Anomalies of inferior vena cava and left renal vein: Risks in aortic surgery

Although most aortic surgery is now routinely performed without incident, m ajor venous anomalies can cause unexpected bleeding. In the last 6 years, 4 of 166 patients undergoing abdominal aortic surgery at our institution wer e found to have a major venous anomaly, including a double inferior vena ca va (2), a preaortic iliac vein confluence (1), and a circumaortic renal col lar (1). The 3 men and 1 woman had a mean age of 62.3 years (range, 56 to 6 8 years). All four patients underwent surgery for an abdominal aortic aneur ysm. Preoperative imaging revealed all of the venous anomalies except for t he renal collar. Unexpected venous injuries complicated the operation in on e patient who had a double inferior vena cava and an inflammatory abdominal aortic aneurysm and in the pateint with the circumaortic renal collar. Maj or venous anomalies are rarely encountered in patients undergoing aortic su rgery. Preoperative assessment and intraoperative awareness are important t o prevent unexpected venous injuries. Patients with an anomaly of the left renal vein and an inflammatory abdominal aortic aneurysm are at a particula rly high risk. DOI: 10.1007/s100169910071.