Porta-caval fibrous connections — the lesser-known structure of intrahepatic connective-tissue framework: A unified view of liver extracellular matrix

Abstract

Knowledge about the connective-tissue framework of the liver is not systematized, the terminology is inconsistent and some perspectives on the construction of the hepatic matrix components are contradictory. In addition, until the last two decades of the 20 th century, the connective-tissue sheaths of the portal tracts and the hepatic veins were considered to be independent from each other in the liver and that they do not make contact with each other. The results of the research carried out by Professor Shalva Toidze and his colleagues started in the 1970s in the Department of Operative Surgery and Topographic Anatomy at the Tbilisi State Medical Institute have changed this perception. In particular, Chanukvadze I showed that in some regions where they intersect with each other, the connective tissue sheaths of the large portal complexes and hepatic veins fuse. The areas of such fusion are called porta-caval fibrous connections (PCFCs). This opinion review aims to promote a systematic understanding of the hepatic connective-tissue skeleton and to demonstrate the hitherto underappreciated PCFC as a genuine structure with high biological and clinical significance. The components of the liver connective-tissue framework — the capsules, plates, sheaths, covers — are described, and their intercommunication is discussed. The analysis of the essence of the PCFC and a description of its various forms are provided. It is also mentioned that analogs of different forms of PCFC are found in different mammals.

Late-onset Rupture of the Intrahepatic Pseudoaneurysm Developed by Endoscopic Ultrasonography-guided Hepaticogastrostomy: A Case Report and Literature Review

“…Intrahepatic pseudoaneurysms can develop anywhere in the liver if the drill dilator is in proximity within an artery. However, the hepatic arteries are enveloped in Glisson's cap- sule, with the bile duct and portal veins extending from the liver hilum to the periphery (16,17). Therefore, the vessels in the Glisson's capsule are always at risk of being injured by the drill dilator.…”

Interrelationship of Hepatic Veins with Separate Components of Portal Triad

“…A direct relationship between the hepatic vein and the bile duct within the area of the portocaval connective tissue connection is a frequent phenomenon. [7][8][9][10][11][12] This is explained by the fact that, firstly, the intrahepatic bile ducts in the portal tract are located most peripherally from the other elements of the portal triad, and secondly, because the sectional and segmental bile ducts are usually located superior to the other elements of the portal triad and, therefore, appear closer to the hepatic veins. In this regard, it is also important that the portal triad often contains several bile ducts of different calibers, one of which is usually directed to the hepatic vein (Fig.…”