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Experimental and Clinical... Apr 2017Transplant renal vein thrombosis usually occurs early after surgery with a reported prevalence of 0.1% to 4.2%. It is a devastating event that ultimately leads to graft... (Review)
Review
Transplant renal vein thrombosis usually occurs early after surgery with a reported prevalence of 0.1% to 4.2%. It is a devastating event that ultimately leads to graft loss in almost all cases. There are many predisposing factors related to donor, recipient, surgery, and immunosuppression, with mechanical factors being considered the most common causes of transplant renal vein thrombosis. The clinical manifestations of acute renal vein thrombosis are nonspecific and are not dissimilar to the features of urine leak, urinary obstruction, or severe acute rejection. The diagnosis of transplant renal vein thrombosis depends on a high index of clinical suspicion and duplex ultrasonographic scans. Although venography remains the criterion standard, this procedure is invasive and nephrotoxic, due to use of ionizing contrast agents and also due to exposure to ionizing radiation. There are 2 therapies that have been described in the literature for salvaging a renal allograft with transplant renal vein thrombosis: thrombolytic therapy and surgical thrombectomy. The usual end result is renal allograft.
Topics: Allografts; Humans; Immunosuppressive Agents; Kidney Transplantation; Magnetic Resonance Angiography; Nephrectomy; Predictive Value of Tests; Prevalence; Renal Veins; Risk Factors; Thrombectomy; Thrombolytic Therapy; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Venous Thrombosis
PubMed: 28338457
DOI: 10.6002/ect.2016.0060 -
European Journal of Vascular and... Aug 2007The aim of this article is to review the published English literature on aetiology, pathology, clinical presentation, diagnostic methods and treatment of renal vein... (Review)
Review
OBJECTIVE
The aim of this article is to review the published English literature on aetiology, pathology, clinical presentation, diagnostic methods and treatment of renal vein thrombosis.
MATERIALS AND METHODS
We searched the published literature from Medline & Pubmed using keywords renal vein thrombosis, anti-phospholipid syndrome and nephrotic syndrome. Data was extracted from individual case reports, case series, articles on pathology, diagnostic tests, treatment modalities, and previous reviews. Case reports which did not add any new information were excluded.
RESULTS
We selected 60 references based on the above criteria. Renal vein thrombosis is relatively rare. CT angiography is considered the investigation of choice. Alternatives include MR angiography or renal venography in highly selected patients. As the condition is relatively uncommon, consensus on the best form of therapy for this condition has been slow to evolve. The trend in management has shifted to non-surgical therapies particularly systemic anticoagulation except in highly selected group of patients.
Topics: Anticoagulants; Humans; Magnetic Resonance Angiography; Patient Selection; Phlebography; Practice Guidelines as Topic; Renal Veins; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures; Venous Thrombosis
PubMed: 17543556
DOI: 10.1016/j.ejvs.2007.02.017 -
Surgical and Radiologic Anatomy : SRA 1999The highly complex embryological development of the left renal vein compared to its right counterpart results in greater variations which are clinically significant. The... (Review)
Review
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.
Topics: Adult; Cadaver; Dissection; Fetus; Humans; Incidence; Kidney Transplantation; Phlebography; Renal Veins; Retrospective Studies
PubMed: 10370998
DOI: 10.1007/BF01635058 -
The Journal of the American Osteopathic... Sep 2019
Topics: Abdominal Pain; Adolescent; Female; Humans; Renal Veins; Tomography, X-Ray Computed; Venous Thrombosis
PubMed: 31449310
DOI: 10.7556/jaoa.2019.107 -
Journal of Medical Ultrasonics (2001) Apr 2021Ascites can cause compression of the inferior vena cava (IVC), leading to increased renal venous pressure and renal congestion. Previously, the left renal vein diameter... (Observational Study)
Observational Study
PURPOSE
Ascites can cause compression of the inferior vena cava (IVC), leading to increased renal venous pressure and renal congestion. Previously, the left renal vein diameter in liver cirrhosis patients with ascites was measured using computed tomography, showing that enlargement of the left renal vein diameter affects the prognosis. Herein, the diameter and flow velocity of the renal veins were measured using ultrasonography.
METHODS
Abdominal ultrasonography was performed on 186 patients. The patients were divided into four groups: normal liver (n = 102), liver cirrhosis (LC) without ascites (n = 37), LC with ascites (n = 30), and congestive liver (n = 17). Ultrasonographic measurements for diameter and flow velocity of the IVC, left renal vein main trunk, and segmental renal vein were performed.
