Management of the Left Renal Vein in the Surgery for Inflammatory Abdominal Aortic Aneurysm: Ligation 1 Case, Reno-splenic Venous Anastomosis 1 Case

ABSTRACT

Surgery for the inflammatory abdominal aortic aneurysm (IAAA) is a technically challenging procedure and it's associated with increased morbidity and mortality. Injuries of the vena cava, the duodenum, the left ureter and the renal vein are common in an operation for IAAA. Herein, we report 2 cases of ligation of the left renal vein during repair of the IAAA. Cases The 1st case was a 75- year-old male patient, who had an abrupt onset of abdominal pain and a pulsatile abdominal mass. An 8.5 cm sized IAAA and left hydronephrosis were detected via CT angiogram. During the operation, the left renal vein was mobilized and then divided to gain access to the aneuysmal neck. We couldn't reconstruct the divided left renal vein. On the follow-up CT scan, the left renal vein drained into the left paravertebral plexus, and no renal congestion was demonstrated. The 2nd patient was a 72-year-old male who experienced sudden abdominal pain and a growing pulsatile mass on the abdomen. A huge IAAA 10.5 cm in diameter was detected in CT scan. During the repair of IAAA, the left renal vein was divided and ligated to expose the neck of the aneurysm. The divided left renal vein was anastomosed to the splenic vein in an end-to-side fashion instead of performing direct reconstruction. On follow-up CT scan, neither left renal congestion nor significant increment of the portal venous flow was noted. The two patients were doing well at the 15th and 10th postoperative month, respectively.