Skip to main content
Log in

Left renal vein variations

Variations de la veine rénale gauche

  • Anatomic Variations
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Summary

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.

Résumé

Du développement embryologique très complexe de la veine rénale gauche, comparé à son homologue droit, il résulte d'importantes variations, significatives du point de vue clinique. Le but de cette étude est d'identifier ces variations et de préciser leur fréquence. 1-Recherches cadavériques : (153 paires de reins ont été prélevées en bloc, disséquées) 100 moulages par résines et 53 plastinations. En outre, des phlébographies rénales post-mortem ont été réalisées, 58 chez des adultes, 20 chez des fœtus. 2-Etudes cliniques (analyse rétrospective) : a) radiologiques : 104 veinogrammes rénaux, b) lors de transplantations rénales : 148 reins gauches de donneurs, c) au cours de la chirurgie de l'anévrysme de l'aorte thoracique : 525 patients. Soit, au total, 1008 reins. Le collier rénal a été observé dans 0,3 % de la série ; la v. rétro-aortique, 0,5 %, des vv. rénales supplémentaires : 0,4 % ; enfin, un collecteur rénal postérieur existait dans 23,2 % des séries cadavériques (16,7 % du type IB de notre classification et 6,5 % du type II B). Nos résultats diffèrent de façon significative par leur faible fréquence de celle relatée dans la littérature : collier rénal (0,2–30 %), veine rétro-aortique (0,8–7,1 %), veine rénale supplémentaire (0.8–6%). Les variations sont silencieuses cliniquement et demeurent méconnues jusqu'à leur découverte par phlébographie, opération ou autopsie. Pour le chirurgien transplanteur, la morphologie a une signification particulière puisque les variations déterminent la faisabilité technique ou non de l'opération. La connaissance préalable de la veine circum-aortique est importante lors du prélèvement d'échantillons sanguins des veines surrénaliennes ou rénales. Le collier rénal peut favoriser la formation d'un réseau collatéral dense immédiatement après l'opération, si l'interruption de la veine rénale est pratiquée sans connaissance de ce dispositif. Les variations restreignent l'utilisation de la veine dans les techniques de mobilisation. Lors de la cure d'un anévrysme aortique, l'existence d'une veine rétro-aortique est importante à connaitre. Lors d'une intervention rétro-péritonéale, le chirurgien repère la veine pré-aortique, mais il méconnait une branche rétro-aortique supplémentaire, ou un tronc primaire postérieur qu'il peut léser en mobilisant le rein ou en clampant l'aorte.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Anson BJ, Richardson GA, Minear WL (1936) Variations in the number and arrangement of the renal vessels: A study of the blood supply of 400 kidneys. J Urol 36: 211–219

    Google Scholar 

  2. Anson BJ, Cauldwell EW (1947) The pararenal vascular system: A study of 425 anatomical specimens. Quarterly Bull North Western Univ Med School 21: 320–328

    Google Scholar 

  3. Anson BJ, Daseler EH (1961) Common variations in renal anatomy affecting blood supply, form and topography. Surg Gynecol Obst 112: 439–449

    Google Scholar 

  4. Beckmann CF, Abrams HL (1979) Circumaortic venous ring: incidence and significance. AJR 132: 561–565

    PubMed  Google Scholar 

  5. Beckmann CF, Abrams HL (1980) Renal venography: Anatomy, technique, applications, analysis of 132 venograms, and a review of the literature. Cardiovasc Intervent Radiol 3: 45–70

    PubMed  Google Scholar 

  6. Brener BJ, Darling RC, Frederick PL, Linton RR (1974) Major venous anomalies complicating abdominal aortic surgery. Arch Surg 108: 159–165

    PubMed  Google Scholar 

  7. Chuang VP, Mena CE, Hoskins PA (1974) Congenital anomalies of the left renal v.: angiographic consideration. Br J Radio 47: 214–218

