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      Umbilical cord vessels other than the umbilical arteries and vein: a histological study of midterm human fetuses


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          At birth, the umbilical cord contains various types of thin vessels that are near and outside the umbilicus and separate from the umbilical arteries and vein. These vessels are regarded as the remnant “vitelline vessels” and are often called “umbilical vessels”, although this terminology could lead to confusion with the true umbilical arteries and vein. No study has yet comprehensively examined these vessels using histological sections. Our examination of these vessels in 25 midterm fetuses (gestational age: 10–16 weeks) led to five major findings: (i) all specimens had umbilical branches of the inferior epigastric artery; (ii) 5 specimens had vitelline vein remnants; (iii) 4 specimens had a thin artery originating from the left hepatic artery that ran along the umbilical vein; (iv) 2 specimens had a so-called “para-umbilical vein” that was along the umbilical vein and reached the umbilicus; and (v) all specimens had lymphatic vessels originating from the umbilicus that ran caudally along the umbilical artery. The pelvic vein tributaries were well developed along the intra-abdominal umbilical artery, but did not reach the umbilicus. The lymphatic vessel was distinguished from the veins by an intraluminar cluster of lymphocytes attaching to the endothelium. The arterial branch in the umbilical cord did not accompany veins and lymphatic vessels, in contrast to the mother artery in the rectus abdominis. All these thin vessels seemed to be obliterated when the fibrous umbilical ring grew during late-term. The para-umbilical collateral vein in adults might develop outside the fibrous umbilical ring after birth.

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          The umbilical and paraumbilical veins of man.

          During its transit through the umbilicus structural changes occur in the thick wall of the extra-abdominal segment of the umbilical vein whereby the components of the intra-abdominal segment acquire an essentially longitudinal direction and become arranged in fibro-elastic and fibro-muscular zones. The vein lumen becomes largely obliterated by asymmetrical proliferation of loose subendothelial conective tissue. The latter forms a new inner zone within which a small segment of the lumen persists in an eccentric position. This residual lumen transmits blood to the portal system from paraumbilical and systemic sources, and is retained in the upper part of the vein, even in old age. A similar process of lumen closure is observed in the ductus venosus. In early childhood the lower third of the vein undergoes breakdown, with fatty infiltration, resulting in its complete division into vascular fibro-elastic strands, and in old age some breakdown occurs in the outermost part of the wall of the upper two thirds. The paraumbilical veins are thick-walled and of similar structure to the umbilical vein. Together they constitute an accessory portal system which is confined between the layers of the falciform ligament and is in communication with the veins of the ventral abdominal wall. The constituents form an ascending series, namely, Burow's veins, the umbilical vein, and Sappey's inferior and superior veins. The main channel of Sappey's inferior veins may be the remnant of the right umbilical vein since it communicates with the right rectus sheath and often communicates directly with the portal system within the right lobe of the liver. The results are of significance in relation to clinical usage of the umbilical vein.
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              The vascular anatomy of the ligaments of the liver: gross anatomy, imaging and clinical applications

              The vessels that communicate between the liver and adjacent structures require bridges between them. The bridges comprise the ligaments of the liver as follows: the falciform ligament, right and left coronary ligaments, lesser omentum including the hepatogastric ligament and hepatoduodenal ligament. Each ligament has specific communications between the intrahepatic and extrahapetic vessels. The venous communications called as the portosystemic shunt would become apparent in patients with portal hypertension, intrahepatic portal vein thrombosis and superior vena cava syndrome. The location of the venous communication is related to the pseudolesion or focal enhancement of the liver demonstrated on the CT scan. The arterial communications called collateral vascularization would become apparent in patients with hepatic artery occlusion, especially post-transhepatic arterial embolization, or in patients with the hepatic tumour abutting diaphragm. The knowledge of these collateral arteries is necessary to accomplish the effective transarterial embolization for the hepatic tumours. We reviewed the vessels in these ligaments using contrast-enhanced CT scans and angiography and discussed the clinical applications. Cadaver dissection photos were included as supplementary images for readers to recognize the actual spatial anatomy of the vessel in each ligament.

                Author and article information

                Anat Cell Biol
                Anat Cell Biol
                Anatomy & Cell Biology
                Korean Association of Anatomists
                31 December 2022
                31 December 2022
                31 December 2022
                : 55
                : 4
                : 467-474
                [1 ]Department of Anatomy, Jeonbuk National University Medical School, Jeonju, Korea
                [2 ]Department of Anatomy, Division of Basic Medicine, Tokai University School of Medicine, Isehara, Japan
                [3 ]Department of Anatomy, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
                [4 ]Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan
                [5 ]Department of Anatomy and Embryology, School of Medicine, Complutense University, Madrid, Spain
                Author notes
                Corresponding author: Ji Hyun Kim, Department of Anatomy, Jeonbuk National University Medical School, Jeonju 54907, Korea, E-mail: 407kk@ 123456hanmail.net
                Author information
                Copyright © 2022. Anatomy & Cell Biology

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 16 May 2022
                : 7 June 2022
                : 8 June 2022
                Original Article

                Cell biology
                umbilical cord,umbilical arteries and vein,para-umbilical vein,inferior epigastric artery,lymphatic vessels


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