Hepatic Veins

What are the hepatic veins?

Your hepatic veins are a group of blood vessels that drain blood from your liver into your inferior vena cava (IVC). Your IVC is a large vein that collects blood from your lower body and returns it to the top right chamber of your heart (right atrium).

What are the three major hepatic veins?

The three major hepatic veins are your:

• Right hepatic vein.
• Left hepatic vein.
• Middle hepatic vein.

Your hepatic veins are an important part of your circulatory system. They’re responsible for draining oxygen-poor blood from your liver and carrying it to your inferior vena cava (IVC). This blood then flows through your heart and lungs and gains oxygen before your heart pumps it back out to your body.

Where are the hepatic veins located?

Your hepatic veins are in your liver. They travel within and across your liver’s eight segments and mark the boundaries of its four anatomical sectors. Healthcare providers call these four areas your right anterior, right posterior, left medial and left lateral sectors.

Within your liver, your hepatic veins drain blood from your central veins. These are tiny blood vessels that collect blood from capillaries throughout your liver.

Your hepatic veins leave the back of your liver and immediately enter your inferior vena cava (IVC). They enter your IVC near your spine just below your diaphragm.

The right hepatic vein typically enters the IVC on its own, while the middle and left hepatic veins merge to form a common trunk before draining into the IVC. However, variations often occur.

Anatomical variations

Variations in your hepatic vein anatomy are harmless. But surgeons look for them before performing certain operations (like liver transplantation and liver resection).

There are many possible variations, including:

• Accessory inferior right hepatic vein. An additional vein drains into your IVC below the level of the three major hepatic veins.
• Two right hepatic veins. These veins may unite to form a common trunk before draining into your IVC. Or they may enter your IVC separately.
• Early branching of right hepatic vein. A small vein tributary drains into your right hepatic vein just before it enters your IVC.
• Independent drainage of middle and left hepatic veins. These two veins drain separately into your IVC, instead of first merging into a common trunk.

How big are the hepatic veins?

Hepatic veins have an average diameter of 15 millimeters.

What conditions affect the hepatic veins?

Budd-Chiari syndrome is a condition that occurs when blood clots form in your hepatic veins. The clots narrow or block your veins, causing a backup of blood in your liver. This congestion disrupts the network of blood vessels in and around your liver. Possible complications include:

• Portal hypertension.
• Esophageal varices.
• Ascites.
• Cirrhosis of the liver.

Common symptoms

Symptoms of Budd-Chiari syndrome and its complications include:

• Blood in your poop.
• Digestive issues like loss of appetite, indigestion or constipation.
• Fatigue or weakness.
• Pain in your upper belly.
• Swelling from fluid in your belly and quick weight gain.
• Shortness of breath.
• Swelling (edema) in your legs or ankles.
• Vomiting blood.

Common tests

Healthcare providers diagnose hepatic vein issues through a physical exam and one or more of the following tests:

• Blood tests that check your liver function.
• Ultrasound.
• Computed tomography (CT) scan.
• Magnetic resonance imaging (MRI).
• Liver biopsy.

Common treatments

Treatment includes medication to dissolve the blood clots (thrombolytic therapy) and procedures to help your blood flow better. Your provider will discuss specific treatment methods with you based on your diagnosis and individual needs.

How can I keep my hepatic veins healthy?

Here are some tips for keeping your hepatic veins and all of your blood vessels working at their best:

• Limit how much alcohol you drink. Too much alcohol can harm your heart, blood vessels and liver. If you choose to drink, follow the guidelines for moderation.
• Don’t use tobacco products. Smoking harms your blood vessels and is a major risk factor for cardiovascular disease.
• Manage underlying conditions. Talk to your provider about any health conditions you have, like high blood pressure or metabolic syndrome, and how to manage them. Some conditions can damage your blood vessels over time.
• Eat a heart-healthy diet. The Mediterranean diet in particular helps lower your risk for cardiovascular disease.
• Exercise. Ask your provider what types of exercise are safe and helpful for you. Moving more can help improve blood flow through your body.
• Visit your provider for yearly checkups. Your provider will check your vital signs and order other tests as necessary to diagnose and treat any issues that arise.

Are the hepatic vein and portal vein the same?

No. Your hepatic veins and your portal vein are different blood vessels with opposite functions. Your portal vein, sometimes called your hepatic portal vein, carries blood into your liver. Meanwhile, your hepatic veins carry blood out of your liver.

Your portal vein is part of your portal venous system. This is a network of veins that drains blood from organs in your belly and sends it to your liver for processing.

Your hepatic veins aren’t part of that system. They carry blood that your liver has already processed. They deliver this blood to your inferior vena cava, which sends it directly to your heart.