Circumaortic left renal vein: Surgical challenges and management in a case report and literature review

The circumaortic left renal vein is an uncommon anatomical variant, accounting about 10 % of cases. Undiagnosed, this vascular anomaly may increase the risk of intraoperative vascular injury, particularly during renal surgeries or transplantation procedures. Recognizing this variation preoperatively is essential to minimize intraoperative challenges and improve patient outcomes.

We report the case of a 54-year-old patient who referred to our institute for the management of serous endometrial adenocarcinoma diagnosed following postmenopausal metrorrhagia. Pelvic Magnetic Resonance Imaging (MRI) confirmed a stage IIIC1 serous adenocarcinoma. During the lymphadenectomy of the lumboaortic lymph nodes performed as part of the surgical treatment, an uncommon anatomical variant was discovered: a circumaortic left renal vein. Although this vascular anomaly is often asymptomatic, it carries significant implications in the context of surgical interventions in the retroperitoneal space, particularly during lymphadenectomies or vascular procedures.

Preoperative imaging analysis is essential for detecting these anatomical variations which can significantly impact surgical strategy. Undiagnosed, this vascular anomaly may increase the risk of intraoperative vascular injury, particularly during renal surgeries or transplantation procedures. High-resolution imaging modalities, including multidetector CT angiography and MR angiography, offer precise visualization of renal vasculature, allowing surgeons to adjust their approach and minimize intraoperative risk.

The circumaortic left renal vein is typically asymptomatic and is often identified incidentally through imaging, or less commonly, due to clinical symptoms. Its presence has significant surgical implications, making awareness of this anomaly crucial for safe and effective surgical planning and intervention.