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European Journal of Medical Research Jun 2022Leiomyosarcoma originating from the renal vein (RVLMS) is extremely rare. RVLMS lacks specific clinical manifestations and specific imaging features. This article...
BACKGROUND
Leiomyosarcoma originating from the renal vein (RVLMS) is extremely rare. RVLMS lacks specific clinical manifestations and specific imaging features. This article discusses the epidemiological characteristics and diagnostic difficulties of RVLMS, as well as imaging features, differential diagnosis, treatment strategy, and prognostic factors of this disease.
METHOD
A case of RVLMS at our center, and 55 cases from the literature based on the PubMed search.
RESULTS
Total operation time was 224 min, and total blood loss during the surgery was 200 ml. Resected tumor was irregular in shape, with negative margins. On the 6th day after the operation, the drainage tube was removed, and the patient was discharged from the hospital. Postoperative pathological results confirmed the renal vein leiomyosarcoma: spindle cell sarcoma, diffuse severe atypia, S-100 (-), SMA ( +), desmin ( +), CD34 (-), CD99 ( +). Twenty-seven months after the surgery, the patient is alive, and without local recurrence or distant metastases.
CONCLUSION
Unspecific clinical manifestations and imaging features make the diagnosis of RVLMS difficult. Most patients are diagnosed intra-operatively or following postoperative pathology. Differential diagnosis with paraganglioma (PG) and retroperitoneal sarcoma (RPS) should be made. Early and complete resection is considered as the first choice of treatment, and whether to preserve the kidney is based on the patient's condition. RVLMS is highly malignant, and may recur locally or metastasize to distant locations; therefore, adjuvant therapy and regular follow-up should be carried out after surgery.
Topics: Humans; Leiomyosarcoma; Neoplasm Recurrence, Local; Renal Veins; Retroperitoneal Neoplasms; Sarcoma
PubMed: 35761392
DOI: 10.1186/s40001-022-00721-z -
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 -
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 -
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 -
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 -
Journal of Medical Case Reports Feb 2021Posterior nutcracker syndrome is defined by the compression of the left renal vein between the abdominal aorta and a lumbar vertebral body. It can be clinically...
BACKGROUND
Posterior nutcracker syndrome is defined by the compression of the left renal vein between the abdominal aorta and a lumbar vertebral body. It can be clinically manifest with intermittent hematuria, gonadal or spermatic reflux resulting in varicocele. Ultrasound is the first-line imaging which require more accurate study with contrast-enhanced computed tomography. Management can be conservative in younger patients with mild hematuria due to the high spontaneous remission rate and invasive with open surgical and endovascular interventions. We describe a very rare case with compression of the left renal vein due to an osteophyte of the spine.
CASE PRESENTATION
A 62-year-old Caucasic male came to our radiology department for chronic hepatitis B virus (HBV)-related liver disease follow-up and mild scrotal pain. The ultrasound examination revealed a compression of the left retro-aortic renal vein in the aorto-vertebral space caused by an osteophyte. Duplex Doppler ultrasound revealed flow congestion in the left renal vein and renal failure; power Doppler ultrasound showed left varicocele.
CONCLUSIONS
Doppler ultrasound is the first-line imaging and allows the detection of all the typical signs of posterior nutcracker: left renal vein stenosis, flow congestion and renal failure. Nutcracker syndrome should be suspected in older patients with left varicocele associated with hematuria. Failure to diagnose and treat these patients could have serious consequences for their health.
Topics: Aged; Hematuria; Hepatitis B, Chronic; Humans; Male; Middle Aged; Renal Nutcracker Syndrome; Renal Veins; Varicocele
PubMed: 33522968
DOI: 10.1186/s13256-020-02617-0 -
Cleveland Clinic Journal of Medicine Nov 2018
Topics: Humans; Male; Middle Aged; Nephrotic Syndrome; Pulmonary Embolism; Renal Veins; Venous Thrombosis
PubMed: 30395527
DOI: 10.3949/ccjm.85a.18064 -
BMC Nephrology Sep 2022Performing percutaneous renal biopsy procedures in lupus nephritis (LN) and nephrotic syndrome presents a unique challenge to the nephrologist because of the risk of...
BACKGROUND
Performing percutaneous renal biopsy procedures in lupus nephritis (LN) and nephrotic syndrome presents a unique challenge to the nephrologist because of the risk of bleeding from the procedure and the hypercoagulable state in hypoalbuminemia. The management of a patient with venous thrombosis with perinephric hematoma post renal biopsy can be difficult if occurred.
CASE PRESENTATION
We are presenting a case of perinephric hematoma following percutaneous renal biopsy in a 23-year-old man with lupus nephritis, nephrotic syndrome, and lower limbs deep vein thrombosis (DVT). The patient developed persistent frank haematuria, flank pain and acute urinary retention post-procedure. We have withheld his oral warfarin three days before the procedure, and no anticoagulation was given subsequently. Initial CT Angiography (CTA) renal showing stable hematoma and no visible evidence of vascular injury. Three weeks later, the patient still has persistent frank haematuria and a repeated CTA renal revealed new bilateral renal vein thrombosis. Considering the high risk of worsening symptomatic venous thrombosis, we gave subcutaneous enoxaparin sodium and restart oral warfarin despite ongoing haematuria. The frank haematuria resolved within two days of anticoagulation with no radiological evidence of worsening of the perinephric hematoma. The follow-up ultrasonography a month later showed resolution of the hematoma and renal vein thrombosis with no adverse effect.
