On a complex arrangement of the vascular pedicle of the left kidney

During the dissection of an 83 year-old male cadaver, we observed that the left renal vein passed behind the aorta to follow an oblique course before draining into the inferior vena cava. The left renal vein was connected to the left suprarenal, spermatic, lumbar ascending and azygos veins. The left spermatic vein, after collecting the suprarenal vein, crossed in front of the abdominal aorta to reach the inferior vena cava directly. Furthermore, the arterial pedicle of the left kidney was composed of two tortuous and intermingled vessels. Variations in the number and arrangement of the vessels terminating in the renal veins are not uncommon, but so complex a vascular arrangement as this has not to our knowledge been previously described. The ontogenetic explanation and clinico-surgical implications of such a variation are reviewed and discussed.