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Wang D, Cui M, Chu X, Han X, Liu P, Zhao X, Fan Y. Risk factor of postoperative adverse events among children with duplex kidney undergoing upper pole heminephrectomy: a single-center experience. Front Pediatr 2024; 12:1305456. [PMID: 38742242 PMCID: PMC11089135 DOI: 10.3389/fped.2024.1305456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 04/03/2024] [Indexed: 05/16/2024] Open
Abstract
Objective The aim of this study was to identify the risk factors for postoperative adverse events in children with duplex kidney undergoing upper pole heminephrectomy. Methods We collected clinical data from pediatric patients with duplex kidney who underwent upper pole heminephrectomy. Based on the presence or absence of postoperative adverse events, the patients were divided into two groups: an adverse events group (n = 16) and a non- adverse events group (n = 37), using multivariate logistic regression analysis to screen for independent risk factors for postoperative adverse events. Results Through univariate and multivariate analysis, we found that the presence of upper renal ureterocele (P = 0.042, OR = 7.116, 95% CI 1.073-47.172), as well as the presence of accessory renal artery type (P = 0.016, OR = 10.639, 95% CI 1.551-72.978) and other types (P = 0.039, OR = 3.644, 95% CI 0.351-37.836) as the upper kidney's blood supply artery increase the risk of postoperative adverse events, with these differences being statistically significant. Conclusions In pediatric patients with duplex kidney undergoing upper pole heminephrectomy, the presence of upper renal ureterocele and the presence of accessory renal artery type and other types as the upper kidney's blood supply artery are independent risk factors for postoperative adverse events.
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Affiliation(s)
- Denghui Wang
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengjie Cui
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangyang Chu
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaojiang Han
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pengpeng Liu
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiang Zhao
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingzhong Fan
- Department of Pediatric Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Lledo E, Tabbara MM, Alvarez A, Chandar J, González J, Vianna R, Ciancio G. Venous vascular reconstruction of a robotically procured right kidney with two renal veins transplanted into a pediatric recipient. Pediatr Transplant 2024; 28:e14646. [PMID: 37975173 DOI: 10.1111/petr.14646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/19/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Right versus left kidney donor nephrectomy remains a controversial topic in renal transplantation given the increased incidence of right kidney vascular anomalies and associated venous thrombosis. We present the case of a 3-year-old pediatric recipient with urethral atresia and end-stage kidney disease who received a robotically procured living donor right pelvic kidney with two short same-size renal veins and a short ureter. METHODS We utilized a completely deceased iliac vein system (common iliac vein with both external and internal veins) to extend the two renal veins. Due to the distance between both renal veins, the external iliac vein was anastomosed to the upper hilum renal vein, and the internal iliac vein was anastomosed to the lower hilum renal vein. The donor's short ureter was anastomosed to the recipient's ureter end-to-side. RESULTS The patient had immediate graft function and there were no post-operative complications. Renal ultrasound was unremarkable at 48 hours post-transplant. Serum creatinine was 0.5 mg/dL at 3 months post-transplant. CONCLUSION We demonstrate the successful transplantation of a robotically procured right pelvic donor kidney with two short renal veins using a deceased donor iliac vein system for venous reconstruction without increasing technical complications. This technique of venous reconstruction can be used in right kidneys with similar anatomical variations without affecting graft function.
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Affiliation(s)
- Enric Lledo
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Marina M Tabbara
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Angel Alvarez
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Jayanthi Chandar
- Divison of Pediatric Nephrology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Javier González
- Servicio de Urología, Unidad de Trasplante Renal, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rodrigo Vianna
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
- Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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Kovačević N, Hočevar M, Vivod G, Merlo S. Vascular and Urinary Tract Anatomic Variants Relevant to Para-Aortic Lymphadenectomy in Women with Gynecological Cancers. Cancers (Basel) 2023; 15:4959. [PMID: 37894326 PMCID: PMC10605252 DOI: 10.3390/cancers15204959] [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: 08/23/2023] [Revised: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Para-aortic lymphadenectomy is an essential part of gynecologic oncologic surgical treatment. The surgeon should be aware of the complex usual anatomy and its common variants. METHODS Between January 2021 and May 2023, 58 women underwent para-aortic lymphadenectomy for gynecologic malignancies. RESULTS Vascular and urinary tract anatomic variants were retrospectively reviewed from the prospective institutional database and results were compared with preoperative contrast-enhanced abdominal CT. Of these 58 women, 47 women had no vascular or urinary tract variants. One woman had a double inferior vena cava, two patients were found to have a retro-aortic left renal vein, four had accessory renal arteries, two had a double left ureter, one had a ptotic kidney in the iliac fossa, and one patient had bilateral kidney malrotation. Anatomic variants in the preoperative CT were described by a radiologist in only two patients, and additional vascular and urinary tract variants were found incidentally at the time of surgery. CONCLUSIONS Acknowledgment of vascular and urinary tract variants is helpful for the surgeon to establish an appropriate surgical plan and to avoid iatrogenic surgical trauma.
