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World Journal of Surgery Aug 2021Spontaneous lienorenal shunts (SLS) siphon blood away from the portal circulation and may compromise portal inflow in liver transplantation (LT). Performing a left renal...
BACKGROUND
Spontaneous lienorenal shunts (SLS) siphon blood away from the portal circulation and may compromise portal inflow in liver transplantation (LT). Performing a left renal vein ligation (LRVL) is a relatively easy and efficacious method of overcoming this portal 'steal'. However, given the delicate state of renal function in these patients, its short and long term effects remain undefined. The aim of this study was to evaluate the efficacy of LRVL in augmenting portal flow and safety with regards to renal function.
METHODS
A prospectively collected database of 1638 consecutive LT recipients between January 2010 and August 2020 was reviewed. Twenty-eight patients who underwent LRVL were identified. There were six paediatric recipients, who were analysed separately. Data with regards to imaging, renal function, intraoperative portal hemodynamics, and renal morbidity were analysed.
RESULTS
Of the 22 adults, 21 underwent live donor LT. 22.5% had a pre-transplant history of acute kidney injury (AKI). Pre-operative CT demonstrated portal vein thrombosis and SLS in 63.6% and 92.9% of patients respectively. LRVL resulted in a significant augmentation of portal hemodynamics in both the adult and paediatric recipients. Postoperatively, 14.3% and 35.7% of patients developed chylous drain output and AKI respectively. Of 13 patients who underwent CT at various timeframes, 5 patients had a partial re-canalisation of LRV at 6 months.
CONCLUSION
From renal and portal standpoints, LRVL is a safe and effective technique of augmenting portal inflow. Further large-scale multicentre studies and consensus will help define an objective algorithmic approach to LT recipients with SLS.
Topics: Adult; Child; Humans; Kidney; Ligation; Liver Transplantation; Portal Vein; Renal Veins
PubMed: 33866424
DOI: 10.1007/s00268-021-06112-5 -
The Pan African Medical Journal 2017Renal angiomyolipoma is a benign tumor. It is characterized of three different components: muscular, vascular and greasy. Their distribution is variable. Diagnosis is... (Review)
Review
Renal angiomyolipoma is a benign tumor. It is characterized of three different components: muscular, vascular and greasy. Their distribution is variable. Diagnosis is based on the identification of the intratumoral greasy component on CT scan and MRI. In exceptional circumstances, this tumor may be aggressive with locoregional and venous extension (renal vein and inferior vena cava). We here report the case of a 37-year old patient with voluminous renal angiomyolipoma extending to the renal vein.
Topics: Adult; Angiomyolipoma; Female; Humans; Kidney Neoplasms; Magnetic Resonance Imaging; Renal Veins; Tomography, X-Ray Computed
PubMed: 29599888
DOI: 10.11604/pamj.2017.28.190.7746 -
Seminars in Vascular Surgery Mar 2013Nutcracker syndrome is one of the abdominal venous entrapments, caused by compression of the left renal vein between the superior mesenteric artery and the abdominal... (Review)
Review
Nutcracker syndrome is one of the abdominal venous entrapments, caused by compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. Occasionally a retro-aortic left renal vein is compressed between the aorta and the vertebral body (posterior nutcracker syndrome). The renal vein distal to the compression is dilated and renal venous flow can be diverted toward the pelvis through an incompetent, refluxing, left ovarian or spermatic vein, in addition to drainage through retroperitoneal venous collaterals. In this article, we describe the different surgical and endovascular techniques that are used to treat this syndrome.
Topics: Collateral Circulation; Constriction, Pathologic; Diagnostic Imaging; Endovascular Procedures; Humans; Renal Circulation; Renal Nutcracker Syndrome; Renal Veins; Treatment Outcome; Vascular Surgical Procedures
PubMed: 23932560
DOI: 10.1053/j.semvascsurg.2013.04.006 -
Vascular and Endovascular Surgery Jan 2022Renal vein aneurysms (RVAs) are considered rare clinical entities. RVAs can be secondary to thrombosis, venous hypertension, or renal arteriovenous fistula (RAVF). RVAs...