    Google Scholar 

  8. Davis CJ, Lundberg GD (1968) Retro-aortic left renal vein: A relatively frequent anomaly. Am J Clin Path 50: 700–703

    PubMed  Google Scholar 

  9. Davis RA, Milloy FJ, Anson BJ (1958) Lumbar, Renal and Associated parietal and visceral veins based upon a study of 100 specimens. Surg Gynecol Obst 107: 1–22

    Google Scholar 

  10. Eisendrath DN (1920) The relation of variations in the renal vessels to pyelotomy and nephrectomy. Ann Surg 71: 726–743

    Google Scholar 

  11. Fagarasanu I (1938) Recherches anatomiques sur la veine rénale gauche et ses collatérales. Ann Anat Pathol 8: 15

    Google Scholar 

  12. Ferris EJ, Vittenberger FJ, Bryne JJ, Nasbeth DC, Shapiro JH (1967) The inferior vena cava after ligation and plication. Radiology 89: 1–10

    PubMed  Google Scholar 

  13. Field S, Saxton H (1974) Venous anomalies complicating left adrenal catherisation. Br J Radio 47: 219–225

    Google Scholar 

  14. Froriep A, Froriep L (1895) Über eine verhältnismässig häufige Varietät und Bereich der unteren Hohlvene. Anat Anz 10: 574–583

    Google Scholar 

  15. Gérard G (1920) Mention d'une anastomose veineuse rénocave rétro-aortique oblique descendante. C R Soc Biol 83: 185–186

    Google Scholar 

  16. Gillot C (1978) The left renal vein: anatomical study, angiographic aspects and surgical approach. Anat Clin 1: 135–156

    Google Scholar 

  17. Gurewich V, Thomas DP, Robinson KR (1966) Pulmonary embolism after ligation of the inferior vena cava. N Engl J Med 274: 1350–1354

    PubMed  Google Scholar 

  18. Hoeltl W, Hruby W, Aharinejad S (1990) Renal vein anatomy and its implications for retroperitoneal surgery. J Urol 143: 1108–1114

    PubMed  Google Scholar 

  19. Hovelacque A (1914) Note sur les origines de la veine grande azygos et de l'heime inférieure et sur leurs rapports avec le diaphragme. Biblio Anat 24: 204–210

    Google Scholar 

  20. Huntington GS, McClure CFW (1907) The interpretations of variations of the post cava and tributaries of the adult cat, based on their development. Anat Rec 1: 33

    Google Scholar 

  21. Jeanbrau E, Desmonts C (1910) Contribution à la du pédicule vasculaire du rein. Bull Soc Anat 85: 669–692

    Google Scholar 

  22. Katoh N, Ono Y, Kinukawa T (1995) Efficacy of a retroperitoneal approach in a laparoscopic nephrectomy for benign renal disease, part 2, Abstract 1002. J Urol 153: 497A.

  23. Kramer B, Grine FE (1980) The incidence of the renal venous collar in South African Blacks. S Afr Med J 57: 875–876

    PubMed  Google Scholar 

  24. Krause RJ, Cranley JJ, Hallaba MA, Strusser EJ, Hafner CD (1963) Caval ligation in thromboembolic disease. Arch Surg 87: 184–192

    PubMed  Google Scholar 

  25. McClure CFW, Butler EG (1925) The development of the vena cava inferior in man. Am J Anat 35: 331–383

    Google Scholar 

  26. Merklin RJ, Michels NA (1958) The variant renal and suprarenal blood supply with data on the inferior phrenic, ureteral and gonadal arteries. J Int Coll Surg 29: 41–76

    PubMed  Google Scholar 

  27. Mitty HA (1975) Circum-aortic renal collar. A potentially hazardous anomaly of the left renal vein. Am J Roentgenol 125: 307–310

    Google Scholar 

  28. Nishimura Y, Fushik M, Yoshida M, Nakamura K, Imai M, Ono T, Morikawa S, Hatayama T, Komatz Y (1986) Left renal vein hypertension in patients with left renal bleeding of unknown origin. Radiology 160: 663–667

