Small hepatic vein entry into the retrohepatic inferior vena cava: implications for transjugular intrahepatic Portosystemic shunt creation

Abstract

Purpose: To determine, using necropsy material, the feasibility of transcaval transjugular intrahepatic Portosystemic (TTIPS) shunt creation according to the variability of small hepatic veins (SHV) entry into the retrohepatic inferior vena cava (RIVC). Material and methods: A total of 68 autopsied specimens of RIVC were analyzed. The inner surface of RIVC was divided into three equal horizontal parts (superior, middle, inferior) and five vertical areas depending on the entry of the major hepatic veins (MHV). The number, location and orifice diameters of SHV were measured and fixed. Results: Only 4% of SHV orifices were found in the superior part of RIVC; 56% and 40% of SHV orifices were found in the middle and inferior parts, respectively. From the RIVC circumference point, 87% of SHV drained in the area below MHV. The diameter of SHV was variable: in 78% the diameter was less than or equal to 1 mm, in 12% it was 2-3 mm and in 10% greater than or equal to 4 mm. Conclusion: The most useful superior part of RIVC for the creation of TTIPS did not have substantial orifices of SHV. However, the vast majority of anterior SHV position creates the presumption of employing higher localized SHV for the creation of TTIPS.