Kidney function after left renal vein ligation in the dog

Abstract

The ligature of the left renal vein is an alternative whenever this vessel is injured. The purpose of this study was to evaluate the capacity of the affluents of the left renal vein, proximal to the ligature, to maintain tissue vitality and function of the left kidney. Fifteen mongrel male dogs were divided in 3 groups of 5 dogs: Group I (control) -a laparotomy was performed, and the abdominal structures were only identified; Group II -the left renal vein was tied, close to vena cava; Group III -the same procedure as for Group II and a right nephrectomy. Blood urea nitrogen and serum creatinine levels were measured before the procedure, and every 3 days during 4 weeks in the postoperative period. Renal arteriography and an excretory urogram were performed on the animals that survived 60 days. Thereafter, or immediately after precocious death, the kidneys were removed for histological examination. All the animals of Group III died before two months (mean = 10.5 +-3.2 days), while the animals of Group II survived during that period. There was a complete exclusion of the left kidney in all dogs that underwent renal vein ligature. In the animals of Group II, the renal cortico-medullary limits could not be identified. At microscopy, the aspect was suggestive of nephrosclerosis. In the animals of Group III, the left kidney was enlarged, and a great amount of intravascular and intrapelvic blood clots were observed. At microscopy, extensive areas of necrosis, inflammatory infiltration, and hemorrhage were identified. In conclusion, the tributaries of the renal vein were not sufficient to maintain the tissue vitality and function of the left kidney after ligature of its main vein. The anatomical particularities of the renal veins permit a series of considerations when the veins are lesioned or obstructed. The left renal vein is longer than the right one, crosses the aorta anteriorly, and receives several tributaries during its course, such as the left gonadal vein, the ureteral vein, and the suprarenal vein. The left renal vein communicates with a variable number of lumbar veins and the retroaortic and prevertebral venous plexi, which may serve as possible collateral venous drainage pathways through the pericapsular path 1 .On the basis of these anatomical peculiarities, Whipple (1945), Teixeira (1967), Warren (1967), Erlik (1964, and Lázaro da Silva and Petroianu (1992) proposed splenorenal, portorenal, and mesenterorenal shunts for the treatment of portal hypertension using left renal vein anastomosis with or without ligation 2-6 . These surgical techniques were based on the assumption that the collateral vessels of the renal vein are responsible for the drainage of the left kidney after ligation of its main vein. Siderys and Kilman have shown in dogs that left renal vein ligation was associated with high mortality (60%), but kidney function was found to be intact in the surviving dogs 7 .There are different causes for the interruption of renal blood flow, such as thrombosis of the vena cava or renal vein, trauma, liga...

Left Renal Vein Anomaly Associated with Abdominal Aortic Aneurysm Surgery: Report of a Case

“…However, it remains controversial as to whether or not a ligation of the left renal vein causes the postoperative renal function to deteriorate. [11][12][13][14] Although uncommon, anomalies of the left renal vein and IVC may make it difficult for sugeons to expose the proximal neck of an abdominal aortic aneurysm. A preoperative CT examination should be performed in all patients undergoing a repair of AAAs because it can provide details of anomalous venous anatomy.…”