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Damen NS, Jianu AM, Lazăr M, Rusu MC, Piţigoi G, Petrescu S. The Incidence and Variants of the Reno-Hemiazygos Connection. Diagnostics (Basel) 2025; 15:441. [PMID: 40002592 PMCID: PMC11854636 DOI: 10.3390/diagnostics15040441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Revised: 02/08/2025] [Accepted: 02/10/2025] [Indexed: 02/27/2025] Open
Abstract
Background/Objectives: Although common anomalies of the left renal vein (LRV) are pretty well documented in the literature, the drainage of the left renal blood via the hemiazygos vein lacks comprehensive support. We, therefore, aimed to study the incidence of the reno-hemiazygos connection (RHC). Methods: A total of 150 computed tomography scans (85 men and 65 women) were documented for the origin of an RHC from the LRV. Results: RHCs were found in 14/150 cases (9.34%). They were more prevalent in women (71.43%). In 11/14 cases, type 1 RHCs ascended directly along the postero-lateral left side of the aorta (direct hemiazygos flow). In 3/14 cases, type 2 RHCs (indirect hemiazygos flow) had a lumbar segment corresponding to the second lumbar vein and a pretransversary segment corresponding to an ascending lumbar vein. In 9/14 cases (64.29%), the RHC was connected to a typical LRV. In 1/14 cases (7.14%), the RHC was connected to the junction between the LRV and a left retropelvic tributary. In another case (7.14%), the RHC was connected to a retroaortic LRV and, in three cases (21.43%), to a circumaortic LRV. Triple left renal arteries were found in type 1 and, respectively, type 2 cases. The vertebral level of the inferior end of the RHC was variable, from the L1/L2 disc level to the L3 level. Conclusions: When present, the RHC serves to connect the superior and inferior caval systems. This may be physiologically of use or not, but surgically, it is a major anatomical risk factor for bleeding if its presence is not checked preoperatively.
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Affiliation(s)
- Nawwaf Sebastian Damen
- Department of Anatomy and Embryology, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (N.S.D.); (A.M.J.)
| | - Adelina Maria Jianu
- Department of Anatomy and Embryology, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (N.S.D.); (A.M.J.)
| | - Mihai Lazăr
- Department 2, Division of Physiopathology II, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Mugurel Constantin Rusu
- Division of Anatomy, Department 1, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Gabriel Piţigoi
- Department 9—Physical and Rehabilitation Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.P.); (S.P.)
| | - Silviu Petrescu
- Department 9—Physical and Rehabilitation Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.P.); (S.P.)
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Valenzuela Fuenzalida JJ, Vera-Tapia K, Urzúa-Márquez C, Yáñez-Castillo J, Trujillo-Riveros M, Koscina Z, Orellana-Donoso M, Nova-Baeza P, Suazo-Santibañez A, Sanchis-Gimeno J, Bruna-Mejias A, Gutiérrez Espinoza H. Anatomical Variants of the Renal Veins and Their Relationship with Morphofunctional Alterations of the Kidney: A Systematic Review and Meta-Analysis of Prevalence. J Clin Med 2024; 13:3689. [PMID: 38999255 PMCID: PMC11242292 DOI: 10.3390/jcm13133689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/01/2024] [Accepted: 06/14/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Variations in renal veins are quite common, and most people do not experience issues due to them. However, these variations are important for healthcare professionals, especially in surgical procedures and imaging studies, as precise knowledge of vascular anatomy is essential to avoid complications during medical interventions. The purpose of this study was to expose the frequency of anatomical variations in the renal vein (RV) and detail their relationship with the retroperitoneal and renal regions. Methods: A systematic search was conducted in the Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception until January 2024. Two authors independently carried out the search, study selection, and data extraction and assessed methodological quality using a quality assurance tool for anatomical studies (AQUA). Ultimately, consolidated prevalence was estimated using a random effects model. Results: In total, 91 studies meeting the eligibility criteria were identified. This study included 91 investigations with a total of 46,664 subjects; the meta-analysis encompassed 64 studies. The overall prevalence of multiple renal veins was 5%, with a confidence interval (CI) of 4% to 5%. The prevalence of the renal vein trajectory was 5%, with a CI of 4% to 5%. The prevalence of renal vein branching was 3%, with a CI of 0% to 6%. Lastly, the prevalence of unusual renal vein origin was 2%, with a CI of 1% to 4%. Conclusions: The analysis of these variants is crucial for both surgical clinical management and the treatment of patients with renal transplant and hemodialysis.
