Hepatic Veins

venae hepaticae

The hepatic veins are three major veins (right, middle, and left) that drain the liver directly into the inferior vena cava at the level of T8-T9 as the IVC passes through the diaphragm. The right hepatic vein is the largest and drains the right lobe; the middle hepatic vein drains the middle segments and often joins the left vein before the IVC; the left hepatic vein drains the left lobe and caudate. The hepatic veins define the intersegmental boundaries of the liver used in hepatic resection planning.

Region: Abdomen

Clinical Relevance

Clinical Notes

The hepatic veins are the anatomical landmarks defining the functional segments of the liver (Couinaud segments) and their interrelationship determines the extent of hepatic resection possible. Budd-Chiari syndrome results from hepatic vein thrombosis, producing hepatomegaly, ascites, and right upper quadrant pain from hepatic venous outflow obstruction. In liver transplantation, the hepatic veins or the piggyback IVC are the critical outflow anastomoses. Hepatocellular carcinoma invasion of the hepatic veins is a contraindication to resection.

Pathology

Common Injuries & Conditions

Budd-Chiari Syndrome

Thrombosis of the hepatic veins from hypercoagulable states, myeloproliferative disease, or congenital webs obstructs hepatic venous outflow, producing ascites, hepatomegaly, liver failure, and the classic centrizonal hepatic congestion on biopsy, managed with anticoagulation, TIPS, or liver transplantation.

Hepatic Vein Injury in Liver Resection

Division of hepatic vein branches during parenchymal transection for hepatic resection risks injury to the main hepatic veins or the IVC, producing life-threatening haemorrhage requiring vascular control and primary or patch repair.