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Circumaortic Renal Vein Remodeling Following Abdominal Aortic Aneurysm Repair
Merlyn Varghese1, Anish Tayal1, Madeline Drake1
1Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, USA.
Insights
A rare congenital vascular anomaly, circumaortic left renal vein (LRV), can lead to unexpected complications during abdominal aortic aneurysm (AAA) surgery. Ligating the preaortic branch of a circumaortic LRV resulted in compensatory hypertrophy of the retroaortic branch.
Area of Science:
- Vascular Surgery
- Congenital Anomalies
- Anatomical Variations
Background:
- A circumaortic left renal vein (LRV) is a congenital vascular anomaly where an additional vein courses posterior to the aorta, alongside the normal anteriorly positioned LRV.
- Left renal vein ligation is a common surgical step during aortic surgery for exposure, usually well-tolerated due to collateral circulation.
Purpose of the Study:
- To report a case of a circumaortic LRV managed during abdominal aortic aneurysm (AAA) surgery.
- To highlight the potential consequences of ligating the preaortic branch of a circumaortic LRV.
Main Methods:
- Case report of a patient undergoing AAA repair.
- Identification and management of a circumaortic LRV.
- Postoperative follow-up imaging to assess venous adaptation.
Main Results:
- The preaortic branch of the circumaortic LRV was ligated during AAA surgery.
- Postoperative follow-up revealed significant hypertrophy of the retroaortic LRV.
- This compensatory hypertrophy suggests a functional adaptation to the altered venous anatomy.
Conclusions:
- Circumaortic LRV presents a unique challenge in aortic surgery.
- Ligation of the preaortic branch can necessitate adaptation by the retroaortic component.
- Awareness of this anomaly is crucial for surgical planning and preventing potential complications.
Abstract:
A circumaortic renal vein is a congenital vascular anomaly involving an additional renal vein that traverses posterior to the aorta in addition to the normal renal vein traversing anterior to the aorta.12 In aortic surgery, it is common to ligate the left renal vein (LRV) to aid in surgical exposure, which is typically inconsequential due to collateral venous channels. We report a case of a circumaortic LRV with the preaortic branch ligated during abdominal aortic aneurysm (AAA) surgery and, as a result, retroaortic LRV hypertrophy was observed during follow-up.