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Affiliation(s)
- Juan Jose Valenzuela Fuenzalida
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile (K.V.-T.); (J.Y.-C.); (M.T.-R.); (Z.K.); (M.O.-D.); (P.N.-B.)
- Departamento de Ciencias Química y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins, Santiago 8370993, Chile
| | - Karla Vera-Tapia
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile (K.V.-T.); (J.Y.-C.); (M.T.-R.); (Z.K.); (M.O.-D.); (P.N.-B.)
| | - Camila Urzúa-Márquez
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile (K.V.-T.); (J.Y.-C.); (M.T.-R.); (Z.K.); (M.O.-D.); (P.N.-B.)
| | - Javiera Yáñez-Castillo
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile (K.V.-T.); (J.Y.-C.); (M.T.-R.); (Z.K.); (M.O.-D.); (P.N.-B.)
| | - Martín Trujillo-Riveros
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile (K.V.-T.); (J.Y.-C.); (M.T.-R.); (Z.K.); (M.O.-D.); (P.N.-B.)
| | - Zmilovan Koscina
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile (K.V.-T.); (J.Y.-C.); (M.T.-R.); (Z.K.); (M.O.-D.); (P.N.-B.)
| | - Mathias Orellana-Donoso
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile (K.V.-T.); (J.Y.-C.); (M.T.-R.); (Z.K.); (M.O.-D.); (P.N.-B.)
- Escuela de Medicina, Universidad Finis Terrae, Santiago 7501015, Chile
| | - Pablo Nova-Baeza
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile (K.V.-T.); (J.Y.-C.); (M.T.-R.); (Z.K.); (M.O.-D.); (P.N.-B.)
| | | | - Juan Sanchis-Gimeno
- GIAVAL Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, 46001 Valencia, Spain
| | - Alejandro Bruna-Mejias
- Departamento de Ciencias y Geografía, Facultad de Ciencias Naturales y Exactas, Universidad de Playa Ancha, Valparaíso 2360072, Chile
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Damen NS, Hostiuc S, Jianu AM, Manta BA, Rusu MC, Dobra MA. Anatomical variants of the retroaortic left renal vein. Ann Anat 2024; 251:152170. [PMID: 37844738 DOI: 10.1016/j.aanat.2023.152170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Anatomical variants of the left renal vein (LRV), such as the retroaortic (RLRV) and circumaortic (CLRV) course, are of surgical importance. Different morphological and topographical possibilities of the RLRV could occur. It was aimed at documenting the anatomical variables of the RLRV. METHOD A retrospective study on 375 computed tomography angiograms was performed. Five different anatomical types of LRV were documented: preaortic types 1 and 2 and retroaortic types 3-5. RESULTS In 344/375 cases, preaortic LRVs were found. In 31/375 cases, different types of RLRV were found: type 3a - single RLRV, 41.94%; type 3b - single RLRV with bifid caval end, 9.68%; type 3c - single RLRV with trifid caval end, 3.23%; type 4a - CLRV with extrahilar origin, 29.03%; type 4b - CLRV with renal sinus origin, 12.9%; type 5 - triple LRV (one preaortic LRV and two RLRVs), 3.23%. Reference vertebral levels were recorded for the prevertebral segment of the RLVR. The vertebral level of type 3a varied from the L1/L2 disc to the upper third of the L4 vertebra. Type 3b was found in 3/31 RLRV cases; in one of these, the hemiazygos vein was inserted by two roots into the LRV and its upper caval end trunk. There was a significant statistical association between type 3b and the vertebral level, all cases being centered on the middle third of the L4 vertebra. CONCLUSIONS New morphological possibilities of the LRV were distinguished, and a new anatomical classification system of the RLRV results. The RLRV variant should be documented case-by-case as it has its anatomical variables.
