Case Report
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Retroaortic left renal vein: a clinically significant vascular variation with suggestion of a practical typological scheme

Year 2022, Volume: 16 Issue: 1, 41 - 45, 20.04.2022

Abstract

The retroaortic left renal vein (RLRV) is a rare vascular variant with a typical position of the vein between the abdominal aorta and the vertebral column. Despite usually asymptomatic, RLRV might be associated with posterior nutcracker syndrome, other vascular pathologies and may cause major surgical complications. An existing but not expected RLRV might hamper aortic surgical dissection and to cause a life threatening bleeding. A case of a RLRV was observed during routine dissection of a formalin fixed 62-year-old female cadaver. The left kidney was found to be ectopic and located lower than usual between the level of L1 and L4 vertebra. The left renal vein was formed in the renal hilum at the level of L2/L3 intervertebral disc, and then passed obliquely downwards behind the abdominal aorta to join in the inferior vena cava at the level of upper border of L4 vertebra. The length of the RLRV was 7.5 cm. The main tributaries were the left suprarenal and left ovarian veins. Measuring the diameters of the renal vein showed slight dilation at its origin. Based on the literature review, the vascular variation reported here can be classified as Type II – RLRV draining at a lower than normal level of the inferior vena cava. An extended classification scheme of the left renal vein variations is presented here as well as an optional typological scheme.