RESULTS
The left renal vein diameter increased in the following order: normal liver, LC, LC with ascites, and congestive liver groups (P < 0.001). IVC flow velocity was lower and left renal vein diameter was larger in the congestive liver and LC with ascites groups. These results suggest that the two groups have different pathological conditions, but the mechanism of renal congestion is similar. In patients with LC, IVC compression due to ascites might cause blood stagnation and renal congestion.
CONCLUSION
The left renal vein and IVC can be measured using ultrasonography. It might help in furthering our understanding of the pathophysiology of renal congestion in these patients.
Topics: Adult; Aged; Aged, 80 and over; Ascites; Cross-Sectional Studies; Female; Heart Failure; Humans; Liver Cirrhosis; Male; Middle Aged; Renal Veins; Ultrasonography
PubMed: 33768355
DOI: 10.1007/s10396-021-01088-0 -
Folia Morphologica 2019Renal vessels exhibit a high degree of anatomical variations in terms of their number, level of origin, diameter and topographical relationships. In particular, it... (Review)
Review
Renal vessels exhibit a high degree of anatomical variations in terms of their number, level of origin, diameter and topographical relationships. In particular, it applies to the left renal vein which can take retroaortic or even circumaortic placement. Anatomical variations of the left renal vein may be of great clinical significance, particularly in the case of renal transplantation, retroperitoneal surgery as well as vascular or diagnostic procedures. Thus, the aim of this report was to present a complete anatomical description of two cases of the circumaortic left renal vein (CLRV; circumaortic renal collar) co-existing with the presence of various vascular anomalies. In the first case, the circumaortic renal collar was connected via a large anastomosis with the hemiazygos vein and was associated with the presence of the supernumerary left renal artery located below the main left renal artery. In the second case, the circumaortic renal collar was accompanied by the renal artery dividing close to its origin. Moreover, in the latter case, the fusiform aneurysm of the abdominal aorta was observed. In both cases, the CLRV began as a single and short trunk. On its further course, the initial segment of the CLRV was divided into two limbs - anterior (anterior left renal vein) and posterior (posterior left renal vein). Both anterior and posterior limb of the CLRV opened into the inferior vena cava.
Topics: Aged; Female; Humans; Male; Renal Veins; Vascular Diseases
PubMed: 30280373
DOI: 10.5603/FM.a2018.0090 -
Experimental and Clinical... Apr 2021Large spontaneous splenorenal shunts can result in portal vein steal syndrome and is a risk factor for portal vein thrombosis after orthotopic liver transplant....
Left Renal Vein Ligation for Spontaneous Splenorenal Shunts During Deceased-Donor Orthotopic Liver Transplant Is Safe and Can Mitigate Complications from Portal Steal: A Case Series.
OBJECTIVES
Large spontaneous splenorenal shunts can result in portal vein steal syndrome and is a risk factor for portal vein thrombosis after orthotopic liver transplant. Disconnection of these shunts by left renal vein ligation has been suggested as a potential technique for improving portal venous flow and mitigating risk of portal vein thrombus, thus improving graft perfusion. We present a series of 6 patients who underwent left renal vein ligation for spontaneous splenorenal shunts and their outcomes.
MATERIALS AND METHODS
This retrospective analysis included all orthotopic liver transplant recipients who underwent left renal vein ligation for spontaneous splenorenal shunts between 2016 and 2017. Portal venous flow, patency, and renal function were assessed postoperatively. Liver Doppler ultrasonography scans were obtained 1, 3, and 5 days postligation, and serum creatinine was evaluated at 1 and 2 weeks and 1, 3, 6, and 12 months postligation.
RESULTS
Over the 1-year study period, 92 orthotopic liver transplants were performed. In 6 patients who underwent left renal vein ligation, spontaneous splenorenal shunts were identified preoperatively. One patient received a retransplant complicated by portal vein thrombus and underwent thrombectomy with left renal vein ligation. Concurrent left renal vein ligation and liver transplant were performed in 5 patients, 2 with known portal vein thrombus at the time of transplant requiring thrombectomy. All patients had subjective intraoperative improvements in portal venous flow after ligation. Zero patients developed postoperative portal vein thrombus. No patients developed clinically significant renal dysfunction at 1-year follow-up.
CONCLUSIONS
Left renal vein ligation is technically feasible, has minimal and transient effects on renal function, and can improve portal venous flow, thus mitigating the risk for portal vein thrombus, graft hypoperfusion, and possible dysfunction.
