Vascular Review

Hepatic Vasculature Review

Interactive Slideshow

Venous System

Middle Hepatic Vein

RT Hepatic Vein

LT Hepatic Vein

Splenic Vein

Main Portal Vein

RT Portal Vein

LT Portal Vein

Splenic Vein

• drains the spleen, pancreas, and stomach
• courses posterior to the body of the pancreas
• unites with SMV to form the main portal vein
• hepatopetal
• color doppler will depend on transducer and vessel position

Hepatic Veins

Portal Veins

Hepatofugal

Hepatopedal

Hepatic Veins vs. Portal Veins

• provide 75% of blood flow to the liver
• drains nutrient rich blood from the intestines, spleen, stomach, gallbladder, and pancreas
• transversely oriented and intrasegmental
• formed by the SMV, IMV, and splenic vein
• converge at porta hepatis
• enlarge as they approach the porta hepatis
• surrounded by an echogenic fibrous sheath
• monophasic and unidirectional

• Longitudinally oriented and intersegmental

• RT, middle, and LT converge into the IVC at the diaphragm to drain blood from the liver
• largest tributaries of the IVC
• enlarge toward the diaphragm
• pulsatile, triphasic, and bidirectional

Venous System Normal Waveforms

Hepatic Veins

Portal Venous System

Splenic Vein

IVC

Normal Flow

• empties into the right atrium
• changes in size with respiration

Normal Spectral Doppler:

• pulsatile at proximal
• phasic, spontaneous at distal

Abnormal Spectral Doppler:

• continuous signal

Arterial System

• branch off the celiac artery
• gives rise to the GDA and turns into proper hepatic artery

Common Hepatic Artery

• follows the portal vein and CBD
• within the liver it divides into right and left hepatic arteries to supply blood to the liver
• low resistive waveform
• normal RI ranges from 0.5-0.7
• hepatopedal

Proper Hepatic Artery

• supply blood to the spleen
• branch of the celiac trunk
• runs superior to the pancreas
• tortuous and typically turbulent

Splenic Artery

Variants

Hepatic Anomalies

Arteries:

• common or right hepatic artery may arise from the SMA
• common or right hepatic artery may arise off the aorta
• left hepatic artery may arise from the left gastric artery

Veins:

• middle and left hepatic vein may join to form a common trunk before entering the IVC
• a hepatic vein may be absent
• right more commonly absent
• left hepatic frequently duplicated

Replaced Hepatic Artery

replaced: a vessel arises from an anomalous origin and supplies a portion of the liver solely Two most common variants: replaced right hepatic artery = right hepatic artery arising from the SMA Replaced left hepatic artery = left hepatic artery arising from the left gastric artery

Resources

https://www.wjgnet.com/1007-9327/full/v28/i19/2057.htmhttps://radiopaedia.org/images/4708936?case_id=24894 https://www.swissnephro.org/blog/2016/3/10/liver-doppler-ultrasound-increased-pulsatility-in-portal-vein-flow https://thoracickey.com/ultrasound-of-the-hepatoportal-circulation/ https://radiologykey.com/hepatobiliary-ultrasound/

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