References

  • Karkos CD, Bruce IA, Thomson GJ, Lambert ME. Retroaortic left renal vein and its implications in abdominal aortic surgery. Ann Vasc Surg 2001;15:703–8.
  • Karaman B, Koplay M, Ozturk E, Basekim CC, Ogul H, Mutlu H, Kizilkaya E, Kantarci M. Retroaortic left renal vein: multidetector computed tomography angiography findings and its clinical importance. Acta Radiol 2007;48:355–60.
  • Tatar I, Töre HG, Çelik HH, Karcaaltincaba M. Retroaortic and circumaortic left renal veins with their CT findings and review of the literature. Anatomy 2008;2:72–6.
  • Turamanlar O, Ünlü E, Toktaş M, Horata E, Songur A. Variation of right renal artery duplication with retroaortic left renal vein: a case report. Anatomy 2015;9:91–3.
  • Dilli A, Ayaz UY, Karabacak OR, Tatar IG, Hekimoglu B. Study of the left renal variations by means of magnetic resonance imaging. Surg Radiol Anat 2012;34:267–70.
  • Yi SQ, Ueno Y, Naito M, Ozaki N, Itoh M. The three most common variations of the left renal vein: a review and meta-analysis. Surg Radiol Anat 2012;34:799–804.
  • Hoeltl W, Hruby W, Aharinejad S. Renal vein anatomy and its implications for retroperitoneal surgery. J Urol 1990;143:1108–14.
  • Bass JE, Redwine MD, Kramer LA, Huynh PT, Harris JH Jr. Spectrum of congenital anomalies of the inferior vena cava: cross-sectional imaging findings. Radiographics 2000;20:639–52.
  • Kurklinsky AK, Rooke TW. Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc 2010;85:552–9.
  • Hangge PT, Gupta N, Khurana A, Quencer KB, Albadawi H, Alzubaidi SJ, Knuttinen M-G, Naidu SG, Oklu R. Degree of left renal vein compression predicts nutcracker syndrome. J Clin Med 2018;7:107.
  • Ali-El-Dein B, Osman Y, Shehab El-Din AB, El-Diasty T, Mansour O, Ghoneim MA. Anterior and posterior nutcracker syndrome: a report on 11 cases. Transplant Proc 2003;35:851–3.
  • Shindo S, Kubota K, Kojima A, Iyori K, Ishimoto T, Kobayashi M, Kamiya K, Tada Y. Anomalies of inferior vena cava and left renal vein: risks in aortic surgery. Ann Vasc Surg 2000;14:393–6.
  • Knipp B, Knechtges P, Gest T, Wakefield T. Inferior vena cava: embryology and anomalies. In: Upchurch GR Jr, Criado E, editors. Aortic aneurysms: pathogenesis and treatment. New York (NY): Humana Press; 2009. p. 289–307.
  • Satyapal KS, Rambiritch V, Pillai G. Morphometric analysis of the renal veins. Anat Rec 1995;241:268–72.
  • Kumaresan M, Sankaran PK, Gunapriya R, Karthikeyan G, Priyadarshini A. Morphometric study of renal vein and its variations using CT. Indian Journal of Medical Research and Pharmaceutical Sciences 2016;3:41–9.
  • Minniti S, Visentini S, Procacci C. Congenital anomalies of the venae cavae: embryological origin, imaging features and report of three new variants. Eur Radiol 2002;12:2040–55.
  • Nam JK, Park SW, Lee SD, Chung MK. The clinical significance of a retroaortic left renal vein. Korean J Urol 2010;51:276–80.
  • Zhu J, Zhang L, Yang Z, Zhou H, Tang G. Classification of the renal vein variations: a study with multidetector computed tomography. Surg Radiol Anat 2015;37:667–75.
  • Chuang VP, Mena CE, Hoskins PA. Congenital anomalies of the left renal vein: angiographic consideration. Br J Radiol 1974;47:214–8.
  • Guttmann G, Endean E. Embryology. In: Cronenwett J, Johnston W, editors. Rutherford’s vascular surgery. Vol. 1. 7th ed. Philadelphia (PA): Saunders Elsevier; 2010. pp. 15–30.
  • Kyung DS, Lee JH, Shin DY, Kim DK, Choi IJ. The double retro-aortic left renal vein. Anat Cell Biol 2012;45:282–284.
  • Panagar AD, Subhash LP, Suresh BS, Nagaraj DN. Circumaortic left renal vein – a rare case report. J Clin Diagn Res 2014;8:111–2.
  • Koc Z, Ulusan S, Tokmak N, Oguzkurt L, Yildirim T. Double retroaortic left renal veins as a possible cause of pelvic congestion syndrome: imaging findings in two patients. Br J Radiol 2006;79:e152–5.
  • Shin JI, Lee JS. Nutcracker phenomenon or nutcracker syndrome? Nephrol Dial Transplant 2005;20:2015
  • Brener BJ, Darling RC, Frederick PL, Linton RR. Major venous anomalies complicating abdominal aortic surgery. Arch Surg 1974;108:159–65.
  • Kim MK, Ku YM, Chun CW, Lee SL. MDCT findings of right circumaortic renal vein with ectopic kidney. Korean J Radiol 2013;14:786–8.
  • Calligaro KD, Savarese RP, DeLaurentis DA. Unusual aspects of aortovenous fistulas associated with ruptured abdominal aortic aneurysms. J Vasc Surg 1990;12:586–90.
  • Polguj M, Stefaƒczyk K, Stefaƒczyk L. Coexistence of the aortic aneurysm with the main vein anomalies: its potential clinical implications and vascular complication. In: Kirali K, editor. Aortic aneuryam. Rijeka, Croatia: IntechOpen; 2017. Chapter 8. pp: 129–42.
  • Mansour MA, Rutherford RB, Metcalf RK, Pearce WH. Spontaneous aorto-left renal vein fistula: the “abdominal pain, hematuria, silent left kidney” syndrome. Surgery 1991;109:101–6.
  • Meyerson SL, Haider SA, Gupta N, O’Dorsio JE, McKinsey JF, Schwartz LB. Abdominal aortic aneurysm with aorta-left renal vein fistula with left varicocele. J Vasc Surg 2000;31:802–5.
  • Savarese LG, Trad HS, Joviliano EE, Muglia VF, Elias Junior J. Fistula between the abdominal aorta and a retroaortic left renal vein: a rare complication of abdominal aortic aneurysm. Radiol Bras 2017; 50:407–8.
  • Stoyanova B, Nikolov N, Lukanova D, Stankev M, Atanasov A. Case report of ruptured aneurysm of the abdominal aorta to retro-aortic renal vein. [Article in Bulgarian] Angiology and Vascular Surgery 2017;3:42–8.
Year 2022, Volume: 16 Issue: 1, 41 - 45, 20.04.2022