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Affiliation(s)
- Nawwaf Sebastian Damen
- Division of Anatomy and Embryology, Faculty of Medicine, "Victor Babeș" University of Medicine and Pharmacy, Timișoara RO-300041, Romania
| | - Sorin Hostiuc
- Division of Legal Medicine and Bioethics, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy, Bucharest 050474, Romania
| | - Adelina Maria Jianu
- Division of Anatomy and Embryology, Faculty of Medicine, "Victor Babeș" University of Medicine and Pharmacy, Timișoara RO-300041, Romania
| | - Bogdan Adrian Manta
- Division of Clinical Practical Skills, Faculty of Medicine, "Victor Babeș" University of Medicine and Pharmacy, Timișoara RO-300041, Romania
| | - Mugurel Constantin Rusu
- Division of Anatomy, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy, Bucharest RO-020021, Romania.
| | - Mihai Adrian Dobra
- Division of Urological Surgery - Fundeni Clinical Institute, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest 050474, Romania
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Arslan S, Sarıkaya Y. Aneurysm of the left ascending lumbar communicating vein: Its prevalence and possible association with nutcracker phenomenon. Clin Imaging 2022; 85:22-28. [DOI: 10.1016/j.clinimag.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 11/03/2022]
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Giron-Luque F, Baez-Suarez Y, Garcia-Lopez A, Patino-Jaramillo N. Safety and Intraoperative Results in Live Kidney Donors with Vascular Multiplicity After Hand-Assisted Laparoscopy Living Donor Nephrectomy. Res Rep Urol 2022; 14:23-31. [PMID: 35118016 PMCID: PMC8801362 DOI: 10.2147/rru.s341028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose Vascular multiplicity is the most frequent anatomic variation in kidney donors. Despite concerns about risks, these allografts are increasingly used to overcome the shortage of kidney donors. The safety and clinical outcomes in living kidney donors were evaluated with vascular multiplicity after hand-assisted laparoscopic living donor nephrectomy (HALDN). Patients and Methods Data from all living kidney donors who underwent HALDN from 2008 to 2021 was retrospectively reviewed. Patients were divided into two groups as single (SRV) and multiple renal vessels (MRV), and a comparative analysis was done. The primary outcomes include operating room time (ORT), days of hospital stay, estimated blood loss, complications, conversion, and re-operations. Results MRV were present in 166 out of 612 donors (27.1%). Among those, 10 (1.6%) donors had simultaneous multiple arteries and veins. Additionally, the prevalence of artery and vein multiplicity was 21.8% (n = 134) and 3.5% (n = 22), respectively. Warm ischemia time was significantly different among the two groups but not clinically important. The number of conversions to open technique, the mean ORT, the median blood loss, and days of hospital stay were similar between the SRV and MRV groups, without significant differences. According to the modified Clavien-classification system, no differences were found in the complication rates between the two groups (p = 0.29). Complication rates were 3.3% and 3.6% for the SRV and MRV groups, respectively. Conclusion HALDN is a procedure with safe intraoperative results, even with vascular multiplicity. The presence of multiple renal arteries or veins has no negative impact on the outcome of the donor after living donor nephrectomy.
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Affiliation(s)
| | | | - Andrea Garcia-Lopez
- Research Department, Colombiana de Trasplantes, Bogotá, Colombia
- Correspondence: Andrea Garcia-Lopez Research Department, Colombiana de Trasplantes, Av Carrera 30, No. 47A-74, Bogotá, ColombiaTel +57 300 502 4618 Email
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