Retroaortic left renal vein and its new Variations: Triple retroaortic and circumiliac left renal veins

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Ukrit Rompsaithong
Pattama Amarttayakong
Jaturat Kanpittaya
Arada Chaiyamoon
Sukrit Sangkhano


Variations of renal veins are important in urology and other areas of medicine. The purpose of this study was to evaluate the prevalence and type of retroaortic left renal vein (RLRV) in patients who underwent multidetector computed tomography (MDCT). Between January 2010 and December 2019, a retrospective study was performed on 4,424 patients examined with abdominal MDCT. The prevalence and type of RLRV were determined. Age, gender, indications for imaging, and symptoms related to the variants of renal venous anatomy were recorded. MDCT images revealed RLRV in 84 of 4,424 patients (1.90% [95% cumulative incidence (CI) 1.52–2.34%]). These included 44 males (52.38%) and 40 females (47.62%). The average age of patients with RLRV was 58.29 ± 12.45 years (range, 19–88 years). RLRV types I, II, III, and IV had a distribution of 34 (0.77%), 1 (0.02%), 45 (1.02%), and 0 (0%), respectively. The extremely rare double RLRV was additionally detected in 2 cases (0.05%). Two new variations, 1 case (0.02%) with the triple RLRV and 1 case (0.02%) with the circumiliac left renal vein, were discovered. None of the patients had symptoms related to renal vein variations. Congenital anomaly of RLRV is clinically important in the investigation and exploration of retroperitoneal procedures. Therefore, preoperative imaging should be carefully considered to avoid fatal problems during surgery. To the best of our knowledge, this is the first study that reports two new variations of the left renal vein, that is, the triple RLRV and the circumiliac left renal vein.


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Rompsaithong, U., Amarttayakong, P., Kanpittaya, J., Chaiyamoon, A., & Sangkhano, S. (2022). Retroaortic left renal vein and its new Variations: Triple retroaortic and circumiliac left renal veins. Asia-Pacific Journal of Science and Technology, 27(05), APST–27.
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Satyapal KS, Kalideen JM, Haffejee AA, Singh B, Robbs JV. Left renal vein variations. Surg Radiol Anat. 1999;21(1):77-81.

Karaman B, Koplay M, Ozturk E, Basekim CC, Ogul H, Mutlu H, et al. Retroaortic left renal vein: multidetector computed tomography angiography findings and its clinical importance. Acta Radiol. 2007;48(3):355-360.

Shi Y, Yang H, Feng Z, Chen F, Zhang H, Wu Z. Evaluation of posterior nutcracker phenomenon using multisection spiral CT. Clin Radiol. 2018;73(12):P1060.E9-P1060.E16.

Hoeltl W, Hruby W, Aharinejad S. Renal vein anatomy and its implications for retroperitoneal surgery. J Urol. 1990;143(6):1108-1114.

Covantev S, Mazuruc N, Belic O. Renal veins: developmental variations and clinical significance. Online J Health Allied Scs. 2017;16(4):12.

Sabouri S, Hosseini A, Shivaei SS. Retro-aortic inverted left renal vein: a rare anomaly found in a renal donor. Iran J Radiol. 2015;12(2):e11374.

Karkos CD, Bruce IA, Thomson GJ, Lambert ME. Retroaortic left renal vein and its implications in abdominal aortic surgery. Ann Vasc Surg. 2001;15(6):703-708.

Thomas TV. Surgical implications of retroaortic left renal vein. Arch Surg. 1970;100(6):738-740.

Otsuki H, Kuroda K, Kosaka T, Ito K, Hayakawa M, Asano T. A case report of retroaortic left renal vein with tumor thrombus of renal cell carcinoma. Clin Exp Nephrol. 2011;15(3):438-441.

Silva TA, Buonfiglio VB. Triple retroaortic renal vein with tumor thrombus. Urol. 2021;154:e17-e18.

Tatar I. Retroaortic and circumaortic left renal veins with their CT findings and review of the literature. Int J Clin Exp Anat. 2008;2:72-76.

Trigaux JP, Vandroogenbroek S, Wispelaere JF, Lacrosse M, Jamart J. Congenital anomalies of the inferior vena cava and left renal vein: evaluation with spiral CT. J Vasc Interv Radiol. 1998;9(2):339-345.

Lau JL, Lo R, Chan FL, Wong KK. The posterior “nutcracker”: hematuria secondary to retroaortic left renal vein. Urol. 1986;28(5):437-439.

Koc Z, Ulusan S, Tokmak N, Oguzkurt L, Yildirim T. Double retroaortic left renal veins as a possible cause of pelvic congestion syndrome: imaging findings in two patients. Br J Radiol. 2006;79(946):e152-e155.

Marone EM, Psacharopulo D, Kahlberg A, Coppi G, Chiesa R. Surgical treatment of posterior nutcracker syndrome. J Vasc Surg. 2011;54(3):844-847.

Gibo M, Onitsuka H. Retroaortic left renal vein with renal vein hypertension causing hematuria. Clin Imaging. 1998;22(6):422-424.

Arslan H, Etlik O, Ceylan K, Temizoz O, Harman M, Kavan M. Incidence of retro-aortic left renal vein and its relationship with varicocele. Eur Radiol. 2005;15(8):1717-1720.

Türkvatan A, Ozdemir M, Cumhur T, Olçer T. Multidetector CT angiography of renal vasculature: normal anatomy and variants. Eur Radiol. 2009;19(1):236-244.

Nam JK, Park SW, Lee SD, Chung MK. The clinical significance of a retroaortic left renal vein. Korean J Urol. 2010;51(4):276-280.

Anson BJ, Caudwell EW. The anatomy of the para-renal system of veins, with comments on the renal arteries. J Urol. 1948;60(5):714-737.

McClure CFW, Butler EG. The development of the vena cava inferior in man. American J Anat. 1925;35(3):331-383.

Mathews R, Smith PA, Fishman EK, Marshall FF. Anomalies of the inferior vena cava and renal veins: embryologic and surgical considerations. Urol. 1999;53(5):873-880.

Huntington GS, McClure CFW. The development of the veins in the domestic cat (felis domestica) with especial reference, 1) to the share taken by the supracardinal veins in the development of the postcava and azygos veins and 2) to the interpretation of the variant conditions of the postcava and its tributaries, as found in the adult. Anat Rec. 1920;20(1):1-31.

Kyung D, Lee J, Shin D, Kim D, Choi I. The double retro-aortic left renal vein. Anat Cell Biol. 2012;45:282-284.

Calàbria CH, Gómez QS, Cerqueda SC, Presa BR, Miranda A, Castells AA. Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance. Eur Radiol. 2005;15(8):1745-1751.

Nishimura Y, Fushiki M, Yoshida M, Nakamura K, Imai M, Ono T, et al. Left renal vein hypertension in patients with left renal bleeding of unknown origin. Radiology. 1986;160(3):663-667.