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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.
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Article info
Footnotes
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.
Identification
Copyright
© 1990 Reed Publishing USA. Published by Elsevier Inc.
