Ruptured Abdominal Aortic Aneurysm in A Patient with A Retroaortic Left Renal Vein

The surgical management of Abdominal Aortic Aneurysms (AAAs) is well established, and the most challenging intraoperative complication of this procedure is venous bleeding. A Retroaortic Left Renal Vein (RLRV) is an infrequent anomaly, with a reported incidence of 1.8 to 2.4% . An RLRV is sometimes overlooked on the preoperative images, because surgeons are focused on evaluating the AAA. However, the presence of an RLRV makes it difficult to clamp the proximal neckof the AAA without injuring the venous structures. Injury to an RLRV may resultin life-threatening bleeding. Therefore, accurate preoperative diagnosis of venous anomalies is an important aspect of minimizing the risks associated with abdominal aortic surgery. We report a case of ruptured AAA associated with an RLRV, in which accurate preoperative diagnosis was obtained by evaluation of contrast-enhanced Computed Tomography (CT) images.

Case Report:  An 84-year-old woman was referred to our hospital by ambulance because of severe lumbar pain. She was diagnosed with AAA at another hospital before. She was conscious and alert at admission with a blood pressure of 112/60 mmHg and a heart rate of 72 beats/min. Her hemoglobin level was 7.4 g/dL, serum creatinine level was 1.66 mg/dL, and estimated glomerular filtration rate was 23.1 mL/min/1.73 m2. No hematuria was detected. Ultrasound examination and contrast-enhanced CT showed a 64-mm diameter juxtarenal AAA, not extending below the bifurcation of the abdominal aorta. The AAA was adjacent to the lowest of three left renal arteries (Figure 1), an RLRV, and a left retroperitoneal hematoma. The inferior vena cava was in the normal position on the right side of the aorta. Read more........