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Affiliation(s)
- Nina Kovačević
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (N.K.); (M.H.); (G.V.)
- Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
- Faculty of Health Care Angela Boškin, Spodnji Plavž 3, 4270 Jesenice, Slovenia
| | - Marko Hočevar
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (N.K.); (M.H.); (G.V.)
- Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Gregor Vivod
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (N.K.); (M.H.); (G.V.)
- Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Sebastjan Merlo
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (N.K.); (M.H.); (G.V.)
- Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
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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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Renal Vascular and Ureteral Anatomic Variations in 1859 Potential Living Renal Donors. Transplant Proc 2021; 53:2153-2156. [PMID: 34404539 DOI: 10.1016/j.transproceed.2021.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Renal vascular and ureteral anomalies detected by preoperative computed tomography angiography (CTA) are important for determining the side of the donor nephrectomy and the optimal surgical technique. In the present study, we aimed to examine the renal vascular and ureteral variations in living kidney donor candidates. METHODS A retrospective analysis was made of 1859 patients who were examined in our clinic as donor nephrectomy candidates between November 2008 and December 2019. Renal CTA images were acquired using a 64-channel multidetector computed tomography scanner, and renal vascular and ureteral variations were evaluated. RESULTS The prevalence rates of multiple renal arteries on the right and left sides were 18.3% and 22.6%, respectively. The prevalence rates of early branching of the renal arteries, in turn, were 6.3% on the right side and 6.5% on the left side. The overall rate of renal artery variations on both the right and left sides was significantly higher in male individuals than in female individuals (P < .001). Multiple renal veins rates were 28.2% and 2.3% on the right and left sides, respectively, and the short renal veins rates on the right and left sides were 10.1% and 4.35%, respectively. Among the 941 cases undergoing donor nephrectomy, the procedure was completed by laparoscopy in 815 and by conversion from laparoscopic to open surgery in 36. The rate of vascular variations was higher in the conversion to open surgery group than in the laparoscopy group (P = .015). CONCLUSIONS Careful preoperative assessments of donor renal vascular and ureteral anatomy and variations in CTA are essential for successful and safe renal transplant.
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Jayaprakash V, Jose N, Deiva A, Sai V, Jayakumar M. Renal angiographic evaluation of prospective renal donors: Single-center data and outcome analysis from South India - A retrospective observational study. INDIAN JOURNAL OF TRANSPLANTATION 2021. [DOI: 10.4103/ijot.ijot_77_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Popov Z, Stankov O, Stavridis S, Saidi S, Ivanovski O, Spasovski G, Cakalaroski K, Ivanovski N. Management of Multiple Renal Arteries and Unusual Venous Anatomy During Kidney Transplant: From a Simple Technical Problem to a Graft-Saving Procedure. EXP CLIN TRANSPLANT 2020; 18:763-770. [PMID: 33349206 DOI: 10.6002/ect.2019.0314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Incidence of vascular anomalies in donor kidneys varies from 18% to 30% and presents a challenge for a transplant surgeon in kidney transplant. Here we present our personal experience for man - agement of the complicated and unexpected cases. MATERIALS AND METHODS A total of 250 kidney transplants (226 living, 24 deceased) were performed in a period of 24 years; mean donor age was 55 years (range, 25-86 years), and mean recipient age was 38.6 years (range, 14-66 years). We analyzed the surgical techniques, complications and outcomes, rejection episodes, kidney function, and graft and patient survival rates. RESULTS Of 250 nephrectomies, 209 had a single artery (83.6%), 34 had 2 arteries (13.6%), and 7 had 3 arteries (2.8%). Of 34 double arteries, 14 had 2 main arteries, 15 had a main and a polar artery, and 5 had an aortic Carrel patch after deceased donation. According to the size, type, and position, the anastomoses were performed with branches of hypogastric, epigastric inferior, iliac external, and main renal artery, intracorporeally or in bench surgery. Regarding veins, 1 double inferior vena cava, 1 left-side inferior vena cava, 4 retroaortic, 2 circumaortic, 10 large lumbar veins draining into the left renal veins, and 8 cases with 2 or more different size renal veins were managed. In 9 cases with short right renal vein, an extension with vena cava (a "Barry cavoplasty") was performed in deceased donor organs. No serious surgical complications related to vascular anomalies were observed. There were no statistical differences in 1-, 6-, and 12-month graft survival rates between the groups with or without vascular anomalies. CONCLUSIONS Vascular anomalies should no longer be considered a contraindication for transplant, if careful anastomosis is performed in every case to avoid ischemia and further complications. Therefore, management of vascular anomalies could be a graftsaving procedure.
