Left renal vein division during open abdominal aortic aneurysm repair

The purpose of this study was to evaluate the impact of left renal vein (LRV) division in patients undergoing open abdominal aortic aneurysm (AAA) repair.

This systematic review and meta-analysis was registered in the PROSPERO register of systematic reviews (CRD42025640222) and conducted in accordance with Cochrane's guidelines for systematic review and meta-analysis. The PubMed, EMBASE, and Cochrane databases were searched systematically for studies comparing outcomes of patients who underwent open AAA repair with and without LRV division. Two authors screened the search results and collected data of interest independently, according to the PRISMA protocol. The primary outcome was 30-day mortality and secondary outcomes were short and long-term renal function. Risk ratios (RRs) and mean differences (MDs) with corresponding 95% confidence intervals (CI) were estimated using a random effects model. Significance was defined as a P value of <.05.

A total of 190 studies were screened for inclusion, of which nine studies (8 cohort studies and 1 case-control study) met the inclusion criteria. These studies included a total of 1324 patients, 350 of whom underwent LRV division and 974 patients who did not. Meta-analysis revealed no significant difference in 30-day mortality (28/205 vs 123/512; RR, 0.90; 95% CI, 0.63-1.29; P = .42; I² =0%), acute kidney injury (RR, 1.74; 95% CI, 0.39-7.83; P = .33; I² = 69%), need for dialysis (4/178 vs 10/473; RR, 1.61; 95% CI, 0.54-4.84), discharge estimated glomerular filtration rate (MD, -0.32; 95% CI, -2.57 to 1.92; P = .60; I² = 0%), and discharge serum creatinine (MD, -0.01; 95% CI, -0.02 to 0.01; P = .29; I² = 0%). LRV division was associated with an increase in postoperative serum creatinine (MD, 0.08; 95% CI, 0.04-0.11; P = .009; I² = 0%) compared with patients with the LRV left intact.

Among patients undergoing AAA open surgical repair, our results demonstrate that LRV division is not associated with an increase in 30-day mortality or worse renal function.