Renal vein aneurysms (RVAs) are considered rare clinical entities. RVAs can be secondary to thrombosis, venous hypertension, or renal arteriovenous fistula (RAVF). RVAs secondary to RAVF are rare. Patients with RVA may present with hypertension, abdominal pain, hematuria, or may even be asymptomatic. However, there may be life-threatening emergencies including aneurysm rupture, thrombosis, and pulmonary embolism. The treatment of RVAs includes reconstruction of the renal vein, nephrectomy, and endovascular treatment. In this technical note, we report the endovascular treatment of a giant RVA that developed secondary to an acquired RAVF by the placement of multiple vascular plugs. Endovascular occlusion of the RAVF with vascular plugs is effective to prevent a life-threatening rupture of RVA. Clinical follow-up is crucial to detect leakage or migration of the vascular plugs.
Topics: Aneurysm, Ruptured; Arteriovenous Fistula; Humans; Renal Artery; Renal Veins; Treatment Outcome
PubMed: 34538156
DOI: 10.1177/15385744211045608 -
Cancer Reports (Hoboken, N.J.) Dec 2023Renal metastasis is a rare manifestation of germ cell tumors. Extension of malignant lesions into the renal vein can complicate the scenario.
BACKGROUND
Renal metastasis is a rare manifestation of germ cell tumors. Extension of malignant lesions into the renal vein can complicate the scenario.
CASE
This report presents a 35-year-old man with primary stage IS NSGCT. Fourteen months after radical orchiectomy he presented with metastasis in the lung, kidney, and para-aortic lymph nodes. He received multiple lines of salvage treatments including chemotherapy and surgery. Intraoperative exploration during radical nephrectomy and retroperitoneal lymphadenectomy revealed intra-renal vein involvement with a prominent teratomatous component.
CONCLUSION
Defining the exact extent of malignant lesions, especially endovascular lesions, is very important to clarify how advanced the malignant lesions are. The surgeons must be aware of the risk factors that predict vascular involvement, and therefore, providing intraoperative access to vascular surgery procedures when needed.
Topics: Male; Humans; Adult; Testicular Neoplasms; Renal Veins; Neoplasms, Germ Cell and Embryonal; Lymph Node Excision; Neoplasms, Second Primary; Thrombosis
PubMed: 37807242
DOI: 10.1002/cnr2.1910 -
Experimental and Clinical... Jun 2020Nutcracker syndrome is rare, and a proportion of patients with this syndrome continue to have intractable pain and symptoms. Due to the heterogeneity of patients' chief...
OBJECTIVES
Nutcracker syndrome is rare, and a proportion of patients with this syndrome continue to have intractable pain and symptoms. Due to the heterogeneity of patients' chief complaints and symptoms, the surgeon's preferred approach may be inherently different but is of paramount importance to the outcome.
MATERIALS AND METHODS
We present 4 cases in which renal autotransplant with extraction and ligation of previously placed gonadal coils was performed following previously attempted renal vein stenting or combined renal vein transposition followed by renal vein stenting.
RESULTS
Autotransplant resulted in flank pain resolution with improvement in symptoms associated with pelvic congestion syndrome.
CONCLUSIONS
The approach to such cases requires meticulous and adequate vena cava exposure, with preparation for potential caval reconstruction. No firm inferences can be made from such a small series; however, we believe in renal autotransplant as first-line therapy, and failure after an initial renal vein stent should be salvaged by renal autotransplant over further endovascular attempts.
Topics: Adolescent; Adult; Device Removal; Endovascular Procedures; Female; Humans; Kidney Transplantation; Nephrectomy; Renal Nutcracker Syndrome; Renal Veins; Stents; Transplantation, Autologous; Treatment Outcome; Young Adult
PubMed: 31104623
DOI: 10.6002/ect.2019.0015 -
Actas Urologicas Espanolas Sep 2013
Topics: Anatomic Variation; Donor Selection; Humans; Kidney Transplantation; Organ Size; Renal Veins
PubMed: 23769896
DOI: 10.1016/j.acuro.2013.04.004 -
Vascular and Endovascular Surgery Nov 2021Ligation of the left renal vein is an accepted manoeuvre where it is difficult to access the pararenal abdominal aorta for the open treatment of aortic occlusive or...
