Ligation of the left renal vein during aortic surgery. Indications for venous reconstruction

The exposure and control of juxtarenal aorta in case of peculiar lesions (juxtarenal aneuryms, supra- and underrenal) can be simplified by splitting the left renal vein (LRV). This procedure, easy to perform, is not devoid of complications, determined by a secondary increase in LRV stump pressure. An inconstant incidence of complication following LRV splitting is reported in different series: this can be ascribed to anatomical variations in venous drainage, namely whether an efficient alternative draining circle is present or not. Accordig to the literature, the restoration of LRV becomes mandatory when stump pressure exceeds 40 mm Hg. In agreement with that, the authors had to restore LRV following retroperitoneal bleeding in two patients whose LRV stump pressure rose up to 80 mmHg The authors discuss a case record of 24 LRV ligatures within a series of 200 aortic endoaneurysmectomies performed in their Institute; the indications for LRV restoring are further stressed.