Surgical objective and anatomical approach
The main objective of transumbilical catheterization is to create direct access to the portal vein system for targeted administration of necessary medications or radiopaque agents.
To perform the approach, the surgeon makes an incision of the anterior abdominal wall strictly along the midline. The incision is placed 3–4 cm above the umbilicus, and its total length is 4–5 cm.
Step-by-step technique of isolation and bougienage
The surgical intervention is performed according to the following algorithm:
- Access and isolation: The linea alba is opened layer by layer, after which the umbilical vein is found in the preperitoneal tissue. The central end of the vessel is grasped with a clamp and transected transversely.
- Bougienage: To dilate the lumen, a metal bougie 0.4–0.5 cm in diameter or a No. 6 ureteral catheter is used. The instrument is advanced toward the porta hepatis at a 45° angle, overcoming the natural resistance before entering the portal vein with extreme caution.
Drainage and potential complications
Following successful bougienage, a polyethylene drainage tube is inserted into the vessel lumen. It is securely fixed with a ligature, and the peripheral segment of the vessel must be ligated.
Dangerous technical errors may occur during the operation:
- perforation of the vein in the porta hepatis region;
- dissection of the vessel wall.
Briefly: answers to topical questions
Which layers of the anterior abdominal wall are incised layer by layer during a midline approach to the umbilical vein?
During a midline approach to the umbilical vein, the skin with subcutaneous tissue and the linea alba are incised. The incision is made along the midline, 3–4 cm above the umbilicus. After opening the linea alba, the umbilical vein is identified and isolated in the preperitoneal tissue.
Into which specific branch of the portal vein does the umbilical vein empty?
The umbilical vein empties into the left branch of the portal vein. After passing within the round ligament of the liver, it retains its lumen and connects directly with the left branch of the portal vein. This anatomical feature is of great clinical importance, as it allows the umbilical vein to be used for translumbar/transhepatic portography (portography) and targeted drug administration directly into the portal vein system.
Within which ligament of the liver is the umbilical vein located?
The umbilical vein is located within the round ligament of the liver (ligamentum teres hepatis). This ligament runs from the umbilicus to the porta hepatis in the eponymous sulcus and lies inside the falciform ligament (ligamentum falciforme). Along with the umbilical vein (v. umbilicalis), the paraumbilical veins (vv. paraumbilicales) run within the round ligament. After birth, the umbilical vein obliterates only near the umbilical ring, while along the rest of its course inside the ligament it retains its lumen.
Class and exam questions
What is the main goal of umbilical vein catheterization?
The main goal is the administration of medications or radiopaque solutions directly into the portal vein system.
Where is the anterior abdominal wall incision made during this approach?
The incision is made along the midline, 3–4 cm above the umbilicus, and its length is 4–5 cm.
What instruments are used for bougienage of the umbilical vein?
A No. 6 ureteral catheter or a metal bougie with a diameter of 0.4–0.5 cm is used.
What are the main complications described during catheterization?
The main complications include perforation of the vein in the area of the porta hepatis and dissection of its wall.
What else to study on this topic
- Anatomical features of the umbilical and portal veins
- Hemostasis in surgeries on the liver and biliary tract
- Selection of radiopaque agents for administration
- Prevention of vascular complications during bougienage
- Techniques for fixing drainage tubes in vessels
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