An echo-Doppler evaluation revealed thin linear
suprahepatic veins and confirmed the presence of ascites.
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 IVC control.
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 [31].