Major Venous Anomalies Complicating Abdominal Aortic Surgery

Brener, Bruce J.

doi:10.1001/archsurg.1974.01350260019004

Cited by 146 publications

(64 citation statements)

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“…Because of its anatomical location, the retroaortic left renal vein, and anomalous left renal vein coursing behind the abdominal aorta, has received a clinical attention for the surgical retroperitoneal operations and the misinterpretation of clinical diagnosis (Thomas, 1970;Brener et aL , 1974;Moul et al, 1992) as well as the rise in internal pressure of the left renal vein. This anomaly has been detectable by clinicians using computerized tomography, magnetic resonance imaging and ultrasound examination, and thus, reported recently in many clinical cases (Hoeltl et al, 1990;Moul et al, 1992).…”

mentioning

confidence: 99%

An Anatomical Study of the Retroaortic Left Renal Vein

Yoshinaga

Kawai

Kodama

2000

Okajimas Folia Anatomica Japonica

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Summary:Retroaortic left renal vein was found in a 55-year-old male cadaver during a student course anatomical dissection. This anomaly coursed dorsal to the abdominal aorta and opened into the inferior vena cava at the upper level of the 3rd lumbar vertebra.This retroaortic left renal vein connected directly to the azygos vein system and the 3rd lumbar vein. It also received the posterior suprarenal and posterior inferior phrenic veins.Because of its anatomical location, the retroaortic left renal vein, and anomalous left renal vein coursing behind the abdominal aorta, has received a clinical attention for the surgical retroperitoneal operations and the misinterpretation of clinical diagnosis (Thomas, 1970;Brener et aL , 1974;Moul et al., 1992) as well as the rise in internal pressure of the left renal vein. This anomaly has been detectable by clinicians using computerized tomography, magnetic resonance imaging and ultrasound examination, and thus, reported recently in many clinical cases (Hoeltl et al., 1990;Moul et al., 1992). Since the development of the retroperitoneal veins including the left renal vein is highly complex (McClure and Butler, 1925), a full understanding of the regional anatomy of this anomaly and its related veins is imperative not only for surgical operations but also for the knowledge of the venous morphogenesis. However, the retroaortic left renal vein has been described in detail by only 3 dissected cases in the anatomical literature (Kitamura et al., 1979;Izumiyama and Horiguchi, 1997).Recently, we have found the retroaortic left renal vein during a student course dissection. Since this anomaly is not only rare case but also is seemed to be significant for understanding the development of the retroperitoneal venous system, we report here a detailed anatomy of this anomaly and its related vessels, and discuss its anatomical and embryological significance. Materials and MethodsA total of 203 Japanese bodies were dissected in the anatomical practice during a period of 1993 through 1999 at the Kumamoto University School of Medicine. In this period, an anomalous left renal vein was found in the cadaver of a 55-year-old Japanese male who died from cancer of the rectum. This anomaly and its related vessels in the retroperitoneal cavity were carefully examined, and the findings were recorded by line drawings and photographs. ObservationsA single left renal vein emerging from the renal hilum at the middle level of the 2nd lumbar vertebra ran horizontally for a distance of 25 mm, then course obliquely caudal and dorsal to the abdominal aorta, and finally opened into the left margin of the inferior vena cava (IVC) at the upper level of the 3rd lumbar vertebra (Figs. 1, 2). This opening was 40 mm distal to the caudal side of the opening for the right renal vein and 22 mm in diameter, while the diameter of the IVC was 25 mm. The

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confidence: 99%

An Anatomical Study of the Retroaortic Left Renal Vein

Yoshinaga

Kawai

Kodama

2000

Okajimas Folia Anatomica Japonica

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“…Aortic dissection may be complicated by massive intraoperative bleeding, the most troublesome being venous rather than arterial hemorrhage [3]. Control of this bleeding is very difficult [3,50]. Brener et al [50] reported that during abdominal aortic reconstruction, approximately 40% of retroaortic left renal veins were injured.…”

Section: Retroaortic Left Renal Veinmentioning

confidence: 99%

“…Control of this bleeding is very difficult [3,50]. Brener et al [50] reported that during abdominal aortic reconstruction, approximately 40% of retroaortic left renal veins were injured. Of these, five were successfully repaired, two needed nephrectomy for control of the hemorrhage, and two patients died as a result of hemorrhage.…”

Section: Retroaortic Left Renal Veinmentioning

confidence: 99%

Coexistence of the Aortic Aneurysm with the Main Vein Anomalies: Its Potential Clinical Implications and Vascular Complication

Polguj¹,

Stefańczyk²,

Stefańczyk³

2017

Aortic Aneurysm

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Four major variations of the venous system in the retroperitoneal space are the retroaortic left renal vein, left renal vein collar, left-sided inferior vena cava, and caval duplication. During surgery, especially, injury in veins is responsible for the most unexpected intraoperative bleeding. Therefore, above-mentioned anomalies pose potential hazards to surgeons during treatment of abdominal aortic aneurysm. Preoperative diagnosis is highly desirable but is not always available so, during abdominal surgery, familiarity with the anatomy of the most common types of venous variations is the first step toward preventing vascular injury. The chapter includes information describing the demographic, clinical, and morphological characteristics of the presence of the aforementioned main vein anomalies including: gender distribution, frequency in population, the most commonly reported symptoms, and associate complications. Massive intraoperative bleeding may be dangerous during aortic dissection; however, venous bleeding is more complicated than arterial hemorrhage. Significant venous bleeding, in particular, can occur if major retroperitoneal venous anomalies are present. The anomalous veins are typically thinwalled, dilated, and tortuous. As a result, manipulation of these veins during abdominal aortic surgery places the patient at high risk of long-term massive hemorrhage.

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“…1,4,5) It has been reported that approximately 3% of the population has retroaortic left renal vein. 6) In these people, the left renal vein does not become a landmark for renal artery during surgery because the vein is located dorsal to the aorta. Aorto-left renal vein fistula is often seen in patients with retroaortic left renal vein.…”

Section: Case Reportmentioning

confidence: 99%

Aorto-Left Renal Vein Fistula Caused by a Ruptured Abdominal Aortic Aneurysm

Tanaka

Naito

Murayama

et al. 2013

Annals of Vascular Diseases

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Retroaortic left renal vein is a malformation in which the left renal vein courses dorsal to the abdominal aorta. In patients with abdominal aortic aneurysm, an aorto-left renal vein fistula can form if the left renal vein is sandwiched between the aneurysm wall and lumbar vertebrae. The patient was an 84-year-old man with lower back pain. We performed a contrast-enhanced computed tomography (CT), although renal dysfunction was noted. The CT showed a ruptured juxta-renal abdominal aortic with aorto-left renal vein fistula. This clinical condition can cause severe renal dysfunction, in spite of which an enhanced contrasted CT scan would be extremely informative preoperatively.

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Major Venous Anomalies Complicating Abdominal Aortic Surgery

Cited by 146 publications

References 18 publications

An Anatomical Study of the Retroaortic Left Renal Vein

An Anatomical Study of the Retroaortic Left Renal Vein

Coexistence of the Aortic Aneurysm with the Main Vein Anomalies: Its Potential Clinical Implications and Vascular Complication

Aorto-Left Renal Vein Fistula Caused by a Ruptured Abdominal Aortic Aneurysm

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