The Anatomy Features and Variations of the Point Where Right Gastroepiploic Vein Flows into Superior Mesenteric Vein/Portal Vein: Anatomical Study of Catheterization of Portal Vein Infusion Chemotherapy.

Introduction: To study the anatomical features and classification of the angle between the right gastroepiploic vein (RGEV) and superior mesenteric vein/portal vein (SMV/PV) and to guide the catheterization of intraportal infusion chemotherapy through RGEV and reduce surgical complications. Patients and Methods: A retrospective three-dimensional (3D) computed tomography study was undertaken on 200 consecutive subjects with or without hepatic malignant tumors with a dedicated workstation 3D-MIA (the improved MI-3DVS workstation) developed by ourselves to determine the prevalence of surgically significant angle between RGEV and SMV/PV anatomic variations and its classification. Results: The mean value of the angles between the end of RGEV and SMV/PV (AERS/P) (200 cases) was 84.2 degrees 23.8 (31.4 degrees-151.5 degrees): 40.6 degrees +/- 92.3 (-177.9 degrees to 178.0 degrees) (sagittal angle), 81.7 degrees +/- 29.8 (-79.3 degrees to 160.7 degrees) (coronal angle), and 10.5 degrees +/- 94.3 (-178.7 degrees to 175.8 degrees) (horizontal angle). The mean value of the angles between the right bend of RGEV and SMV/PV (ARRS/P) (168 cases) was 104.8 degrees +/- 26.1 (20.5 degrees-159.7 degrees):49.3 degrees +/- 117.8 (-175.3 degrees to 179.5 degrees) (sagittal angle), 103.5 degrees +/- 37.7 (-178.8 degrees to 168.9 degrees) (coronal angle), and 12.6 degrees +/- 102.8 (-179.9 degrees to 179.2 degrees) (horizontal angle). The AERS/P were classified into large angle group (32 cases, 16%), middle angle group (113 cases, 56.5%), and small angle group (55 cases, 27.5%) based on angle variations and risks of catheterization. Conclusions: Precognition of the variations of AERS/P and ARRS/P before surgery is useful during chemotherapy pump catheterizing through RGEV in reduction of surgical complications by modulating the angle and direction of RGEV running into SMV/PV properly.