Clinical and Radiological Significance of the Retroaortic Left Renal Vein

Yıl 2019, Cilt: 24 Sayı: 1, 38 - 41, 30.01.2019

Fatma Aktaş

https://doi.org/10.21673/anadoluklin.468690

Öz

Aim:

Retroaortic left renal vein is an anatomical variation
with a relatively increasing frequency due to the growth in the number of
radiological imaging. It is usually asymptomatic. In this study, it was aimed
to identify if there is a pressure increase in asymptomatic patients by
measuring the diameters of left gonadal vein and left renal vein in the
patients with left renal vein through contrast abdomen computed tomography .

Materials
and Methods:

This study included a patient group consisting of 138
patients who were diagnosed with retroaortic left vein through CT examination
and 100 participants sharing common age and gender patterns with the control
group. Preaortic  segment of left renal vein diameter, narrowest
retroaortic segment o left renal vein diameter and  left 
gonadal vein diameter measured.

Results:

When diameters of left renal vein at preaortic segment
belonging to the control group and the patients with RLRV, it was significantly
higher in the patients with retroaortic left renal vein. Furthermore left gonadal
vein diameter was found to have increased in the patients with retroaortic left
renal vein compared to the control group.

Conclusion:

In
conclusion, while retroaortic
left renal vein is typically an asymptomatic anatomical
variation, it can cause press of
left renal vein at posterior of aorta  and pressure increase in left renal
vein and gonadal vein. This pressure increase is important in terms of pelvic
congestion in women and varicosele etiology in men. Moreover, it can lead to
clinical symptoms like flank pain and hematuria by causing retroaortic impingement syndrome.

Anahtar Kelimeler

computed tomography, pelvic congestion, retroaortic left renal vein

Retroaortik sol renal venin klinik ve radyolojik önemi

Öz

Amaç:

Retroaortik
sol renal ven radyolojik görüntüleme sıklığının artması nedeniyle son yıllarda
sıklığı görece artan anatomik varyasyondur. Sıklıkla asemptomatiktir. Biz
çalışmamızda kontrastlı abdomen bilgisayarlı tomografi  tetkikinde 
retroaortik sol renal ven saptanan hastalarda sol renal ven ve sol
gonodal ven çaplarını ölçerek asemptomatik hastalarda vende basınç artışı olup
olmadığını göstermeyi amaçladık.

Gereç ve Yöntemler:

Çekilen
kontrastlı abdomen BT tetkiklerinde saptanan retroaortik sol renal veni bulunan
138 hasta ve hasta grubu ile yaş ve cinsiyet benzerliği bulunan 100 kişi dahil
edildi. Sol renal ven çapı, retroaortik sol renal venin aorta posteriorunda en
dar olduğu segmentte çapı ve sol gonadal ven çapı ölçüldü.

Bulgular:

Kontrol
grubu ve retroaortik sol renal ven bulunan hastaların preaortik segmentte sol
renal ven çapları karşılaştırıldığında, retroaortik sol renal ven bulunan
hastalarda anlamlı olarak daha yüksek bulundu. Aynı zamanda sol gonadal ven
çapları retroaortik sol renal ven bulunan hastalarda kontrol grubu ile
karşılaştırıldığında artmış olarak bulundu.

Sonuç:

Sonuç
olarak retroaortik sol renal ven sıklıkla asemptomatik seyreden anatomik bir
varyasyon olmakla birlikte sol renal venin aorta arkasında sıkışması ile sol
renal ven ve gonadal venlerde basınç artışına neden olabilir. Bu basınç artışı
kadınlarda pelvik konjesyon erkeklerde ise varikosel etyolojisinde önemlidir.
Aynı zamanda retroaortik sıkışma sendromuna neden olarak hematüri ve yan ağrısı
gibi klinik semptomlara yol açabilir. 

Anahtar Kelimeler

bilgisayarlı tomografi, pelvik konjesyon, retroaortik sol renal ven

Kaynakça

• 1. Karaman B, Koplay M, Qzturk E, et al. Retroaortic left renal vein: multidetector computed tomography angiography findings and its clinical importance. ActaRadiol 2007;48:355e60.
• 2. Brancatelli G, Galia M, Finazzo M, et al. Retroaortic left renal vein joining the left common iliac vein. Eur Radiol 2000;10:1724e5.
• 3. Arslan H, Etlik O, Cevlan K, et al. Incidence of retro-aortic left renal vein and its relationship with varicocele. Eur Radiol2005;15:1717e20.4. Gibo M, Onitsuka H. Retroaortic left renal vein with renal vein hypertension causing hematuria. Clin Imaging. 1998 Nov-Dec;22(6):422-4. PubMed PMID: 9876912
• 5. Poyraz AK, Firdolas F, Onur MR, Kocakoc E. Evaluation of left renal vein entrapment using multidetector computed tomography. Acta Radiol. 2013 Mar 1;54(2):144-8. doi: 10.1258/ar.2012.120355. Epub 2012 Nov 1. PubMed PMID:23117197.
• 6. Thomas TV. Surgical complications of retroaortic left renal The “nutcracker phenomenon,” compression of vein. ArchSurg 1970;100:738–740.
• 7. Mayo J, Gray R, St Louis E, Grosman H, McLoughlin M, Wise D. Anomalies of the inferior vena cava. AJR Am J Roentgenol 1983;140:339-45.
• 8. Lee CM, Ng SH, Ko SF, Tsai CH, Tsai CC. Circumaortic left renal vein: report of a case. J Formos Med Assoc 1992; 91:356- 358.
• 9. Gibo M, Onitsuka H. Retroaortic left renal vein with renal vein hypertension causing hematuria. Clin Imaging 1998; 22:422- 424.
• 10. Berthelot JM, Douane F, Maugars Y, Frampas E. Nutcracker syndrome: A rare cause of left flank pain that can also manifest as unexplained pelvic pain. Joint Bone Spine. 2017 Oct;84(5):557-562.
• 11. Scultetus AH, Villavicencio JL, Gillespie DL. The nutcracker syndrome: its role in the pelvic venous disorders. J Vasc Surg 2001 Nov;34(5):812–9.
• 12. Graif M, Hauser R, Hirshebein A, Botchan A, Kessler A, Yabetz H. Varicocele and the testicular-renal venous route: hemodynamic Doppler sonographic investigation. J Ultrasound Med 2000;19:627-31.
• 13. Takahashi Y, Ohta S, Sano A, Kuroda Y, Kaji Y, Matsuki M, et al. Does severe nutcracker phenomenon cause pediatric chronic fatigue? Clin Nephrol 2000;53:174-81.
• 14. d’Archambeau O, Maes M, De Schepper A. The pelvic congestion syndrome: role of the ‘‘nutcracker phenomenon’’and results of endovascular treatment. JBR-BTR 2004;87(1):1–8