Complication arising from a duplicated inferior vena cava following laparoscopic living donor nephrectomy: a case report.

Selecting a kidney for living donor nephrectomy is driven by the tenet that donors are left with the higher functioning kidney. Traditionally, the left kidney is used because it has a longer renal vein, which aids anastamosis, and has an easier surgical approach. Anomalous left renal vasculature is not considered a contraindication to living donor nephrectomy. In the case of duplicated inferior vena cava, no specific considerations have been reported. We present a 42-year-old patient with infrarenal duplication of the vena cava who underwent laparoscopic living donor nephrectomy. His postoperative course was complicated by painful scrotal swelling necessitating multiple emergency room visits. Ultrasonography revealed bilateral hydroceles 5 weeks after surgery, which resolved with the use of a scrotal sling. Intraoperative ligation of a visibly dilated left gonadal vein was the likely etiology. Careful consideration should be taken in living donor nephrectomy in patients with duplication of inferior vena cava.

Early changes in nutrient artery blood flow following tibial nailing with and without reaming: a preliminary study.

OBJECTIVE: To quantify the changes in nutrient artery blood flow following reamed and unreamed nailing of intact canine tibias. DESIGN: In vivo animal study. INTERVENTION: Eighteen dogs underwent nutrient artery blood flow measurements over a fourteen-day period. The intervention groups consisted of controls (Group I), nailing without reaming (Group II), and nailing with reaming (Group III). MAIN OUTCOME MEASUREMENTS: Nutrient artery blood flow was measured through implantable ultrasonic blood flow probes placed around the nutrient artery of the tibia. RESULTS: Nutrient artery blood flow averaged 1.94 milliliters per minute over the fourteen-day period in Group I (no reaming or nailing performed). Nutrient artery blood flow following nailing without reaming (Group II) decreased to 44 percent of baseline values immediately after the procedure. By postoperative day 1, flow had decreased to 23 percent of baseline; over the fourteen-day period, nutrient artery blood flow recovered toward baseline values. Immediately following nailing with reaming (Group III), nutrient artery blood flow measured zero milliliters per minute. Over the fourteen-day period, nutrient artery blood flow in this group averaged 39 percent of the baseline level (range 19 to 58 percent). Whereas nutrient artery blood flow recovered toward baseline values (99 percent of baseline) by fourteen days in Group II, nutrient artery blood flow measured only 26 percent of the baseline level on postoperative day fourteen in Group III. CONCLUSIONS: The preliminary data suggest that nailing with reaming provides a double insult to the nutrient artery distribution.