Left Renal Vein Division Research Articles

Renal Artery Clamping and Left Renal Vein Division during Abdominal Aortic Aneurysm Repair

Objectives. To determine whether renal artery clamping and division of the left renal vein affects renal function in the patients who undergo repair of infrarenal abdominal aortic aneurysm (AAA). Methods. Between 1992 and 2000, 267 patients had open surgery for infrarenal AAA. Of these, 22 (8%) required temporary bilateral (15) or unilateral (7) renal artery clamping. 8 also had the left renal vein divided, three of which were re-anastomosed. Results. Renal artery clamping and/or renal vein divisions did not affect the incidence of complications and long term renal failure. Conclusions. Clamping of the renal arteries and/or renal vein division during AAA surgery does not in itself compromise short or long term renal function.

Cavectomy for neoplastic infiltration from right renal cell carcinoma

Thirty years ago inferior vena cava division was considered incompatible with acceptable life conditions, but in the sixties experimental findings showed that left renal vein division did not cause renal failure in animals, due to a new venous drainage. We report the case of a forty-seven-year old male patient with right renal cell carcinoma. He underwent radical nephrectomy with cavectomy and left renal vein ligation for extensive infiltration of the vena cava wall by a neoplastic thrombus. The post-operative course of renal function after the surgical procedure is described.

Does Division of the Left Renal Vein During Aortic Surgery Adversely Affect Renal Function?

Between July 1980 and July 1988, 478 consecutive patients underwent aortic aneurysm operations at Royal Prince Alfred Hospital. Renal function was assessed by measurement of serum creatinine levels. The left renal vein was divided in 28 (8%) of the 355 patients undergoing elective aneurysm resection. The mean immediate postoperative creatinine values were significantly higher after left renal vein division, 193 +/- 174 mumol/L, compared to 133 +/- 93 mumol/l for those whose left renal vein remained intact (p less than 0.05 by Mann-Whitney U test). After one month, serum creatinine levels had decreased but were still significantly higher in those patients in whom the left renal vein had been divided, 170 +/- 166 mumol/l, compared to those in whom it was left intact 109 +/- 49 mumol/l (p less than 0.05 by Mann-Whitney U test). The suprarenal aorta was cross-clamped in seven (25%) of the 28 patients in whom the left renal vein was divided, compared to 21 (6%) of the 327 with the left renal vein intact. A rise in creatinine level was observed after suprarenal aortic cross-clamping. The left renal vein was divided in 17 (14%) of the 123 patients having emergency surgery for ruptured aortic aneurysm, 61 (49%) of whom survived more than 30 days. The mean immediate postoperative creatinine values were significantly higher after left renal vein division, 426 +/- 277 mumol/l, compared to those in whom the vein was left intact, 178 +/- 136 mumol/l (p less than 0.05 by Mann-Whitney U test). After one month, serum creatinine levels were still significantly higher in those patients in whom the left renal vein had been divided. Although division of the left renal vein is a useful way to improve exposure of the juxtarenal aorta, the maneuver is associated with an adverse effect on renal function.

Division of the left renal vein during aortic surgery

Perirenal aortic exposure and control can be facilitated by division of the left renal vein (LRV), but only if adequate collateral venous drainage is present. When incremental elevations in LRV pressure were produced in nine dogs, we noted that left renal glomerular and tubular function (creatinine clearance, sodium retention, urine osmolality, and urine output) were virtually lost at pressures greater than 50 to 60 cm water. Between January 1967 and December 1989, 64 patients underwent LRV division during the performance of abdominal aortic aneurysm surgery (57 of 589 = 10%) or reconstruction for aortoiliac occlusive disease (7 of 506 = 1%). LRV stump pressures (LRVSPs) were measured in 44 of these patients and were less than or equal to 60 cm water in all but one instance. Ten of the 64 patients died, but none as a consequence of this maneuver. Post-operatively, all survivors had serial serum creatinine levels measured and either an intravenous pyelogram, renal scan, or arteriogram. One case of a non-functioning left kidney was identified. This occurred in the only patient who underwent re-anastomosis after LRV division. A LRVSP equal to or greater than 50 cm water and extreme venous distention after test clamping served as a contraindication to LRV division in seven other patients. We conclude that a LRVSP less than or equal to 50 to 60 cm water indicates that the LRV may be safely divided during juxtarenal aortic exposure. However, a pressure greater than or equal to 50 to 60 cm water suggests that LRV division should not be carried out unless absolutely essential and then only if right kidney function is known to be adequate.

左腎静脈一時切離による腹部大動脈再建術

左腎静脈一時切離による腹部大動脈再建術

Left renal vein division in abdominal aortic aneurysm operations. Effect on renal function.

We examined the effect of left renal vein (LRV) division during abdominal aortic aneurysm operations on renal function during the recovery period. Fifteen patients with LRV division were compared with 26 patients in whom the LRV was not ligated. These two groups of patients did not differ significantly in any of their preoperative characteristics, operative management, or postoperative complications. Preoperative, highest postoperative, and predischarge levels of plasma urea and creatinine, as well as urinary sediment, were compared in both groups. Left renal vein division could not be implicated as a cause of renal function deterioration and was found to be a safe, useful adjunct to abdominal aortic aneurysm surgery.

Division of the left renal vein: a safe surgical adjunct.

Ten patients have undergone surgical division of the left renal vein (LRV) during operations on the abdominal aorta. Nine were elective procedures performed during the resection of a complicated abdominal aortic aneurysm (six patients) or treatment of complete infrarenal aortic occlusion (three patients). The first patient in this series underwent emergency LRV ligation at the renal hilum for the control of hemorrhage incurred during an elective aneurysmectomy. This patient survived postoperative renal failure and myocardial infarction, but died 21 months later from another myocardial infarction. At the time of death, he had moderate renal insufficiency. None of the remaining nine patients undergoing elective LRV division experienced any apparent renal dysfunction, as measured by urine sediment, serum creatinine, blood urea nitrogen, and intravenous pyelography. Although not recommended as a routine maneuver, division of the LRV is advocated as a safe adjunct for surgical exposure in difficult aortic procedures.

Renal Vein Ligation

To the Editor.— Certain comments should be made concerning the case report by E. R. Jennings, MD, and M. A. Glucksman, MD, in the recent LETTERS section ofThe Journal( 213 :1905, 1970). Left renal vein division and ligation has been done with no serious consequences for portal renal shunts, 1-3 splenorenal shunts, 4 and as an aid in abdominal aortic surgery. 5 Anatomically, this is possible because the left renal vein, in contradistinction to the right renal vein, has a number of tributaries through which collateral venous drainage is possible. The inferior phrenic and suprarenal tributaries enter from above; from below, and to the side come gonadal (spermatic and ovarian), capsular, lumbar, and ascending lumbar veins. Also communication is made with the azygos and hemiazygos veins (usually through the lumbars) and with the extensive set of internal and external vertebral plexuses by way of the intervertebral and lumbar veins.