Ligation of the left renal vein is an accepted manoeuvre where it is difficult to access the pararenal abdominal aorta for the open treatment of aortic occlusive or aneurysmal disease. There is some controversy regarding the long-term effect of this on renal function. We describe the case of a 37-year-old gentleman who underwent an elective aorto-bifemoral bypass for aorto-iliac occlusive disease with symptoms of short distance claudication, with intra-operative ligation of the left renal vein. This was complicated by post-operative acute renal failure and haematuria, with CT findings of left renal venous dilatation and peri-renal stranding. The patient underwent successful left renocaval bypass with reversed great saphenous vein, with subsequent resolution of haematuria and improvement in renal function. The syndrome of acute renal failure and haematuria is a rare but possible complication of left renal vein ligation during aortic surgery, and restoration of renal venous outflow via renocaval bypass in this instance was an effective method of treating this complication.
Topics: Acute Kidney Injury; Adult; Aorta, Abdominal; Hematuria; Humans; Male; Renal Veins; Treatment Outcome
PubMed: 33926322
DOI: 10.1177/15385744211010393 -
European Journal of Vascular and... Nov 2023
Topics: Humans; Renal Veins; Aortic Aneurysm; Aorta; Aortic Aneurysm, Abdominal
PubMed: 37562762
DOI: 10.1016/j.ejvs.2023.08.004 -
Surgical and Radiologic Anatomy : SRA Aug 2015To estimate the incidence, anatomical feature as well as type of the renal vein variation with multidetector computed tomography (MDCT) in an adult population.
PURPOSE
To estimate the incidence, anatomical feature as well as type of the renal vein variation with multidetector computed tomography (MDCT) in an adult population.
METHODS
A total of 1,452 patients who underwent MDCT angiography were retrospectively evaluated for the presence (number, length, origination, destination, branching pattern and course) of the renal vein variation. χ² test was used to compare the incidence of variations in left and right renal veins and the incidence of variations in each side renal vein between males and females.
RESULTS
Renal vein variations were observed in 358 patients (24.7 %, 358/1,452), which included 103 patients (7.1 %, 103/1,452) with left renal vein (LRV) variations, 279 patients (19.2 %, 279/1,452) with right renal vein (RRV) variations and 24 patients (1.7 %, 24/1,452) with bilateral renal vein variations. The frequency of RRV variations was significantly higher than that of LRV variations (p < 0.05). No statistically significant correlation was found between variations of renal vein (LRV and RRV) and gender (p > 0.05). According to the morphology of the renal vein, we classified LRV variations into five types: type I, circumaortic LRV (2.1 %, 31/1,452); type II, retroaortic LRV (2.1 %, 30/1,452); type III, abnormal reflux (1.7 %, 24/1,452); type IV, late venous confluence of LRV (0.9 %, 13/1,452); type V, rare type (0.3 %, 5/1,452), and RRV variations into three types: type 1, additional renal vein (18.7 %, 271/1,452); type 2, abnormal reflux (0.4 %, 6/1,452); type 3, rare type (0.1 %, 2/1,452).
CONCLUSION
The renal vein variations are not unusual, particularly in the RRV. Anomalies of the LRV are more complex than those of the RRV. The renal vein anatomy can be well depicted by MDCT angiography. Our new classification of the renal vein variations will improve the recognition of the renal vein morphology preoperatively.
Topics: Adult; Aged; Aged, 80 and over; Angiography; Female; Humans; Incidence; Male; Middle Aged; Multidetector Computed Tomography; Renal Veins; Retrospective Studies
PubMed: 25567101
DOI: 10.1007/s00276-014-1403-6