Abstract

References

  • Karkos CD, Bruce IA, Thomson GJ, Lambert ME. Retroaortic left renal vein and its implications in abdominal aortic surgery. Ann Vasc Surg 2001;15:703–8.
  • Karaman B, Koplay M, Ozturk E, Basekim CC, Ogul H, Mutlu H, Kizilkaya E, Kantarci M. Retroaortic left renal vein: multidetector computed tomography angiography findings and its clinical importance. Acta Radiol 2007;48:355–60.
  • Tatar I, Töre HG, Çelik HH, Karcaaltincaba M. Retroaortic and circumaortic left renal veins with their CT findings and review of the literature. Anatomy 2008;2:72–6.
  • Turamanlar O, Ünlü E, Toktaş M, Horata E, Songur A. Variation of right renal artery duplication with retroaortic left renal vein: a case report. Anatomy 2015;9:91–3.
  • Dilli A, Ayaz UY, Karabacak OR, Tatar IG, Hekimoglu B. Study of the left renal variations by means of magnetic resonance imaging. Surg Radiol Anat 2012;34:267–70.
  • Yi SQ, Ueno Y, Naito M, Ozaki N, Itoh M. The three most common variations of the left renal vein: a review and meta-analysis. Surg Radiol Anat 2012;34:799–804.
  • Hoeltl W, Hruby W, Aharinejad S. Renal vein anatomy and its implications for retroperitoneal surgery. J Urol 1990;143:1108–14.
  • Bass JE, Redwine MD, Kramer LA, Huynh PT, Harris JH Jr. Spectrum of congenital anomalies of the inferior vena cava: cross-sectional imaging findings. Radiographics 2000;20:639–52.
  • Kurklinsky AK, Rooke TW. Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc 2010;85:552–9.
  • Hangge PT, Gupta N, Khurana A, Quencer KB, Albadawi H, Alzubaidi SJ, Knuttinen M-G, Naidu SG, Oklu R. Degree of left renal vein compression predicts nutcracker syndrome. J Clin Med 2018;7:107.
  • Ali-El-Dein B, Osman Y, Shehab El-Din AB, El-Diasty T, Mansour O, Ghoneim MA. Anterior and posterior nutcracker syndrome: a report on 11 cases. Transplant Proc 2003;35:851–3.
  • Shindo S, Kubota K, Kojima A, Iyori K, Ishimoto T, Kobayashi M, Kamiya K, Tada Y. Anomalies of inferior vena cava and left renal vein: risks in aortic surgery. Ann Vasc Surg 2000;14:393–6.
  • Knipp B, Knechtges P, Gest T, Wakefield T. Inferior vena cava: embryology and anomalies. In: Upchurch GR Jr, Criado E, editors. Aortic aneurysms: pathogenesis and treatment. New York (NY): Humana Press; 2009. p. 289–307.
  • Satyapal KS, Rambiritch V, Pillai G. Morphometric analysis of the renal veins. Anat Rec 1995;241:268–72.
  • Kumaresan M, Sankaran PK, Gunapriya R, Karthikeyan G, Priyadarshini A. Morphometric study of renal vein and its variations using CT. Indian Journal of Medical Research and Pharmaceutical Sciences 2016;3:41–9.
  • Minniti S, Visentini S, Procacci C. Congenital anomalies of the venae cavae: embryological origin, imaging features and report of three new variants. Eur Radiol 2002;12:2040–55.
  • Nam JK, Park SW, Lee SD, Chung MK. The clinical significance of a retroaortic left renal vein. Korean J Urol 2010;51:276–80.
  • Zhu J, Zhang L, Yang Z, Zhou H, Tang G. Classification of the renal vein variations: a study with multidetector computed tomography. Surg Radiol Anat 2015;37:667–75.
  • Chuang VP, Mena CE, Hoskins PA. Congenital anomalies of the left renal vein: angiographic consideration. Br J Radiol 1974;47:214–8.
  • Guttmann G, Endean E. Embryology. In: Cronenwett J, Johnston W, editors. Rutherford’s vascular surgery. Vol. 1. 7th ed. Philadelphia (PA): Saunders Elsevier; 2010. pp. 15–30.
  • Kyung DS, Lee JH, Shin DY, Kim DK, Choi IJ. The double retro-aortic left renal vein. Anat Cell Biol 2012;45:282–284.
  • Panagar AD, Subhash LP, Suresh BS, Nagaraj DN. Circumaortic left renal vein – a rare case report. J Clin Diagn Res 2014;8:111–2.
  • Koc Z, Ulusan S, Tokmak N, Oguzkurt L, Yildirim T. Double retroaortic left renal veins as a possible cause of pelvic congestion syndrome: imaging findings in two patients. Br J Radiol 2006;79:e152–5.
  • Shin JI, Lee JS. Nutcracker phenomenon or nutcracker syndrome? Nephrol Dial Transplant 2005;20:2015
  • Brener BJ, Darling RC, Frederick PL, Linton RR. Major venous anomalies complicating abdominal aortic surgery. Arch Surg 1974;108:159–65.
  • Kim MK, Ku YM, Chun CW, Lee SL. MDCT findings of right circumaortic renal vein with ectopic kidney. Korean J Radiol 2013;14:786–8.
  • Calligaro KD, Savarese RP, DeLaurentis DA. Unusual aspects of aortovenous fistulas associated with ruptured abdominal aortic aneurysms. J Vasc Surg 1990;12:586–90.
  • Polguj M, Stefaƒczyk K, Stefaƒczyk L. Coexistence of the aortic aneurysm with the main vein anomalies: its potential clinical implications and vascular complication. In: Kirali K, editor. Aortic aneuryam. Rijeka, Croatia: IntechOpen; 2017. Chapter 8. pp: 129–42.
  • Mansour MA, Rutherford RB, Metcalf RK, Pearce WH. Spontaneous aorto-left renal vein fistula: the “abdominal pain, hematuria, silent left kidney” syndrome. Surgery 1991;109:101–6.
  • Meyerson SL, Haider SA, Gupta N, O’Dorsio JE, McKinsey JF, Schwartz LB. Abdominal aortic aneurysm with aorta-left renal vein fistula with left varicocele. J Vasc Surg 2000;31:802–5.
  • Savarese LG, Trad HS, Joviliano EE, Muglia VF, Elias Junior J. Fistula between the abdominal aorta and a retroaortic left renal vein: a rare complication of abdominal aortic aneurysm. Radiol Bras 2017; 50:407–8.
  • Stoyanova B, Nikolov N, Lukanova D, Stankev M, Atanasov A. Case report of ruptured aneurysm of the abdominal aorta to retro-aortic renal vein. [Article in Bulgarian] Angiology and Vascular Surgery 2017;3:42–8.
There are 32 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Case Reports
Authors