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Affiliation(s)
- Zivko Popov
- From the Medical Faculty, University Saints Cyril and Methodius Skopje, North Macedonia.,From the Macedonian Academy of Sciences and Arts, Skopje, North Macedonia
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Hoff M, Leighton P, Hosgood SA, Nicholson ML. Anastomosis of dual renal transplant veins. J Surg Case Rep 2020; 2020:rjaa310. [PMID: 32963761 PMCID: PMC7490215 DOI: 10.1093/jscr/rjaa310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/13/2020] [Indexed: 11/17/2022] Open
Abstract
As there is usually considerable overlap in the renal venous drainage, it is often possible to ligate supernumerary transplant renal veins in order to simplify the implantation procedure. Nonetheless, decisions about whether to implant multiple veins can be difficult and are usually made subjectively. Here, we describe the use of intraoperative Doppler ultrasound as an adjunct to decision-making when there are two renal veins and a novel technique for the sequential anastomosis of dual veins. The kidney was reperfused after anastomosis of the main renal vein with the second vein clamped. On-table Doppler ultrasound demonstrated reversed flow in diastole indicating that the second renal vein also needed to be anastomosed. By clamping the external iliac vein inferior to the first venous anastomosis it was possible to complete the lower polar renal vein anastomosis to the external iliac vein without interrupting the perfusion of the kidney.
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Affiliation(s)
- Mekhola Hoff
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Philippa Leighton
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Sarah A Hosgood
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Michael L Nicholson
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Serena G, González J, Garcia LE, Guerra G, Morsi M, Ciancio G. Hand-assisted laparoscopic nephrectomy in a high risk overweight donor with left-sided IVC, and previous abdominal surgery. Int J Surg Case Rep 2019; 64:20-23. [PMID: 31593912 PMCID: PMC6796603 DOI: 10.1016/j.ijscr.2019.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/22/2019] [Accepted: 09/25/2019] [Indexed: 11/29/2022] Open
Abstract
Surgical planning based on preoperative CTA is necessary in patients with vascular anomalies in order to avoid complications. Intrabdominal adhesions are common in patients with previous abdominal surgery and can affect the surgical approach for donor nephrectomy. Considering the extension of the donor eligibility criteria, it is expected to see cases with congenital vascular anomalies.
Introduction The extension of donor eligibility criteria represents one of the possible ways to increase the organ shortage, thus decreasing the waiting time for kidney transplantation. Expectedly, this strategy is associated with a growing number of more technically demanding living donor nephrectomy procedures requiring careful assessment, and sound surgical experience in order to avoid intraoperative complications. Case presentation After a thorough evaluation through preoperative imaging, we performed a hand-assisted left laparoscopic living donor nephrectomy in a 56 year-old overweight patient with history of prior abdominal surgery, harboring a left-sided inferior vena cava (IVC). Discussion/conclusion This case describes our comprehensive approach in this complex surgical scenario to preserve donor safety and provide an optimal kidney graft.
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Affiliation(s)
- Giuseppe Serena
- Department of Surgery, Nassau University Medical Center, East Meadow, NY, USA; Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Javier González
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Leonardo E Garcia
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Giselle Guerra
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Department of Medicine, Division of Nephrology, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Mahmoud Morsi
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.
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Hostiuc S, Minoiu C, Negoi I, Rusu MC, Hostiuc M. Duplication and transposition of inferior vena cava: A meta-analysis of prevalence. J Vasc Surg Venous Lymphat Disord 2019; 7:742-755. [DOI: 10.1016/j.jvsv.2019.01.063] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/27/2019] [Indexed: 12/26/2022]
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Anatomical variants of renal veins: A meta-analysis of prevalence. Sci Rep 2019; 9:10802. [PMID: 31346244 PMCID: PMC6658480 DOI: 10.1038/s41598-019-47280-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/15/2019] [Indexed: 11/22/2022] Open
Abstract
The main aim of this article is to establish the actual prevalence of renal vein variations (circumaortic renal vein, retroaortic renal vein, double renal vein), and to increase awareness about them. To this purpose, we have performed a meta-analysis of prevalence, using the MetaXL package, We included 105 articles in the final analysis of prevalence, of which 88 contained data about retroaortic renal vein, 84 – about circumaortic renal vein, and 51 - about multiple renal veins. The overall prevalence for retroaortic renal vein was 3% (CI:2.4–3.6%), for circumaortic renal vein − 3.5% (CI:2.8–4.4%), and for multiple renal veins - 16.7% (14.3–19.2%), much higher on the right 16.6 (14.2–19.1%) than on the left side 2.1 (1.3–3.2%). The results were relatively homogenous between studies, with only a minor publication bias overall.
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