    PubMed  Google Scholar 

  29. Ortmann R (1968) Über Bedeutung Häufigkeit und Variationsbild der linken retroaortaren Nierenvenen. Z Anat Entwicklungsgesch 127: 346–358

    PubMed  Google Scholar 

  30. Piccone VA, Vital E, Yarnoz M, Glass P, Leveen HH (1970) The late results of the caval ligation. Surgery 68: 980–998

    PubMed  Google Scholar 

  31. Pick JW, Anson BJ (1940) The renal vascular pedicle: An anatomical study of 430 body-halves. J Urol 44: 411–434

    Google Scholar 

  32. Pollak R, Prusak BF, Mozes MF (1986) Anatomic abnormalities of cadaver kidneys procured for purposes of transplantation. Am Surg 52: 233–235

    PubMed  Google Scholar 

  33. Reis RH, Esenther G (1959) Variations in the pattern of renal vessels and their relation to the type of posterior vena cava in man. Am J Anat 104: 295–318

    PubMed  Google Scholar 

  34. Ross JA, Samuel E, Millar DR (1961) Variations in the renal vascular pedicle (an anatomical and radiological study with particular reference to renal transplantation). Br J Urol 33: 478–485

    PubMed  Google Scholar 

  35. Royal SA, Callen PW (1979) CT Evaluation of anomalies of the inferior vena cava and left renal vein. AJR 132: 759–763

    PubMed  Google Scholar 

  36. Royster TS, Lacey L. Marks RA (1974) Abdominal aortic surgery and the left renal vein. Am J Surg 127: 552–554

    PubMed  Google Scholar 

  37. Rupert RR (1915) Further study of irregular kidney vessels as found in one hundred cadavers. Surg Gynecol Obstet 21: 471–480

    Google Scholar 

  38. Satyapal KS (1995) Classification of the drainage patterns of the renal veins. J Anat 186: 329–333

    PubMed  Google Scholar 

  39. Satyapal KS, Rambiritch V, Pillai G (1995) Additional renal veins: Incidence and morphometry. Clin Anat 8: 51–55

    PubMed  Google Scholar 

  40. Seib GA (1934) The azygos system of veins in American whites and American negros, including observations on the inferior caval venous system. Am J Phys Anthrop 19: 39–159

    Google Scholar 

  41. Thomas TV (1970) Surgical implications of retro-aortic left renal vein. Arch Surg 100: 738–740

    PubMed  Google Scholar 

  42. Tompsett DH (1970) Anatomical techniques, 2nd edn. E and S Livingstone, Edinburgh, London, pp 93–180

    Google Scholar 

  43. Turgut HB, Bircan MK, Hatipõglu ES, Dogruyol S (1996) Congenital anomalies of the left renal vein and its clinical importance: A case report and review of literature. Clin Anat 9: 133–135

    PubMed  Google Scholar 

  44. von Hagens G (1985) Heidelberg plastination folder collection of technical leaflets for plastination. Anatomisches Institut 1, Universität Heidelberg

  45. Warren WD, Salaam AA, Faraldo A, Huttson D, Smith BB (1972) End renal vein-to-splenic vein shunts for total or selective portal decompression. Surgery 72: 995–1006

    PubMed  Google Scholar 

  46. Weinstein BB, Countis EH, Derbes VJ (1940) The renal vessels in 203 cadavers. Urol Cutaneous Rev 44: 137–139

    Google Scholar 

  47. Zumstein J (1896) Zur Anatomie und Entwicklung des Venensystems des Menschen. 1. Ueber die Beziehungen der Vena cava inferior und ihrer Aeste zu der Vena azygos und hemiazygos beim Neugeborenen und beim Erwachsenen. Hefte 1, Abt, Part 6 Anatomische: pp 571–608

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Satyapal, K.S., Kalideen, J.M., Haffejee, A.A. et al. Left renal vein variations. Surg Radiol Anat 21, 77–81 (1999). https://doi.org/10.1007/BF01635058

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01635058

Key words

Navigation