Left renal vein variations

Abstract

The highly complex embryological development of the left renal vein compared to its right counterpart results in greater variations which are clinically significant. The study aimed to identify these variations and to document its incidence. Cadaveric study: 153 kidney pairs were harvested en bloc, dissected, 100 resin casts prepared and 53 plastinated; renal venography performed on further 58 adults and 20 foetal cadavers. Clinical study: (retrospective analysis): a) radiological study, 104 renal venograms; b) live related renal transplantation, 148 donor left kidneys; c) abdominal aortic aneurysm surgery, 525 patients. Total sample size: 1008. Renal collars observed in 0.3%; retro-aortic vein 0.5%; additional veins 0.4%; posterior primary tributary 23.2%, (16.7% Type IB; 6.5% Type IIB, cadaveric series, only). Our results differ significantly in incidence to that reported in the literature: renal collar 0.2-30%; retro-aortic vein 0.8-7.1%; additional renal vein 0.8-6%. Variations are clinically silent and remain unnoticed until discovered during venography, operation or autopsy. To a transplant surgeon, morphology acquires special significance, since variations influence technical feasibility of operation. Prior knowledge of circum-aortic vein is important when blood samples from suprarenal or renal veins are collected. Collar may provide developed collateral pathway immediately after surgery if renal interruption planned without awareness of its presence. Variations restrict availability of vein for mobilisation procedures. In aortic aneurysm repair, retro-aortic vein is important. During retroperitoneal surgery, the surgeon may visualise a pre-aortic vein but be unaware of an additional retroaortic component or a posterior primary tributary, and may avulse it while mobilising the kidney or clamping the aorta.

Prevalence and Incidence of Clinical Symptoms of the Retroaortic Left Renal Vein

“…This combination is preferable and the data published can certainly be regarded as highly accurate. Our data with close to 8,000 patients, confirming a low RLRV prevalence rate of 0.77%, are comparable to Satyapal et al's [21] and Hoeltl et al's [22] findings.…”

“…Arslan et al [20], studying 1,125 patients, reported an overall prevalence of 1.7%. Among a series of 1,008 patients, Satyapal et al [21] detected 0.5% of RLRV cases. Hoeltl et al [22] reported an overall prevalence of 0.4% studying 4,520 patients.…”

“…Among a series of 1,008 patients, Satyapal et al [21] detected 0.5% of RLRV cases. Hoeltl et al [22] reported an overall prevalence of 0.4% studying 4,520 patients. They both presented data from clinical radiographic investigations and autopsy findings.…”

Double right renal vein: clinical and surgical implications and review of the literature

“…An error of fusion of these two vessels, thus causing their persistence, may result in bilateral or unilateral duplication of these vessels [10]. Occurrences of multiple renal veins are relatively common, and several authors have reported large numbers of venous variations resulting from embryonic developmental errors [1], [5], [11][12][13]. According to Kaneko, Kobayashi and Okada [14], the renal veins present fewer variations than do the renal arteries, and multiple renal veins are more common on the right side than on the left-sid [8].…”

Unusual Combination Of Vascular Variations In The Retroperitoneal Region. A Morphological Study

“…Variations of renal veins are usually asymptomatic and are discovered only during surgical procedures. Morphology of renal vein is significantly important for surgeons during transplantation, since variations restrict the availability of renal vein for mobilization procedures [23].…”