Nikolai Krastev This is me 0000-0002-7276-3707

Yoanna Tivcheva This is me 0000-0002-9886-4266

Lina Malinova This is me 0000-0002-6928-1483

Lazar Jelev This is me 0000-0001-8596-7867

Publication Date April 20, 2022
Published in Issue Year 2022 Volume: 16 Issue: 1

Cite

APA Krastev, N., Tivcheva, Y., Malinova, L., Jelev, L. (2022). Retroaortic left renal vein: a clinically significant vascular variation with suggestion of a practical typological scheme. Anatomy, 16(1), 41-45.
AMA Krastev N, Tivcheva Y, Malinova L, Jelev L. Retroaortic left renal vein: a clinically significant vascular variation with suggestion of a practical typological scheme. Anatomy. April 2022;16(1):41-45.
Chicago Krastev, Nikolai, Yoanna Tivcheva, Lina Malinova, and Lazar Jelev. “Retroaortic Left Renal Vein: A Clinically Significant Vascular Variation With Suggestion of a Practical Typological Scheme”. Anatomy 16, no. 1 (April 2022): 41-45.
EndNote Krastev N, Tivcheva Y, Malinova L, Jelev L (April 1, 2022) Retroaortic left renal vein: a clinically significant vascular variation with suggestion of a practical typological scheme. Anatomy 16 1 41–45.
IEEE N. Krastev, Y. Tivcheva, L. Malinova, and L. Jelev, “Retroaortic left renal vein: a clinically significant vascular variation with suggestion of a practical typological scheme”, Anatomy, vol. 16, no. 1, pp. 41–45, 2022.
ISNAD Krastev, Nikolai et al. “Retroaortic Left Renal Vein: A Clinically Significant Vascular Variation With Suggestion of a Practical Typological Scheme”. Anatomy 16/1 (April 2022), 41-45.
JAMA Krastev N, Tivcheva Y, Malinova L, Jelev L. Retroaortic left renal vein: a clinically significant vascular variation with suggestion of a practical typological scheme. Anatomy. 2022;16:41–45.
MLA Krastev, Nikolai et al. “Retroaortic Left Renal Vein: A Clinically Significant Vascular Variation With Suggestion of a Practical Typological Scheme”. Anatomy, vol. 16, no. 1, 2022, pp. 41-45.
Vancouver Krastev N, Tivcheva Y, Malinova L, Jelev L. Retroaortic left renal vein: a clinically significant vascular variation with suggestion of a practical typological scheme. Anatomy. 2022;16(1):41-5.

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