for either minimizing the congestive area or preserving the hepatic mass th at was being drained via aberrant routes. Conclusions. Identification of he patic venous territories by means of color Doppler ultrasonography may prov ide new information about intrahepatic blood circulation and may increase t he safety and curability of hepatic resection.