Topics: Humans; Liver Transplantation; Renal Veins; Retrospective Studies; Splenorenal Shunt, Surgical; Thrombosis; Treatment Outcome
PubMed: 30501587
DOI: 10.6002/ect.2018.0096 -
Langenbeck's Archives of Surgery Jun 2022Assessing hepatic vein reconstruction using a left renal vein graft and in situ hypothermic liver perfusion in an extended liver resection.
PURPOSE
Assessing hepatic vein reconstruction using a left renal vein graft and in situ hypothermic liver perfusion in an extended liver resection.
METHODS
Patients included in this study were those with liver tumors undergoing curative surgery with resection and reconstruction of hepatic veins. Hepatic vein was reconstructed using a left renal vein graft. We describe the technical aspects of liver resection and vascular reconstruction, the key aspects of hemodynamic management, and the use of in situ hypothermic liver preservations during liver transection (prior to and during vascular clamping).
RESULTS
The right hepatic vein was reconstructed with a median left renal venal graft length of 4.5 cm (IQR, 3.1-5.2). Creatinine levels remained within normal limits in the immediate postoperative phase and during follow-up. Median blood loss was 500 ml (IQR, 300-1500) and in situ perfusion with cold ischemia was 67 min (IQR, 60.5-77.5). The grafts remained patent during the follow-up with no signs of thrombosis. No major postoperative complications were observed.
CONCLUSION
Left renal vein graft for the reconstruction of a hepatic vein and in situ hypothermic liver perfusion are feasible during extended liver resection.
Topics: Hemodynamics; Hepatectomy; Hepatic Veins; Humans; Liver Neoplasms; Neoplastic Processes; Perfusion; Renal Veins
PubMed: 35102435
DOI: 10.1007/s00423-022-02451-6 -
Journal of Ayub Medical College,... 2019Preoperative surgical planning assumes a central role in avoiding catastrophic outcomes of a surgery in the field of renal transplantation, and other urological...
BACKGROUND
Preoperative surgical planning assumes a central role in avoiding catastrophic outcomes of a surgery in the field of renal transplantation, and other urological procedures. This study was aimed to study the different anatomic patterns of human renal venous system.
METHODS
It is a descriptive cross-sectional study including 50 adult male cadavers with well-preserved kidneys, renal vasculature and the inferior vena cava. Cadavers with deformed or congenitally anomalous kidney, evidence of surgery, solitary kidney, tumours of kidneys or injured renal vessels / inferior vena cava were excluded from the study. The kidneys, renal veins and the inferior vena cava were exposed. After securing inferior vena cava fifty ml mixture of Indian ink and gelatine was injected into renal veins via inferior vena cava and was allowed to solidify. Following this, the renal venous anatomy was studied.
RESULTS
Twenty-eight cadavers had their right renal vein formed by 2 tributaries (56%), 13 (26%) had 3 tributaries, 5 (10%) had 4 tributaries, 1 cadaver had a posterior tributary (2%), while 3 cadavers had other numbers of tributaries (6%). Out of total 50 cadavers 40 (80%) had normal distribution of right renal vein. Additional renal veins were found in 14 (7%) cadavers, double renal veins in 1 (2%) and proximally double renal veins in 2 cadavers (4%)..
CONCLUSIONS
There is considerable variation in renal venous anatomy. Knowledge of common venous patterns is necessary for minimizing intraoperative damage to renal anatomy and to prevent intra- and post-operative complications..
Topics: Adult; Cross-Sectional Studies; Humans; Kidney; Male; Renal Veins; Vena Cava, Inferior
PubMed: 30868784
DOI: No ID Found -
AJR. American Journal of Roentgenology May 1978A total of 33 renal venograms were reviewed to determine the incidence of radiographically demonstrable valves. Valves were identified in five of 22 left renal venograms...
A total of 33 renal venograms were reviewed to determine the incidence of radiographically demonstrable valves. Valves were identified in five of 22 left renal venograms and two of 11 right renal venograms. On the right side in both patients the valve was located at the junction of the renal vein with the inferior vena cava. On the left, valves were located in the main renal vein proximal or distal to the gonadal vein and in one patient in a segmental upper pole tributary. These valves are significant because of the technical difficulties they can create during renal venography and their possible usefulness in selecting the site of anastomosis in patients undergoing distal splenorenal shunts.
Topics: Humans; Radiography; Renal Veins; Vena Cava, Inferior
PubMed: 417593
DOI: 10.2214/ajr.130.5.927