Division of the left renal vein: a safe surgical adjunct

Ten patients have undergone surgical division of the left renal vein (LRV) during operations on the abdominal aorta. Nine were elective procedures performed during the resection of a complicated abdominal aortic aneurysm (six patients) or treatment of complete infrarenal aortic occlusion (three patients). The first patient in this series underwent emergency LRV ligation at the renal hilum for the control of hemorrhage incurred during an elective aneurysmectomy. This patient survived postoperative renal failure and myocardial infarction, but died 21 months later from another myocardial infarction. At the time of death, he had moderate renal insufficiency. None of the remaining nine patients undergoing elective LRV division experienced any apparent renal dysfunction, as measured by urine sediment, serum creatinine, blood urea nitrogen, and intravenous pyelography. Although not recommended as a routine maneuver, division of the LRV is advocated as a safe adjunct for surgical exposure in difficult aortic procedures.