Open AccessHuman liver segments: role of cryptic liver lobes and vascular physiology in the development of liver veins and left-right asymmetry
Author(s) -
Jill P. J. M. Hikspoors,
Mathijs M. J. P. Peeters,
Nutmethee Kruepunga,
Hayelom K. Mekonen,
Greet M. C. Mommen,
S. Eleonore Köhler,
Wouter H. Lamers
Publication year - 2017
Publication title -
scientific reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.24
H-Index - 213
ISSN - 2045-2322
DOI - 10.1038/s41598-017-16840-1
Subject(s) - anatomy , hepatic veins , medicine , portal vein , trunk , umbilical vein , right gastric vein , branching (polymer chemistry) , vein , hepatectomy , biology , portal venous pressure , cirrhosis , portal hypertension , radiology , surgery , chemistry , ecology , biochemistry , organic chemistry , resection , in vitro
Couinaud based his well-known subdivision of the liver into (surgical) segments on the branching order of portal veins and the location of hepatic veins. However, both segment boundaries and number remain controversial due to an incomplete understanding of the role of liver lobes and vascular physiology on hepatic venous development. Human embryonic livers (5–10 weeks of development) were visualized with Amira 3D-reconstruction and Cinema 4D-remodeling software. Starting at 5 weeks, the portal and umbilical veins sprouted portal-vein branches that, at 6.5 weeks, had been pruned to 3 main branches in the right hemi-liver, whereas all (>10) persisted in the left hemi-liver. The asymmetric branching pattern of the umbilical vein resembled that of a “distributing” vessel, whereas the more symmetric branching of the portal trunk resembled a “delivering” vessel. At 6 weeks, 3–4 main hepatic-vein outlets drained into the inferior caval vein, of which that draining the caudate lobe formed the intrahepatic portion of the caval vein. More peripherally, 5–6 major tributaries drained both dorsolateral regions and the left and right ventromedial regions, implying a “crypto-lobar” distribution. Lobar boundaries, even in non-lobated human livers, and functional vascular requirements account for the predictable topography and branching pattern of the liver veins, respectively.