Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2021; 13(11): 1484-1493
Published online Nov 27, 2021. doi: 10.4254/wjh.v13.i11.1484
Porta-caval fibrous connections — the lesser-known structure of intrahepatic connective-tissue framework: A unified view of liver extracellular matrix
Leila Patarashvili, Salome Gvidiani, Elza Azmaipharashvili, Keti Tsomaia, Marom Sareli, Dimitri Kordzaia, Ilia Chanukvadze
Leila Patarashvili, Dimitri Kordzaia, Department of Clinical Anatomy and Operative Surgery, Ivane Javakhishvili Tbilisi State University, Tbilisi 0159, Georgia
Salome Gvidiani, Elza Azmaipharashvili, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0159, Georgia
Keti Tsomaia, Clinical Anatomy and Experimental Modeling, Institute of Morphology, Ivane Javakhishvili Tbilisi State University, Tbilisi 0159, Georgia
Marom Sareli, Department of Surgical Oncology (Surgery C), Chaim Sheba Medical Center at HaShomer, Ramat Gan, Tel Aviv 52621, Israel
Ilia Chanukvadze, Faculty of Medicine, Tbilisi State Medical University, Tbilsi 0177, Georgia
Author contributions: Patarashvili L, Azmaipharashvili E, Tsomaia K, Gvidiani S and Kordzaia D contributed equally to the research, data acquisition, and writing of the paper; Kordzaia D, Sareli M and Chanukvadze I elaborated the main concept of the opinion review and provided oversight of the works and manuscript appraisal; all authors agreed on the final version of the paper.
Conflict-of-interest statement: The authors declare no conflict of interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitri Kordzaia, DSc, MD, PhD, Dean, Professor, Clinical Anatomy and Operative Surgery, Ivane Javakhishvili Tbilisi State University, Beliashvili str. 78, Tbilisi 0159, Georgia. dimitri.kordzaia@tsu.ge
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: May 3, 2021
Revised: May 17, 2021
Accepted: August 30, 2021
Article in press: August 30, 2021
Published online: November 27, 2021

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 20th 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.

Keywords: Hepatic capsule, Hilar plate, Perivascular fibrous sheath, Glissonean pedicle, Portal tract, Caval port

Core Tip: In the places of spatial intersection of the Glissonean pedicles with the main hepatic veins, the fusion of their connective tissue sheaths is described. The sites of the above-mentioned fusion are called porta-caval fibrous connections. Various forms of porta-caval fibrous connections are discussed as well as their clinical and scientific implications.