This paper is only available as a PDF. To read, Please Download here.
Perirenal aortic exposure and control can be facilitated by division of the left renal vein (LRV), but only if adequate collateral venous drainage is present. When incremental elevations in LRV pressure were produced in nine dogs, we noted that left renal glomerular and tubular function (creatinine clearance, sodium retention, urine osmolality, and urine output) were virtually lost at pressures greater than 50 to 60 cm water.
Between January 1967 and December 1989, 64 patients underwent LRV division during the performance of abdominal aortic aneurysm surgery (57 of 589=10%) or reconstruction for aortoiliac occlusive disease (7 of 506=1%). LRV stump pressures (LRVSPs) were measured in 44 of these patients and were less than or equal to 60 cm water in all but one instance. Ten of the 64 patients died, but none as a consequence of this maneuver. Postoperatively, all survivors had serial serum creatinine levels measured and either an intravenous pyelogram, renal scan, or arteriogram. One case of a non-functioning left kidney was identified. This occurred in the only patient who underwent re-anastomosis after LRV division. A LRVSP equal to or greater than 50 cm water and extreme venous distention after test clamping served as a contraindication to LRV division in seven other patients.
We conclude that a LRVSP less than or equal to 50 to 60 cm water indicates that the LRV may be safely divided during juxtarenal aortic exposure. However, a pressure greater than or equal to 50 to 60 cm water suggests that LRV division should not be carried out unless absolutely essential and then only if right kidney function is known to be adequate.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The American Journal of Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Division of the left renal vein: guidelines and consequences.Am J Surg. 1979; 138: 257-263
- Renal function and a technique for venography after left renal vein ligation.Am J Surg. 1970; 120: 41-45
- Renal vein ligation.JAMA. 1970; 214 ([Letter]): 1889
- Division of the left renal vein as an adjunct to resection of abdominal aortic aneurysms.Am J Surg. 1967; 113: 763-765
- Temporary transection of the left renal vein: a technical aid in aortic surgery.Surgery. 1969; 65: 32-40
- Ligation of left renal vein during resection of abdominal aortic aneurysm.Can J Surg. 1971; 14: 161-165
- Division of the left renal vein: a safe surgical adjunct.Surgery. 1978; 83: 151-154
- Incidence and results of unusual problems associated with aortic aneurysm. A tertiary care center experience.J Cardiovasc Surg. 1989; 30 ([Abstract]): 102
- Left renal vein division in abdominal aortic aneurysm operations.Arch Surg. 1985; 120: 1033-1036
- Further experience with division of the left renal vein.Surgery. 1990; 107: 105-109
- Survival after excision of a kidney, segmental resection of the vena cava, and division of the opposite renal vein.Lancet. 1961; 2: 1015-1016
- Portarenal shunt for hepatic cirrhosis and portal hypertension.Surgery. 1967; 61: 153-168
- Portorenal shunt: a new technique for porto-systemic anastomosis in portal hypertension.Ann Surg. 1964; 159: 72-78
- The blood supply of the kidney, suprarenal gland and associated structures.Surg Gynecol Obstet. 1947; 84: 313-320
- Porto-renal shunt.Am Surg. 1965; 31: 433-436
- Abdominal aortic surgery and the left renal vein.Am J Surg. 1974; 1277: 552-554
- Rupture of the left kidney following a renosplenic shunt.Surgery. 1976; 79: 710-712
- Massive hemorrhage caused by left renal vein ligation.Br J Surg. 1980; 67: 594-595
- Renal complications to left renal vein ligation in abdominal aortic surgery.J Cardiovasc Surg. 1984; 25: 432-436
- Ruptured abdominal aortic aneurysms.Am Surg. 1976; 42: 538-540
- Ligation of the renal vein during resection of abdominal aortic aneurysm.J Cardiovasc Surg. 1986; 27: 454-456
- Hemodynamics of femoral vein ligation in the canine hind limb.in: Swan KG Venous surgery in the lower extremity. Warren H. Green Publishers, St. Louis1975: 215-221
- Trial clamping before division of the left renal vein.Surgery. 1982; 91: 409-412
- The effects of acute occlusion of the renal vein in dogs.Surgery. 1966; 59: 282-285
- Experimental renal vein occlusion.Surg Gynecol Obstet. 1968; 126: 555-562
- Principles of animal laboratory care.US Department of Health and Human Services publication NIH 80-23. 1985; (Revised ed. Washington, DC)
- Guide for the care and use of laboratory animals.US Department of Health and Human Services publication NIH 80-23. 1985; (Revised ed. Washington, DC)
2Supported by a grant from the John F. Connelly Foundation, Philadelphia, Pennsylvania.
3Presented at the 18th Annual Meeting of the Society for Clinical Vascular Surgery, Palm Desert, California, March 7–11, 1990.
© 1990 Reed Publishing USA. Published by Elsevier Inc.