The anatomical variations of renal veins observed during 342 nephrectomies in living donors are described, 311 cases on the left side and 31 on the right. The following anatomy of the renocava veins was observed: 1. On the left side the renal vein was always unique (311/311) and had two tributaries (suprarenal and gonadal veins) in 100 per cent and one or more renolumbar veins in 65.27 per cent, encircling the aorta in 1.07 per cent, was retroaortic in 1.4 per cent; and the inferior vena cava was double in 0.64 per cent; B-on the right side the renal vein was double in 29 per cent (9/31) and had only one tributary (gonadal vein) in one case, for 3.22 per cent (1/ 31); three or more renal veins in 9.7 per cent (3/31). We concluded that the left renal vein is always unique, presenting variations principally in its tributaries and trajectory. On the right side, the renal vein was double or triple in 38.79 per cent UNITERMS: Nephrectomies. Renal veins. Kidney transplantation. INTROOUCTION It is crucial to know the anatomy of the renal vessels during a retroperitoneal approach to prevent bleeding by accidental tearing. I Comparably, the renal venous pattem of the right side bears little resemblance to that of the left. In its relatively short course from the kidney to the inferior vena cava, the right vein rarely receives a tributary. The longer left renal vein (LRV), on the contrary, regularly receives the following tributaries: suprarenal and inferior phrenic, from above, frequently joined; gonadal (testicular or ovarian) from below; and renolumbar vein posteriorly, often by a confluent with the gonadal vein. ,3Address for correspondence:José Carlos Costa Baptista-Silva Rua Prot. Artur Ramos, 178, 123-Vega São Paulo/SP -Brasil-CEP 01454-904 During the living donor nephrectomy, the left kidney is used more often as a donor organ because its vein is longer than the right renal vein. Usually, the LRV anteriorly crosses the aorta before reaching the vena cava. MATERIAL ANO METHOOSFrom May 1990 to May 1996, 342 living-donor nephretomies (311 on the left side and 31 on the right) were performed at Dom Silvério Gomes Pimenta (260) and Beneficência Portuguesa (82) HospitaIs. Of the 342, 208 cases were female and 134 male, 85 per cent were white, an~the average age was 43.8 years. All cases were studied through preoperative renal angiography and intraoperative observation.

Elongation of a short right renal vein with the inferior vena cava is a feasible mean to overcome technical problems that may compromise the results of cadaveric renal transplantation.

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The development of the postnephrectomy arteriovenous fistula (PNAVF) between the renal vessels stumps is rare. Here we present a case report of PNAVF, and review the diagnosis, treatment and prevention. The most common clinical features include a loud murmur over the previous nephrectomy scar, and heart failure resistant to common medical treatment. A 58-year-old white woman was admitted to the hospital for a complete evaluation of an unexplained congestive heart failure with no response to common medical treatment. She had had a right nephrectomy for pyonephrosis 13 years before. The diagnosis of PNAVF was suspected because over the right lumbar region a definite trill was palpated, and on auscultation a harsh, machinery-like murmur was heard. The diagnosis was confirmed by aortogram and selective renal arteriography. In May 1989, the right arteriovenous was excised through a right subcostal transperitoneal approach. The renal vessel stumps were individually ligated and sutured separately close to aorta and vena cava. The patient's postoperative course was entirely uneventful in the following seven years. We conclude that during nephrectomy, the renal vessels should be ligated separately, and the transfixation in mass of the stumps avoided to prevent arteriovenous fistula.