Management of left renal vein during abdominal aortic aneurysm operations - own experience

Abstract

Background. Although division and reconstruction of the left renal vein is not a routine procedure in the course of abdominal aortic aneurysm operations, this manoeuvre, in selected cases, significantly facilitates access to the neck of the aneurysm or to the suprarenal part of the aorta. The aim of the study was to attempt to find answers to the following questions:
- how often is the procedure of dividing the left renal vein necessary during reconstructive operations on patients with abdominal aortic aneurysms, in the author's experience?
- what is the best way of proceeding with the renal vein after abdominal aortic reconstruction has been finished, and does it influence postoperative renal efficiency?
Material and methods. The study group comprised 375 patients who were surgically treated due to abdominal aortic aneurysm. Eighty-five of them were treated due to ruptured aortic aneurysm. In the group of patients who were examined the retrospective preoperative and postoperative appraisal of renal function was made on the basis of the measurement of creatinine concentration in blood serum.
Results. On the basis of data analysis, it is possible to state that the increase of creatinine concentration in blood serum in the postoperative period was not caused by the manoeuvre of dividing the left renal vein, performed during the operation. The increase of creatinine concentration occurred much more frequently in the group of patients operated for ruptured abdominal aortic aneurysm, and the manoeuvre of dividing the left renal vein itself did not intensify the renal insufficiency symptoms in this group of patients in the postoperative period.
Conclusions. We consider the reconstruction of the left renal vein to be technically relatively easy and it should be performed in every possible case. In certain cases failure to divide the left renal vein may worsen access to the neck of the aneurysm, and its ligation often intensifies venous bleeding from the retroperitoneal space. We claim that in certain cases the division, together with the later reconstruction, of the left renal vein may facilitate the course of reconstructive operation of the abdominal aorta and decreases the risk of haemorrhage complications. Moreover, this manoeuvre does not influence postoperative renal function.