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      Dual Retro-Aortic Left Renal Vein with Drainage into Left Common Iliac Vein: Rare Anomaly of Left Renal Vein

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          Abstract

          Knowledge of the renal vascular anatomy greatly contributes to the success of surgical, invasive and radiological procedures of the retroperitoneal region. In today’s era of transplant, this knowledge is of utmost importance in performing donor nephrectomy so that number of fatal intra-operative complications can be prevented. Herein, we report on a rare anomaly of left renal vein in which dual retro-aortic left renal veins were noted and one of them drained into the left common iliac vein.

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          Left renal vein variations.

          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.
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            The Utility of 64 Channel Multidetector CT Angiography for Evaluating the Renal Vascular Anatomy and Possible Variations: a Pictorial Essay

            The increased use of laparoscopic nephrectomy and nephron-sparing surgery has prompted the need for a more detailed radiological evaluation of the renal vascular anatomy. Multidetector CT angiography is a fast and accurate modality for assessing the precise anatomy of the renal vessels. In this pictorial review, we present the multidetector CT angiography appearances of the normal renal vascular anatomy and a spectrum of various anomalies that require accurate vascular depiction before undergoing surgical treatment.
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              Clinical implications of concomitant variations of the testicular, suprarenal and renal veins: a case report.

              Multiple venous anomalies have been observed during dissection of the posterior abdominal wall in a 65-year-old, white male cadaver. The left testicular and suprarenal veins united inferior to the superior mesenteric artery, coursed anterior to the abdominal aorta and drained into the inferior vena cava (IVC). Further the left renal vein coursed retroaortically and divided into three branches. The superior branch coursed on the vertebral column and drained into the azygos vein while middle and inferior branches drained into the IVC. The right renal vein was double and both drained into the IVC separately. Due to implications for numerous therapeutical and diagnostic procedures in the retroperitoneal region knowledge of these variations could be useful for clinicians in its recognition and protection.
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                Author and article information

                Journal
                Int J Organ Transplant Med
                Int J Organ Transplant Med
                Ijotm
                International Journal of Organ Transplantation Medicine
                Avicenna Organ Transplantation Institute (Shiraz, Iran )
                2008-6482
                2008-6490
                2016
                1 May 2016
                : 7
                : 2
                : 99-101
                Affiliations
                [1]Assistant Professor, Department of Radiology, G. R. Doshi and K. M. Mehta Institute Of Kidney Diseases & Research Centre (IKDRC)- Dr. H.L. Trivedi Institute Of Transplantation Sciences (ITS) Civil Hospital Campus, Asarwa, Ahmedabad- 380016, Gujarat, India
                Author notes
                [* ]Correspondence: Dr. Harsh C Sutariya, Assistant Professor, Department of Radiology, G. R. Doshi and K. M. Mehta Institute Of Kidney Diseases & Research Centre (IKDRC)- Dr. H.L. Trivedi Institute Of Transplantation Sciences (ITS) Civil Hospital Campus, Asarwa, Ahmedabad- 380016, Gujarat, India ,E-mail: surariya@rediffmail.com
                Article
                ijotm-7-099
                5396052
                87275f4e-a726-4762-b1de-744fb2dc7d37

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Case Report

                aorta,transplantation,nephrectomy,renal veins,iliac vein
                aorta, transplantation, nephrectomy, renal veins, iliac vein

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