Morphological Characteristics and Frequency of Accessory Right Hepatic Veins - Evaluation with Computed Tomography

In the liver, there are many vascular variants, which are important in liver surgery, the presence of accessory right hepatic veins (aRHVs) in particular. Th eir frequency, number and diameter vary considerably. Detailed imaging diagnostics with computed tomography (CT) should be undertaken before surgery. Th e aim of our study was to examine the characteristics of aRHVs and their demographic correlations. Th e study included data on 188 patients that underwent CT examination of the abdomen with contrast media, 103 men (54.8%) men and 85 (45.2%) women, mean age 63.1±14.3 (range, 21-94) years. Th e measurements of hepatic veins were carried out on CT images, which were obtained from the Clinical Institute of Radiology, University Medical Centre of Ljubljana. Forty-fi ve of 142 patients had at least one aRHV: one aRHV in 37 (26.1%) cases, two aRHVs in seven (4.9%) cases, and three aRHVs in one (0.7%) case. Th e incidence of aRHV was between 24% and 39.3% (mean, 31.7%) and of more than one aRHV between 2.3% and 10.3% with 95% confi dence interval (CI). Based on the test of proportions, the proportion of cases with inferior aRHV of at least 7 mm was between 7.2% and 18.1% with 95% CI. Th e mean distance between the aRHV and the main RHV confl uences into the inferior vena cava was 3.73 cm (between 3.32 cm and 4.13 cm, 95% CI). Th e proportion of cases with confl uence distance of at least 4 cm was between 21.6% and 49.5% in cases with at least one aRHV. In cases with more than one aRHV, the distance between the middle aRHV and the main RHV ranged from 1.90 cm to 4.32 cm (95% CI). Th e T-test of independent samples showed no eff ect of age on the incidence of accessory veins (p=0.18), and the test of diff erences of interests showed no impact of sex (p=0.75). Evaluation of the incidence and diameter of aRHVs is of great importance for safe surgical procedure. Th eir presence can change the surgeon's decision in 10%-20% of cases when employing appropriate imaging technique. CT examination, which is easily accessible and minimally invasive for patients, was successful in only 80% cases, when using standard protocol for CT scanning.