SURGICAL ANATOMY OF THE LUMBAR VESSELS - IMPLICATIONS FOR RETROPERITONEAL SURGERY

The lumbar vessels in the retroperitoneum must be addressed during man y urological and vascular procedures. Few studies have assessed the ex act pattern of the lumbar vasculature, and most anatomical description s suggest the presence of a generally regular pattern. The number and location of the infrarenal lumbar arteries and veins were documented i n 102 consecutive retroperitoneal lymph node dissections. Anomalies of the renal vessels were also noted. The lumbar arteries followed a fai rly regular pattern and individual variation occurred mainly in the nu mber of lumbar arteries exiting the aorta (range 2 to 4). Great variat ion existed among the lumbar veins. The most common pattern of lumbar arteries (60% of the cases) included 3 paired vessels exiting posterio rly at every third of the infrarenal aorta and coursing diagonally tow ard the lumbar foramina. There was great variation in the number and l ocation of lumbar veins along the inferior vena cava. Commonly 3 lumba r veins entered on the left (44%) and 2 on the right (37%) sides. A lu mbar vein entering the left renal vein was documented in 43% of the ca ses. Accessory renal arteries were found in 24 cases (24%). The number and course of the lumbar vessels are more variable than previously de scribed in the medical literature. Knowledge of these anatomical varia tions is important for surgeons operating in the retroperitoneum. Seve ral techniques to maintain control of the lumbar vessels are described .