Relationship Between Vascular and Biliary Anatomy in Living Liver Donors

Relationship Between Vascular and Biliary Anatomy in Living Liver Donors

David Blair Macdonald¹, Masoom A. Haider¹, Korosh Khalili¹, Tae Kyong Kim¹, Martin O'Malley¹, Paul D. Greig², David R. Grant², Gina Lockwood³ and Mark S. Cattral²

¹ Department of Medical Imaging, Princess Margaret Hospital, University Health Network, University of Toronto, 610 University Ave., Toronto, ON M5G 2M9, Canada.
² MultiOrgan Transplantation Unit, Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, ON, Canada.
³ Department of Biostatistics, University Health Network, Princess Margaret Hospital, Toronto, ON, Canada.

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Fig. 1 —Portal vein branching patterns. RAS = right anterior segmental portal vein supplying segments V and VIII, RPS = right posterior segmental portal vein supplying segments VI and VII. (Adapted with permission from [13])

A-F, Diagrams show conventional branching (A); trifurcation (B), which is defined as simultaneous origin of RAS and RPS from main portal vein; RPS arising from main portal vein (C); RAS arising from left portal vein (D); complete absence of right portal vein (E); and absence of horizontal segment of left portal vein (F).

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Fig. 2 —Intrahepatic biliary duct branching patterns are divided into seven types. Aberrant ducts are indicated in gray. C = cystic duct, Acc = accessory duct. (Adapted with permission from [15])

A, Diagram shows type 1, conventional branching.

B, Diagram shows type 2, which is triple confluence of right anterior segmental duct draining segments V and VIII (RAS), right posterior segmental duct draining segments VI and VII (RPS), and left hepatic duct (LHD) into common hepatic duct (CHD).

C-E, Diagram shows types 3A, 3B, and 3C: RPS drains anomalously into LHD, CHD, or cystic duct, respectively.

F, Diagram shows type 4: Right hepatic duct (RHD) drains into cystic duct.

G and H, Diagram shows types 5A and 5B: Right accessory duct drains into CHD or RHD.

I, Diagram shows type 6: Segments II and III drain individually into RHD or CHD.

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Fig. 3 —Hepatic arterial branching patterns can be divided into 10 types. Aberrant vessels are indicated in black. LHA = left hepatic artery, RHA = right hepatic artery, LGA = left gastric artery, HT = hepatic trunk, SMA = superior mesenteric artery, Acc = accessory, GDA = gastroduodenal artery, SA = splenic artery. (Adapted with permission from [14])

A, Diagram shows type 1, conventional branching, and type 2, replaced LHA arising from LGA.

B, Diagram shows type 3, replaced RHA arising from SMA, and type 4, both replaced LHA and RHA.

C, Diagram shows type 5, accessory LHA, and type 6, accessory RHA.

D, Diagram shows type 7, accessory RHA and accessory LHA, and type 8, replaced RHA and accessory LHA or replaced LHA and accessory RHA.

E, Diagram show type 9, entire HT arising from SMA, and type 10, entire HT arising from LGA.

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Fig. 4 —Graph shows length of right portal vein for anomalous and conventional biliary anatomy. No patients with right portal vein that was 2 cm or longer (dashed line) had anomalous biliary anatomy. Although mean length of right portal vein was shorter in patients with anomalous biliary anatomy, this difference was not significant (p = 0.09). Mean values are indicated by black squares with error bars representing 1 SD of mean.

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