World Journal of Surgery

, Volume 36, Issue 1, pp 120–124 | Cite as

Anatomical Variations of Hepatic Veins: Three-Dimensional Computed Tomography Scans of 200 Subjects

  • Chi-Hua FangEmail author
  • Jin-Hua You
  • Wan Yee LauEmail author
  • Eric C. H. Lai
  • Ying-Fang Fan
  • Shi-Zhen Zhong
  • Ke-Xiao Li
  • Zhi-Xiang Chen
  • Zhong-He Su
  • Su-Su Bao



The impact of hepatic venous anatomic variations on hepatic resection and transplantation is the least understood aspect of liver surgery.


A prospective three-dimensional computed tomography study was undertaken on 200 consecutive subjects with normal livers to determine the prevalence of surgically significant hepatic venous anatomic variations.


The prevailing pattern of the three hepatic veins in these subjects was a right hepatic vein (RHV) and a common trunk for the middle (MHV) and left (LHV) hepatic veins (122/200, 61%). The remaining patients had the RHV, MHV, and LHV draining independently into the inferior vena cava (IVC). In 39% of patients, the RHV was small and was compensated by a large right inferior hepatic vein (21.0%), an accessory RHV (8.5%) or a well-developed MHV (6.5%). A segment 4 vein was seen in 51.5% of patients. This segment 4 vein joined the LHV (26%), the MHV (17.5%), or the IVC (8%). An umbilical vein and a segment 4 vein were seen in 3.5% of patients. These two veins joined either the LHV (2.0%) or the MHV (1.5%).


Knowing the variations of hepatic veins before surgery is useful during both partial hepatectomy and donor operations for living related liver transplantation.


Inferior Vena Cava Hepatic Vein Obstructive Jaundice Liver Surgery Common Trunk 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by the following grants: The National High Technology Research and Development Program of China (863 Program) (grant 2006AA02Z346); The Natural Science Foundation of Guangdong Province, China (grant 6200171); National Natural Science Foundation of China (grant 30470493); The Integration Project of Industry, Education and Research jointly funded by Guangdong Province and the Ministry of Education of P.R. China (grant 2009B080701077); The Strategic Cooperation Project jointly funded by Guangdong Province and the Chinese Academy of Sciences (grant 2010A090100032).

Supplementary material

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  1. 1.
    Nakamura S, Tsuzuki T (1981) Surgical anatomy of the hepatic veins and the inferior vena cava. Surg Gynecol Obstet 152:43–50PubMedGoogle Scholar
  2. 2.
    Nagorney DM (2010) The impact of hepatic venous anatomy on the hepatic remnant: need for assessment? Surgery 147:811–812PubMedCrossRefGoogle Scholar
  3. 3.
    Ou QJ, Hermann ER (1984) The role of hepatic veins in liver operations. Surgery 95:381–391PubMedGoogle Scholar
  4. 4.
    Sakaguchi T, Suzuki S, Inaba K et al (2010) Analysis of intrahepatic venovenous shunt by hepatic venography. Surgery 147:805–810PubMedCrossRefGoogle Scholar
  5. 5.
    Orguc S, Tercan M, Bozoklar A et al (2004) Variations of hepatic veins: helical computerized tomography experience in 100 consecutive living liver donors with emphasis on right lobe. Transplant Proc 36:2727–2732PubMedCrossRefGoogle Scholar
  6. 6.
    Elias H, Petty D (1952) Gross anatomy of the blood vessels and ducts within the human liver. Am J Anat 90:59–111PubMedCrossRefGoogle Scholar
  7. 7.
    Goldsmith NA, Woodburne RT (1957) The surgical anatomy pertaining to liver resection. Surg Gynecol Obstet 105:310–318PubMedGoogle Scholar
  8. 8.
    Gertsch P, Vauthey JN, Looser C et al (1995) Evaluation of adaptive changes by non-invasive imaging in hepatic vein outflow obstruction. HPB Surg 8:231–236PubMedCrossRefGoogle Scholar
  9. 9.
    Bayraktar UD, Seren S, Bayraktar Y (2007) Hepatic venous outflow obstruction: three similar syndromes. World J Gastroenterol 13:1912–1927PubMedGoogle Scholar
  10. 10.
    Fan ST, Lo CM, Liu CL et al (2003) Safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation. Ann Surg 238:137–148PubMedGoogle Scholar
  11. 11.
    Sano K, Makuuchi M, Miki K et al (2002) Evaluation of hepatic venous congestion: proposed indication criteria for hepatic vein reconstruction. Ann Surg 236:241–247PubMedCrossRefGoogle Scholar
  12. 12.
    Terminology Committee of the IHPBA (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB Surg 3:333–339Google Scholar

Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Chi-Hua Fang
    • 1
    Email author
  • Jin-Hua You
    • 1
  • Wan Yee Lau
    • 2
    Email author
  • Eric C. H. Lai
    • 2
  • Ying-Fang Fan
    • 1
  • Shi-Zhen Zhong
    • 3
  • Ke-Xiao Li
    • 1
  • Zhi-Xiang Chen
    • 1
  • Zhong-He Su
    • 1
  • Su-Su Bao
    • 4
  1. 1.Department of Hepatobiliary Surgery, Zhujiang HospitalThe Southern Medical UniversityGuangzhouChina
  2. 2.Faculty of MedicineThe Chinese University of Hong KongShatinHong Kong SAR, China
  3. 3.The Clinical Anatomy InstituteSouthern Medical UniversityGuangzhouChina
  4. 4.The Computer SchoolSouth China Normal UniversityGuangzhouChina

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