Vascular Review

Interactive Slideshow

Hepatic Vasculature Review

Venous System

LT Portal Vein

RT Portal Vein

Main Portal Vein

Splenic Vein

LT Hepatic Vein

RT Hepatic Vein

Middle Hepatic 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

Splenic Vein

Hepatopedal

Hepatofugal

• 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

Portal Veins

• 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

Hepatic Veins

Hepatic Veins vs. Portal Veins

Splenic Vein

Venous System Normal Waveforms

Portal Venous System

Hepatic Veins

• 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

IVC

Normal Flow

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

Arterial System

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

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

Splenic Artery

Proper Hepatic Artery

Variants

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

Hepatic Anomalies

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

Replaced Hepatic Artery

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/

Resources

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