Clinical significance and renal haemodynamics of incidentally detected retroaortic left renal vein: assessment with venous Doppler sonography

Abstract

The purpose of this study was to determine whether renal venous pulsations are affected by compression of the left renal vein (LRV) between the aorta and spine, and also to determine the clinical significance of incidentally detected retroaortic LRV. The study population was recruited from 783 consecutive patients undergoing abdominal CT examination for various indications. 22 patients with a retroaortic LRV were prospectively enrolled in this study, and 22 patients without renal disease served as a control group. After measuring the diameters of the central and peripheral portions of the LRV on CT images, the ratio (P/C) and difference (P-C) of the diameters were calculated. Doppler sonography of the interlobar arteries and veins of the left kidney was then performed to obtain impedance indices. Urine analysis of all subjects and scrotal colour Doppler ultrasound of male patients were also performed. The retroaortic LRV diameters were significantly narrower than the pre-aortic LRV diameters (p = 0.002). The left intrarenal venous impedance indices were significantly higher in the patients with retroaortic LRV (p = 0.026) and in the subgroups with P/C>2 (p = 0.020), with P-C>4 mm (p = 0.007) and without nutcracker-like associations (p = 0.006) than in control subjects, but no significant difference was noted between the arterial resistance indices. Haematuria (n = 8), proteinuria (n = 4), varicocele (n = 3) and collaterals (n = 1) were detected in the study group but not in the control group. In conclusion, incidentally detected retroaortic LRV appears to be associated with haematuria, proteinuria, varicocele and altered venous pulsatility. Further investigations are needed to understand the role of venous Doppler ultrasound in the nutcracker phenomenon.

Evaluation of renal anomalies, inferior vena cava variations, and left renalvein variations by lumbar magnetic resonance imaging in 3000 patients

“…Another study conducted by Yeşildağ et al (23) revealed the incidences of RLRV and CLRV as 2.3% and 0.9%, respectively. Yagci et al (24) also stated the prevalence of RLRV as 2.9%. The frequencies in the present study are within the range of the above-mentioned studies, which helped us compare other imaging modalities with MRI and led us to conclude that MRI can be used in the evaluation of the left renal vein and its variations.…”

Oblique Retro-Aortic Left Renal Vein and its Clinical Importance

“…8 Retro-aortic left renal vein may be compressed between the aorta and the lumbar vertebra leading to left renal venous hypertension which is known as "Posterior Nutcracker Syndrome" which is manifested by left flank and abdominal pain with or without hematuria. [9][10][11] Increased pressure in the left renal vein can lead to the left sided varicocele and this in turn may lead to difficulties in spermatogenesis. 12,13 Presence of retro-aortic left renal vein in females may result in Pelvic Congestion Syndrome which is characterized by lower abdominal pain, dysmenorrhoea, dyspareunia, vulval, gluteal or thigh varices and emotional disturbances.…”

Evaluation of left renal vein and inferior vena cava variations through routine abdominal multi-slice computed tomography

“…This may be due to the negative effects of these variations on renal function. In a previous study, an increase in the intrarenal venous impedance index was found to result from the compression of the retroaortic LRV behind the aorta [14]. Such variations may have negative effects on renal haemodynamics.…”