CONCLUSION
Our experience, in this case, highlighted the importance of case selection for percutaneous renal biopsy among high-risk patients. Additionally, a prolonged frank haematuria in post-renal biopsy with nephrotic syndrome warranted a reassessment, as a clinical presentation of post-procedure perinephric hematoma and renal vein thrombosis can overlap. We also demonstrated that restarting anticoagulation earlier than four weeks in a patient with renal vein thrombosis and post-renal biopsy perinephric hematoma can be safe in the selective case.
Topics: Adult; Biopsy; Enoxaparin; Gastrointestinal Hemorrhage; Hematoma; Hematuria; Humans; Kidney Diseases; Lupus Nephritis; Male; Nephrotic Syndrome; Renal Veins; Ureteral Diseases; Venous Thrombosis; Warfarin; Young Adult
PubMed: 36085017
DOI: 10.1186/s12882-022-02935-z -
Journal of Vascular Surgery. Venous and... Jan 2015Chronic pelvic pain accounts for up to 30% of outpatient gynecologic visits in the United States, potentially affecting up to 40% of the female population during their... (Review)
Review
BACKGROUND
Chronic pelvic pain accounts for up to 30% of outpatient gynecologic visits in the United States, potentially affecting up to 40% of the female population during their lifetime. Pelvic congestion syndrome (PCS) is defined as chronic pelvic pain resulting from reflux or obstruction of the gonadal, gluteal, or periuterine veins, sometimes associated with perineal or vulvar varices. It can also be caused by compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta, also known as the nutcracker syndrome. Whereas PCS accounts for up to 30% of patients presenting with chronic pelvic pain, it is frequently underdiagnosed. We reviewed the literature to investigate the current state of the diagnosis and treatment of this disorder.
METHODS
An online database search was performed with MEDLINE. MeSH headings included PCS, chronic pelvic pain, ovarian vein reflux, nutcracker syndrome, renal vein obstruction, pelvic varicosities, labial varicosities, embolization, treatment, and therapies.
RESULTS
Our MEDLINE search revealed more than 3756 references to chronic pelvic pain. Specific references to PCS, pelvic chronic pain, ovarian vein reflux, nutcracker syndrome, renal vein obstruction, pelvic varicosities, labial varicosities, embolization, treatment, and therapies, however, included only 260 references. Thirty-seven references were small series including fewer than 50 patients or individual case reports documenting medical, surgical, or endovascular treatment of PCS. The majority of these papers demonstrated successful treatment of symptoms from PCS with embolization of one or both ovarian veins in addition to treatment of refluxing internal iliac vein branches. In addition, open surgery and, more recently, endovascular stenting of LRV obstruction have shown some promise in alleviating symptoms attributed to nutcracker syndrome.
CONCLUSIONS
Diagnosis of PCS requires a careful history, physical examination, and noninvasive imaging. Several large case series have demonstrated the efficacy of embolotherapy in the reduction of pelvic pain; thus, it is the most favored treatment option for patients with PCS. For patients with outflow obstruction due to nutcracker syndrome, a limited number of studies have demonstrated remission of symptoms with stenting of the LRV as an alternative to open surgery.
Topics: Chronic Pain; Embolization, Therapeutic; Female; Humans; Ovary; Pelvic Pain; Renal Veins; Syndrome; Varicose Veins
PubMed: 26993690
DOI: 10.1016/j.jvsv.2014.05.007 -
Medical Science Monitor : International... Jul 2018BACKGROUND There are few studies that address how to quickly locate the renal vein after processing the renal artery during retroperitoneal laparoscopic radical...
BACKGROUND There are few studies that address how to quickly locate the renal vein after processing the renal artery during retroperitoneal laparoscopic radical nephrectomy (RLRN) for renal cell carcinoma (RCC). This study aimed to evaluate the feasibility of an easy and effective method to locate the renal vein in RLRN. MATERIAL AND METHODS Between September 2016 and October 2017, a total of 44 consecutive cases of RLRN were performed. All the surgeries used the proposed study method to locate the renal vein, in which surgeons located the renal artery following the medial arcuate ligament on the posterior abdominal wall, then the surgeon directly searched for the renal vein caudally relative to renal artery when performing left nephrectomy, but cranially when performing right nephrectomy. RESULTS Among the 44 enrolled RLRN patients, there were 28 left nephrectomies and 16 right nephrectomies. We found the renal vein in most cases successfully by our proposed method. The renal vein was located caudally relative to the renal artery in 27 cases of the left kidney (96.4%), and was located cranially in 14 cases of the right kidney (87.5%). The mean operative time was 135.0±27.8 minutes. No intraoperative complications occurred. Postoperative complications (fever) developed in 5 patients. Pathological examination revealed: clear cell carcinoma in 34 cases (77.3%), chromophobe renal cell carcinoma (RCC) in 5 cases (11.4%), papillary RCC in 3 cases (6.8%), multilocular cystic RCC in 1 case (2.3%), and oxyphil cell adenoma in 1 case (2.3%). CONCLUSIONS Our proposed method to search for the renal vein might be a safe and feasible procedure to accelerate the process of handling the renal pedicle and of great practical significance in RLRN surgery.
Topics: Adult; Aged; Female; Humans; Kidney; Laparoscopy; Male; Middle Aged; Nephrectomy; Operative Time; Postoperative Complications; Renal Artery; Renal Veins; Retroperitoneal Space; Treatment Outcome
PubMed: 30040793
DOI: 10.12659/MSM.911199