An echo-Doppler evaluation revealed thin linear suprahepatic
veins and confirmed the presence of ascites.
Of these, vascular complications (hepatic artery, portal vein, inferior vena cava or suprahepatic
veins) pose a diagnostic challenge for the critical care physician, given a prevalence of approximately 9% and the potentially devastating consequences (1,2), requiring early surgical treatment in the majority of cases.
After the organs ventral side was turned up the mobilization of the liver was performed using the classical method (intersection of the falciform, triangular and coronary ligaments), which enabled us to locate the suprahepatic
infradiaphragmatic IVC with the insertions of the major hepatic veins, the zone of the IVC passing through the tendon center of the diaphragm, and to evaluate the topography of the phrenic vein insertions in this area.
The falciform ligament was dissected to the ventral surface of the suprahepatic
IVC to show the loose space between the right hepatic vein and the confluence of the left and middle hepatic veins.
Couinaud, "Liver anatomy: portal (and suprahepatic
) or biliary segmentation," Digestive Surgery, vol.
(2,8) Gray-scale depiction of IVC stenosis, which more commonly occurs at the suprahepatic
anastomosis, will demonstrate an area of focal narrowing and color aliasing.
Budd Chiari syndrome (BCS) is a rare disorder that results from hepatic venous outflow tract obstruction, occurring anywhere from the small hepatic veins to the suprahepatic
inferior vena cava.
Nephrectomy with IVC thrombectomy remains one of the most technically challenging and morbid procedure in urology.[sup.5] Adequate suprahepatic
exposure and IVC control can be difficult and often require full mobilization of the liver or sternotomy with pericardiotomy.[sup.6] Exposure often requires a multidisciplinary collaboration with either the cardiac or vascular surgery services.[sup.7] Faced with this problem, we chose instead to employ straight forward endoluminal principles and techniques to gain suprahepatic
Liver anatomy: portal (and suprahepatic
) or biliary segmentation.
A prominent aberrant vessel opening into the suprahepatic
IVC just below the diaphragm creating a curvilinear appearance as shown in Figure-2,3.
1) and congenital suprahepatic
inferior vena cava short interruption with compensatory development of collateral venous circulation (Fig.
In our patient, this latter mechanism likely determined the intramural dissection of small veins and the subsequent passage of air bubbles into the suprahepatic
veins through the hepatic sinusoids or via preexisting shunts between the portal and inferior cava vein .