Which renal vein is longer

The bleeding can be aggravated by oblique course of the renal vein. Hence, the depiction of the venous variants in preoperative imaging facilitates the dissection of these veins and helps to avoid or reduce venous injuries and subsequent bleeding during operations.

Because of the close proximity of the retro-aortic left renal vein to the pancreas, this vein can be indirectly affected by malignant disease of the pancreas.

Therefore, the retro-aortic left renal vein is an important vessel to consider in the evaluation and staging of retroperitoneal tumours. Haematuria, thrombosis, pain, left renal vein hypertension, and varicocele are some of the clinical entities associated with a retroaortic left renal vein [ 10 ]. Anomalous lumbar and retroaortic renal veins are vulnerable to injury in orthopaedic procedures of the lumbar spine and any damage that arises may be difficult to manage and repair. A bifid renal vein that has two points of drainage into the IVC may provide an alternative collateral route of drainage into the IVC if the IVC has been interrupted in an area between these two drainage points.

Anomalous multiple renal veins is a contraindication for donor nephrectomy because this anomaly is associated with a higher risk of thrombosis of the graft renal vein [ 11 ]. The understanding of these variations may also provide safety guidelines for endovascular procedures, such as angioplasties and therapeutic embolisation.

In laparoscopic nephrectomy, the left kidney is preferred owing to its longer vein. Furthermore, it is technically easier to remove and provides a more optimal vessel for venous reanastomosis in the recipient.

However, a right nephrectomy may be performed if the left kidney has a complex anomalous venous pattern. During diagnostic and surgical approaches at the level of the left kidney, not only must the vascular variants be considered, but the associations of these with congenital splenomegaly must also be suspected. Anatomical knowledge of the presented variants is of immense importance for the appropriate selection of operative techniques during surgical interventions as well as for postoperative management.

National Center for Biotechnology Information , U. Journal List Anat Cell Biol v. Anat Cell Biol. Published online Mar Find articles by Seyed Hadi Anjamrooz. Find articles by Hassan Azari. Find articles by Mehdi Abedinzadeh. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Corresponding author: Seyed Hadi Anjamrooz. Box , Sanandaj, Iran. This article has been cited by other articles in PMC. Abstract Knowledge of the renal vascular anatomy may greatly contribute to the success of surgical, invasive and radiological procedures of the retroperitoneal region.

Introduction Normally, the venous drainage of each kidney proceeds through a single vein that drains into the inferior vena cava IVC at a right angle. Case Reports During the dissection of the retroperitoneal region of the cadaver of a year old Iranian male, a complex picture of anatomical variations was observed. Open in a separate window. Discussion A retro-aortic left renal vein is frequently encountered in radiological investigations and in the dissecting room.

Embryological basis Interruption or complete arrest of any developmental stage of the IVC may produce various anomalies in the drainage site, branches and course of the renal veins [ 7 - 9 ]. Clinical significance Because abnormalities of vessels, especially veins, are clinically dormant, venous bleeding is a troublesome intraoperative hazard. References 1. Left renal vein variations. Surg Radiol Anat. Two rare anomalies of the left renal vein.

Clinical implications of concomitant variations of the testicular, suprarenal and renal veins: a case report. Ann Anat. Short- and long-term outcomes of kidney transplants with multiple renal arteries. Ann Surg. Multiple variations of the urogenital vascular system in a single cadaver: a case report.

Cases J. The utility of 64 channel multidetector CT angiography for evaluating the renal vascular anatomy and possible variations: a pictorial essay. Korean J Radiol. Right renal vein elongation with the inferior vena cava for cadaveric kidney transplants. Jose C. Baptista-Silva; Jose O. Medina-Pestana; Marcos J.

Verissimo; Marcos J. Castro; Maris S. Demuner; Marcio F. A short right renal vein SRRV is a frequent and well-known technical inconvenience, which is commonly observed during transplantation of the right kidney 1,2. A short or damaged right renal vein can make renal transplantation very difficult The right renal hilum has a single long artery and a short vein that causes difficulties while performing venous anastomosis either from living or cadaveric kidney transplantation, and especially when the right renal artery has an aortic path in the case of a cadaveric donor.

It is more complicated and takes more time to perform the transplant especially in either deep iliac vessels, or in the obese or in both. Anastomosis of a SRRV to the common or external iliac vein has been reported to be associated with technical problems such as angulation or tension of the venous anastomosis, reduced mobility, limited placement and inspection of the graft for hemostasis, and possible kinking of the donor artery.

One technical solution consists of a more extensive mobilization of the recipient's vessels, with the increased risk of lymphocele formation. A number of surgical approaches have been described to solve the problem of a SRRV 5. Several techniques have been used to overcome this technical challenge such as renal vein extension using an autologous saphenous graft, bovine arterial heterograft or polytetrafluoroethylene PTFE vascular prostheses A technique of extension of the right renal vein using the contiguous inferior vena cava was introduced to make vascular anastomosis feasible Using this technique, a portion of the contiguous inferior vena cava is removed during organ harvesting to be used to extend very short right renal vein from cadaveric kidneys The technique to obtain an appropriate length of the right renal vein using the vena cava is simple, physiological and feasible, and does not interfere with multiorgan procurement In this study, we present our experience with the elongation of the SRRV using the contiguous vena cava.

From to , we performed consecutive cadaveric renal transplants in patients at end-stage end chronic renal insufficiency. The right kidney was used in patients and from those, 34 kidneys had a very short renal vein requiring elongation using the vena cava to make the venous anastomosis technically feasible and to avoid kinking of renal arteries.

From these 34 patients who received the kidney with a very short renal vein, the mean age was A technique used for procurement of cadaveric kidneys is removing the entire block. It was modified from Taylor et al. After removing the kidneys as an entire block, on a bench surgery, the left renal vein is divided at its origin on the vena cava and an entire segment of vena cava is left attached to the right renal vein.

In 34 grafts with very short right renal vein, the segment of the vena cava below the ostium of the right renal vein was bent up to the level of the renal vein. The segment above the ostium and the excess of the bent-up lower segment were cut off. A running monofilament polypropylene thread suture was used to close the upper defect in the vena cava. With this technique we obtained an extended renal vein. The lower segment of vena cava of the right renal vein was left as well as the length of the renal artery, and its excess was cut off.

The aorta artery is split in the midline, leaving each half attached to the renal arteries of each kidney Figure-1 to 3. During renal transplantation an end-to-side anastomosis is performed between the ostium of the segment of vena cava and the recipient's external iliac vein or other vein Figure-4 and 5. In our study, we performed 34 transplants of the right kidney, 10 of which had 2 or more arteries attached to a single aortic patch, and 24 had a single artery.

In 33 cases we used an aortic patch attached to the renal artery to perform the anastomosis. From these 34 kidneys transplanted, the elongated right renal vein anastomosis was performed end to side to the external iliac vein in 24 cases, to the common iliac vein in 8 cases, and to the inferior vena cava in 2 cases. The right renal artery anastomosis was performed end to side using the aortic patch attached to the renal artery in 21 cases in the external iliac artery, in 10 cases in the common iliac artery, and in 2 cases in the aorta.

End to end without aortic patch to the internal iliac artery was used in 1 case. In all cases mentioned the vascular anastomoses were easily performed and no vascular thrombosis occurred.

We have been following the progress of these 34 patients, which received cadaveric renal transplant with right renal vein extension, for more than 5 years. Eight patients lost their grafts from chronic rejection and 5 died from others medical complications heart attack, malignant disease and infections not related to the surgical approach.

These problems usually are related to trauma sustained during graft nephrectomy or transplantation. Difficulties are more likely to occur with the right kidney, since the right renal vein is shorter and anatomical variations are more frequent than on the left side 5, Janschek et al.

Short vessels can consume more time and extend the length of the warm ischemia during renal vessel anastomoses. In renal transplantation, when the vein is slightly longer than the corresponding artery, it allows easier venous and arterial anastomoses.

The renal vein is formed by the union of two-to-three renal parenchymal veins in the renal sinus. It emerges from the renal hilum anterior to the renal artery and drains into the inferior vena cava at the level of L2. The left renal vein courses anteriorly to the abdominal aorta. See article: renal vein anomalies. Anatomy: Abdominopelvic. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Updating… Please wait. Unable to process the form. Check for errors and try again.

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